By Christopher H. Linden MD, James M. Rippe MD, Richard S. Irwin MD
The pharmacology, overdoses, and poisonings part from Irwin and Rippe's Manual of extensive Care medication, Fourth Edition, has now been elevated right into a entire, stand-alone Spiral® guide. This new Manual of Overdoses and Poisonings is a pragmatic quick-reference bedside advisor to the review and therapy of poisonous or most likely poisonous drug and chemical exposures.
The first bankruptcy provides a basic method of differential analysis, prognosis, and remedy of poisoning. next chapters concentrate on particular medicines, chemical compounds, and toxidromes and supply information on medical presentation, pathophysiology, prognosis, and remedy. Chapters are formatted to permit easy accessibility to crucial info and comprise annotated references.
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Extra resources for Manual of overdoses and poisonings
2. Therapeutic serum levels are 4 to 12 mg/L. 4893 Linden p035-040_ch06 38 6/17/05 12:05 PM Page 38 Chapter Six B. Pathophysiology 1. CBZ has multiple actions, including stabilization of sodium channels and alteration of neurotransmitter activity. 2. Oral absorption of CBZ is erratic and inconsistent with unpredictable intermittent surges of absorption. Peak concentrations typically occur 6 to 24 hours postingestion. 3. CBZ is metabolized by the liver cytochrome P-450 enzymes primarily to the active metabolite CBZ-epoxide.
Serum drug levels are not readily available or clinically useful. 4. Hemodialysis may be effective for enhancing gabapentin and topiramate elimination but is rarely necessary. 4893 Linden p035-040_ch06 6/17/05 12:05 PM Page 39 Anticonvulsants 39 B. Gabapentin 1. Mechanism of action is unknown. Despite its name, it does not appear to act at the GABA receptor. 2. Peak serum levels occur 1 to 3 hours postingestion with a half-life of 5 to 7 hours. 3. Symptoms of toxicity include CNS depression, nystagmus, diplopia, unsteady gait, mood changes, and headache.
Peak plasma levels occur 1 to 4 hours postingestion, with a half-life of 12 to 50 hours in therapeutic dosing. b. Tricyclic antidepressant–like cardiac effects have been observed and should be treated the same as for tricyclic antidepressants (see Chapter 7). 2. Non–dose-dependent adverse effects include Stevens–Johnson syndrome, toxic epidermal necrolysis, drowsiness, dizziness, headache, unsteady gait, tremor, diplopia, and nausea. D. Felbamate 1. Appears to act via the GABAA receptor, similarly to sedative hypnotics (see Chapter 32).