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We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.

A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects.

Lung cancer is one of the most rapidly growing malignancies in terms of morbidity and mortality. Although traditional treatments have been used for more than 50 years, it is still far from solving the problems of postoperative risks and systemic toxicity. Emerging targeting and immunotherapy are developing continuously and are gaining recognition; eventually, they face the inevitable challenge of drug resistance. Nanotechnology has several important effects on lung cancer treatment, owing to its unique properties. Several nanoparticle-based treatments have successfully become cancer treatments. Good biocompatibility with higher specific surface area can carry substantial amounts of lung cancer treatment medications while avoiding medication toxicity; editable and modified characteristics give rise to multifunctional nanomedicines; excellent photoelectric effects make lung cancer a multimodal treatment. This article summarizes the breakthroughs achieved by nanotechnology, targeted therapy, and immunotherapy, reflecting the importance and necessity of nanotechnology in the treatment of lung cancer.

Childhood-onset disease represents 10%-20% of systemic lupus erythematosus (SLE) cases. The demographic characteristics largely parallel those seen in adult-onset disease, although the female:male ratio is less skewed in children, and may approach equal in very early-onset SLE. The genetic contribution is thought to be stronger in childhood-onset disease, and this is supported by younger-onset of disease in cases of familial lupus. The clinical manifestations of pediatric lupus are also similar to those seen in adults. However, children generally present with more severe disease and higher prevalence of lupus nephritis. This, together with their longer lifetime burden of disease, means that patients with childhood-onset SLE have higher morbidity and mortality overall. They may also experience greater effects of medication toxicity due to higher cumulative exposure and exposure during their critical period of growth. Pediatric patients require special consideration of these issues in their treatment. They may also benefit from dedicated transition planning when moving care to an adult rheumatologist.

Mechanisms of drug-induced uveitis are poorly understood, and they may include direct medication toxicity, breakdown of blood-aqueous and blood-retina barriers, and immune-mediated vasculitis. A thorough review of medications should be conducted in evaluation of every uveitis patient. Using the 10 criteria proposed by Naranjo et al., the causative relationship between a medication and an adverse reaction can be quantitatively assessed.

Dear editor,Overdose of acetaminophen (APAP) is one of the commonest causes for hospital presentation due to medication toxicity [1,2]. Treatment of acute APAP overdose with the antidote acetylcyst...

The tyrosine kinase inhibitor, JNJ-42756493, is an oral pan-fibroblast growth factor receptor inhibitor being studied as an antineoplastic agent. It is currently the subject of a phase II clinical trial for the treatment of urothelial cancer. We report 2 patients who developed visual disturbance shortly after starting or increasing dosage of this medication and were found to have bilateral foveal detachments on ocular coherence tomography imaging. The first patient discontinued this medication and the retinal lesions resolved with a return to baseline vision within 4 to 6 weeks. After restarting the medication at a lower dose, neither visual disturbance nor retinal lesions recurred. In the second patient, lesions were found to greatly improve shortly after discontinuation of the medication but recurred even on a reduced dose regimen.

Purpose To present a previously unreported retinal side-effect from topiramate use in two cases. Observations Macular neurosensory retinal detachments were seen in two patients shortly after beginning oral topiramate. The macular detachments resolved shortly after discontinuing this medication. Conclusions and importance As these two cases represent the first reports of topiramate-induced macular neurosensory retinal detachment, clinicians should be aware of this potential ocular side effect when administering this medication.

Mrs. P. waved at one of our medical students: not so unusual - how often do patients find something familiar or interesting in one of us, a tone of the relatable in our universe of the strange? For Mrs. P, however, this was striking. She had presented with excited delirium concerning for medication toxicity which prompted a Toxicology consult. On our team's review of her medical records, it seemed entirely plausible: multiple healthcare visits for pain, several recent medication adjustments, and then hallucinations, falls. A familiar story.

