A Review of Adverse Reactions in Infants From Medications in Breastmilk.

The types and rate of adverse drug reactions experienced by breastfed infants whose mothers are taking medications has not been well defined. This article reviews the literature on adverse drug reactions in infants since a previous review in 2002. Case reports and studies of adverse drug reactions in breastfed infants whose mothers were taking a prescribed or over-the-counter medication were selected.

Students' health-related quality of life across the preclinical pharmacy curriculum.

Objectives: To examine health related quality of life (HRQOL), perceived stress, and coping skills in the 3 preclinical years of a doctor of pharmacy (PharmD) curriculum.

Methods: Health-related quality of life, perceived stress, and coping strategies were measured using the Short Form-36, Perceived Stress Scale, and Brief COPE. Average annual scores were compared across curriculum years.

Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications.

Study Objective: The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death.

Methods: Fatalities that involved a child younger than 12 years and mentioned a cough and cold ingredient were obtained from 5 sources.

Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management.

A review of US poison center data for 2004 showed over 9000 ingestions of valproic acid. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline.

Elemental mercury exposure: an evidence-based consensus guideline for out-of-hospital management.

Unlabelled: The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with suspected exposures to elemental mercury. An evidence-based expert consensus process was used to create this guideline. It is based on an assessment of current scientific and clinical information.

Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management.

The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and out-of-hospital management of patients with suspected acute ingestions of atypical antipsychotic medications by 1) describing the process by which an ingestion of an atypical antipsychotic medication might be evaluated, 2) identifying the key decision elements in managing cases of atypical antipsychotic medication ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of atypical antipsychotic medications alone. Co-ingestion of additional substances could require different referral and management recommendations depending on the combined toxicities of the substances.

Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management.

A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline.

Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management.

The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of dextromethorphan by 1) describing the process by which an ingestion of dextromethorphan might be managed, 2) identifying the key decision elements in managing cases of dextromethorphan ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to the ingestion of dextromethorphan alone. Co-ingestion of additional substances could require different referral and management recommendations depending on the combined toxicities of the substances.

Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management.

A review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline.

Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management.

A review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs).

Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management.

A review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products.

Long-acting anticoagulant rodenticide poisoning: an evidence-based consensus guideline for out-of-hospital management.

The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with suspected exposure to long-acting anticoagulant rodenticides (LAAR). An evidence-based expert consensus process was used to create this guideline. It is based on an assessment of current scientific and clinical information.

Camphor Poisoning: an evidence-based practice guideline for out-of-hospital management.

A review of national poison center data from 1990 through 2003 showed approximately 10,000 annual ingestion exposures to camphor-containing products. A guideline that determines the threshold dose for emergency department referral and need for pre-hospital decontamination could potentially avoid unnecessary emergency department visits, reduce health care costs, optimize patient outcome, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline.

Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management.

In 2003, there were 28,092 human exposures to diphenhydramine reported to poison centers in the US. A related drug, dimenhydrinate, is a less frequent cause of poisonings. Between January 2000 and June 2004, there were 2,534 reported dimenhydrinate ingestions in children less than 6 years of age.

Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management.

The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of acetaminophen. An evidence-based expert consensus process was used to create this guideline. This guideline applies to ingestion of acetaminophen alone and is based on an assessment of current scientific and clinical information.

Determining triage guidelines for unintentional overdoses with calcium channel antagonists.

Background: Calcium channel antagonists (CCAs) are known to cause significant toxicity in overdose. Determining triage guidelines for CCAs is an important but difficult task. This study was designed to determine if an unintentional overdose of a patient's CCA could result in clinically significant cardiovascular (CV) symptoms (hypotension, bradycardia, conduction disturbances).

Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.

In 2003, U.S. poison control centers were consulted after 9650 ingestions of calcium channel blockers (CCBs), including 57 deaths.

Iron ingestion: an evidence-based consensus guideline for out-of-hospital management.

From 1983 to 1991, iron caused over 30% of the deaths from accidental ingestion of drug products by children. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher.

Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management.

In 2002, poison centers in the US reported 5816 human exposures to ethylene glycol. A guideline that effectively determines the threshold dose for emergency department referral and need for pre-hospital decontamination could potentially avoid unnecessary emergency department visits, reduce health care costs, optimize patient outcome, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create this guideline.

beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.

In 2003, US poison centers were contacted regarding ingestion of beta-blockers by 15,350 patients including 3766 (25%) under 6 years of age; 7415 (48%) were evaluated in healthcare facilities and 33 died. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher.

Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons.

The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying process as early as possible.

Adverse drug reactions in breastfed infants: less than imagined.

Medication use during breastfeeding shortens the duration of breastfeeding often because of overly cautious information given by healthcare providers. No comprehensive review of the literature on infant adverse reactions from drugs in breastmilk has been published. All published studies and case reports on adverse events in infants caused by medications (excluding drugs of abuse) in breastmilk were identified and analyzed.

Evaluating the utilization of a regional poison center by Latino communities.

Background: Penetrance values estimate the utilization of poison centers services. For a variety of reasons, penetrance values may vary greatly among geographic areas of population. We examined the relationship between ethnicity and penetrance in our population.

A prospective study of acute, unintentional, pediatric superwarfarin ingestions managed without decontamination.

Study Objective: We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K.

Methods: We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded.

5-Year analysis of mushroom exposures in California.

Objective: To evaluate outcomes following toxic mushroom ingestions.

Design: Retrospective data analysis.

Methods: We analyzed American Association of Poison Control Center data for California from 1993 through 1997.