Delirium is one of the most common mental illnesses that can affect elderly patients and patients with advanced medical problems. Because these patients are frequently on multiple medications and/or are more sensitive to medications secondary to their age, interactions with current medications, or existing medical problems, medication toxicity is frequently the etiology behind their delirium. This is a case report of a patient admitted for cellulitis that developed delirium from Linezolid however did not develop any other signs or symptoms of serotonin syndrome; a known side effect of Linezolid. This distinctive case highlights the importance of a careful analysis of a patient’s medications for potential deliriogenicity as well as the value of using a validated tool for assessing and following up a patient with suspected delirium. Specifically, this case should give clinicians warrant for suspicion of Linezolid as the cause of a patient’s delirium regardless of the presence or absence of serotonin syndrome.

The causes of encephalopathy in the posttransplant setting are diverse and include medication toxicity (e.g., posterior reversible encephalopathy syndrome), infections (e.g., human herpes virus type 6 [HHV-6]), and neoplastic disease (posttransplant lymphoproliferative disorder). Autoimmune etiologies are not well recognized in this setting, although a few cases are described.1–5 Herein, we report 3 patients with posttransplant autoimmune encephalitis (AE).

This Month Cell phone use in the OR Key words: cell phones, smartphones, distraction. Lidocaine toxicity Key words: medication toxicity, medication allergy, lidocaine, local anesthetics, adverse reactions. Transporting supplies from the sterile processing department to the OR Key words: sterile supplies, sterile processing department, supply transport, contamination, lift, elevator.

Single-breath diffusing capacity of the lung for carbon monoxide (D(LCO)) is a common pulmonary function test that measures the ability of the lung to exchange gas across the alveolar-capillary interface. D(LCO) testing is used to narrow the differential diagnosis of obstructive and restrictive lung disease, to aid in disability and transplant assessment, and to monitor medication toxicity. The variability in the measurement limits the utility of the test. Variability is attributable to differences in equipment, testing conditions, patient factors, and reference equations. Laboratories can minimize variability by ensuring that equipment meets recommended standards, implementing effective quality control programs, standardizing testing conditions and testing procedures, and accounting for pertinent patient characteristics.

Medication-induced upper gastrointestinal (GI) tract injuries are probably fairly common, yet these injuries are rarely documented in pathology reports. Since these injuries often manifest as non-specific histological changes, making a definitive diagnosis of medication-induced injury can be challenging. Three types of evidence can assist in the establishment of a diagnosis: specific histological patterns, the presence of medication fragments in tissue, and clinical data. Histological patterns may reflect specific tissue responses to medication effects or medication toxicity. Morphological clues of medication use such as pill fragments and crystal deposition may be visible within the tissue itself. Clinical data, including medication history, endoscopic findings, and predisposing conditions can alert the pathologist to situations where medication-induced injury should merit a high ranking on the differential diagnosis list. Except for rare cases where characteristic histological changes can be diagnostic, clinical correlation is essential when diagnosing medication-induced injuries. In this review, key features of the most commonly encountered medication-induced upper GI tract injuries are briefly discussed, and a practical guide to assist the practicing pathologist in the recognition and diagnosis of these injuries is provided.

Any hospice professional can identify the syndrome known as terminal restlessness, and all would agree that it is extremely distressing to patients as well as their families and care-givers. Often, caregivers cannot ameliorate the anguish many patients experience at life’s end. Many clinicians assert that the causes are physical resulting from medication toxicity, organ shutdown and the associated metabolic changes, pain, urinary or fecal retention, dyspnea and related hypoxia, and sepsis. Yet, many also credit psychosocial and spiritual distress as precipitating factors.The purposes of this study were twofold: to compare the perceptions of practicing hospice clinicians with the literature related to terminal restlessness, and to determine if their experience with terminal restlessness agreed with the components of the one established scale for terminal restlessness found in the literature.In general, the study findings corresponded to the literature in regards to frequency, definition, causes, and behavioral manifestations of terminal restlessness. The clinicians in the study supported the impact of psychosocial and spiritual causes of terminal restlessness and defined the phenomenon in terms of time period; emotional, physical, and spiritual distress; changes in consciousness; and increased activity. However, the study did not support the inclusion of impaired consciousness and withdrawal as comprised in the terminal restlessness scale.

A plethora of literature describes the impact of the P450 enzyme system, but this information is limited regarding its relevancy to nursing practice. However, oncology nurses providing palliative symptom management must have a working knowledge of the P450 enzyme system to recognize the variability that exists among individual medication reactions or why a "cookbook approach" to symptom management is not always effective and appropriate. This article describes the variations associated with medication metabolism with reference to ethnic differences. Having a basic understanding of the P450 enzyme system and, more specifically, the CYP2D6 influence on the metabolism of common medications used in palliative symptom management can help to prevent medication toxicity or underdosing, which interferes with patients' quality of life.

Solid organ transplantation has become an important therapeutic option for multiple chronic diseases. With the advent of newer and potent immunosuppressive regimens, graft survival has improved, but at the expense of an increased risk for the development of infections secondary to bacterial, fungal, viral and parasitic pathogens. Prevention of such infectious complications with effective, well tolerated, and cost-effective anti-microbials would be ideal to improve the outcome of transplanted patients. However, the emergence of multi-drug resistant pathogens, medication toxicity and drug-drug interactions need to be carefully evaluated. This review summarizes the most relevant data pertaining to our current understanding of infection prevention for solid organ transplant recipients. Specific recommendations are given for the prevention of each group of microorganisms and types of solid organ transplant.

PURPOSE To describe a distinct and unusual superficial dendriform keratopathy that can be seen in postkeratoplasty eyes. METHOD Three Caucasian women in their sixth decade of life were referred to the Corneal and External Disease Service at the University of California, Davis, and underwent penetrating keratoplasty for different diagnoses. After keratoplasty, hypertrophic dendriform epithelial lesions were observed. These were refractory to debridement as well as topical antibiotic and steroid combinations. Immunofluorescent antibody testing was performed in all cases to rule out herpetic infection, and the patients were treated with nonpreserved lubricants and medications to eliminate medication toxicity as the cause of the lesions. RESULTS All three patients in this series developed raised, hypertrophic epithelial lesions after keratoplasty, which were refractory to therapy. Comfort and mild increase in visual acuity were restored with the use of thin, moderate water content therapeutic contact lenses. CONCLUSIONS Superficial hypertrophic dendriform epitheliopathy is a distinct syndrome that occurs postkeratoplasty in patients with preexisting chronic ocular inflammation, tear dysfunction, and/or lid disease exacerbated by the toxic effects of postoperative topical medication.

The initial assessment of kidney allograft dysfunction follows similar principles to the evaluation of native acute kidney injury, but with special attention to a broader differential diagnosis. Depending upon the timing post-transplant, surgical issues, infectious etiologies, and immunologic causes of graft dysfunction may be more or less likely; these causes are above and beyond typical concerns regarding medication toxicity, hemodynamic factors, and other common causes of kidney dysfunction. The purpose of this chapter is to provide the reader with an understanding of the potential causes of kidney transplant dysfunction and offer a framework for assessment and management in a stepwise manner. Many of the specific causes of graft dysfunction are discussed in greater detail in accompanying chapters, and the reader is directed to these chapters when applicable.

Objectives To conduct an evidence-based review of the common medication toxicities and strategies and utility of drug toxicity monitoring among patients with systemic lupus erythematosus (SLE). Methods PubMed and other databases were searched for articles published between the years 1960 and 2010 for keywords referring to medication toxicity or monitoring strategies for 7 drugs commonly used in SLE. All relevant English-language articles were reviewed. Most of the evidence we reviewed comprised studies that addressed the incidence of toxicity—randomized trials that compare different monitoring strategies for these drugs do not exist. Results Data to describe the frequency of adverse events and appropriate strategies for screening for these events are scarce. Toxicities do not appear to be substantially more common among patients with SLE compared to other conditions for which these drugs are used. Conclusions Our review demonstrates that the scientific basis for many aspects of drug toxicity monitoring is weak and that most current recommendations are based largely on expert consensus. We present a future research agenda to address these gaps.

Complications following hematopoietic stem cell transplantation have long been recognized. The causes are numerous, including chemoradiotoxicity, medication toxicity, metabolic abnormalities, organ failure, graft versus host disease, infection, pancytopenia, and platelet dysfunction. This chapter summarizes the disorders affecting the nervous system associated with hematopoietic stem cell transplantation. As the number of transplants performed annually increases, potential neurologic complications are being seen with increasing frequency.

In Reply We respectfully disagree with Dr Rosansky on several key points and favor a more comprehensive approach to the care of older patients with CKD than he has proposed. First, the current eGFR and the rate of future decline are each important in the care of older patients with CKD. Numerous studies show the current eGFR is related to a broad range of adverse outcomes beyond kidney failure, including cardiovascular disease, metabolic and hormonal complications, medication toxicity, infections, cognitive impairment, and frailty.

Objective: Computerised monitors can detect and, with clinical intervention, often prevent or ameliorate adverse drug events (ADEs). We evaluated whether a computer-based alerting system was useful in a community hospital setting. Methods: We evaluated 6 months of retrospectively collected medication and laboratory data from a 140-bed community hospital, and applied the rules from a computerised knowledge base to determine if the resulting alerts might have allowed a clinician to prevent or lessen harm related to medication toxicity. We randomly selected 11% (n = 58, of which 56 were available) of charts deemed to be high- or critical-priority alerts, based on the likelihood of the alerts being associated with injury, to determine the frequencies of ADEs and preventable ADEs. Results: In 6 months, there were 8829 activations of the rule set, generating a total of 3547 alerts. Of these, 528 were of high or critical priority, 664 were of medium priority and 2355 were of low priority. Chart review among the sample (56 charts) of high- or critical-priority alerts found five non-preventable and two preventable ADEs, suggesting that among the total high- or critical-priority alerts alone, there would be approximately 94 non-preventable ADEs and 37 preventable ADEs annually in this hospital that could be detected using this method. Conclusions: Computer-based rules engines have the potential to identify and, with clinical intervention, mitigate preventable ADEs, and implementation is feasible in community hospitals without an advanced information technology application.

Postexposure prophylaxis is an effective intervention to prevent transmission of the human immunodeficiency virus (HIV). Administration of antiretroviral medications within 72 hours of a percutaneous or mucous membrane exposure to HIV can prevent infection. The use of postexposure prophylaxis for occupational and perinatal HIV exposures is well established. Its efficacy for nonoccupational exposures has only recently been studied. To date in the United States, there are no national guidelines regarding postexposure prophylaxis for nonoccupational exposures. Decisions regarding its use should be made after weighing the risks of seroconversion for a given exposure, the risks of HIV in the source, and the potential toxicities of the antiretroviral medications. Several state guidelines may also serve as important resources. Clinicians should consider initiating postexposure prophylaxis in adolescents for any oral, anal, or vaginal exposure to definitely or possibly HIV-infected blood or body fluids. Adolescents treated should be followed closely for medication toxicity, acute seroconversion, and risk-reduction counseling. Further studies are needed to characterize the use and efficacy of postexposure prophylaxis in an adolescent population.

The purpose of this article is to help nurses prevent adverse drug reactions (ADRs) in the perioperative, endoscopic, and special procedure areas. Up to 30% of hospitalized patients experience an ADR. Taking comprehensive medication histories, maintaining constant vigilance, and recognizing inherently dangerous patient/medication combinations are essential in preventing ADRs. The mechanisms of medication toxicity and identifying potentially preventable adverse reactions are discussed. Practical nursing guidelines and tips that patients can use to prevent ADRs from occurring are delineated. Not every ADR can be prevented, but informed nurses can implement measures to reduce their occurrence.

In elderly people, illness caused by medications may be the most significant treatable health problem (Beers and Ouslander 1989). One-sixth of all U.S. hospital admissions of patients over 70 years of age, compared with 1 in 35 admissions in the rest of the population, have been attributed to adverse drug reactions (National Council on Patient Information 1988). In Britain, 10% of all hospital admissions to geriatric medicine departments were found to be due to medication toxicity. A total of 25.4% of patients admitted under these circumstances were taking four to six drugs and 12% were taking psychotropics (Williamson and Chopin 1980).

This is the first report in a projected series on neurological development among the offspring of schizophrenics. An increased incidence of fetal and neonatal deaths is noted among offspring of schizophrenics when compared to a closely matched control group, using data collected prospectively. In many cases, no apparent reason for death was determined; in some cases, major neurological malformations were found. It is necessary to consider three possible explanations for these findings—genotype of the child, adverse intrauterine environment, and medication toxicity.