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Tricyclic antidepressants such as Elavil amitriptyline and Tofranil imipramine may also have some this activity and thus should be used in caution in patients with narrow angles. The results generic some tests may be 750 by this medicine. Anticholenergic means that these drugs block the action of acetylcholine, a chemical messenger that transmits signals from one nerve cell to another nerve cell, muscle cell, or gland cell, for example.
Nov 27, If possible, KCL should be administered on a dedicated line, always via a volumetric infusion pump. Malpractice allegations spotlight anti-nausea medication.
The true extent of this problem may be unknown. A few examples follow. Figure 1. In , a year-old woman went to the emergency department with flu-like symptoms and received the branded drug Phenergan IV. The patient remained in the hospital for 30 days, during which she watched her previously healthy fingers turn black and shrivel see Figure 1.
Her thumb, index finger, and top of her middle finger had to be amputated. In , a patient received During the injection, the patient complained of extreme burning, but the nurse continued administering the medication.
The patient developed an area of necrosis on his hand, eventually requiring skin grafting and physical rehabilitation. I am hoping anyone who reads this with experience handling this problem or knows of a possible reversal please contact me ASAP.
From what I have been able to gather, there is no current published treatment protocol. The patient will likely have her two fingers amputated soon, and in my opinion, could require more and suffer from lifelong chronic pain. This is a relatively young individual which makes everything more tragic. She developed circulatory problems and then progressive gangrene which led to amputation of her arm in stages.
Nonetheless, ISMP believes these long-standing hazards require further action on the part of healthcare providers, FDA, and promethazine manufacturers. In the s, after numerous reports of infiltration and inadvertent intra-arterial injection of hydroxyzine, FDA asked the manufacturer to revise the label and remove IV as an approved route. Today the drug is only indicated for IM or oral administration. Similarly, FDA should carefully investigate adverse events with this drug to determine if labeling changes are warranted, including removal of approval for IV administration.
Safe Practice Recommendations Along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving IV promethazine. Limit concentration. People who have died from potassium overdoses caused by nurses have done so by direct injection of plain potassium, not cc's with 20 of KCL.
Higher doses than 20KCL or in mixtures less than cc must have a pump where we work. I work in a not-for-profit where pumps are a priviledge in med-surg. Has 16 years experience. Nov 27, Again, people are going to disagree and gasp, because people have a mortal fear of Potassium. Actually, we not long ago had a much beloved patient that we saw often die of a potatium overdose not due to plain potassium, but due to a potassium maintence bag like the one you mentioned.
It does happen and since many IV's tend to be positional, the dial-a-flows on our floor are only used as a last resort if we have nothing else at the time, and then replaced as soon as a pump becomes available.
Nov 27, Actually, we not long ago had a much beloved patient that we saw often die of a potatium overdose not due to plain potassium, but due to a potassium maintence bag like the one you mentioned. I stand corrected. We all know when people are going to gravity that sometimes the bag drips in because of position, or patients messing with it, or whatever. However, most of the time even if the patient received the entire bag, which will take 15 or more minutes to infuse, it doesn't kill them because it's such a small amount mixed in a large volume.
I don't do this with every patient, I look at the patient's age, fluid status, cardiac status, general condition, etc. But since most of my patients are trauma patients, usually in relatively good health except for emotionally and chemically dependent, but that doesn't matter.
LOL prior to their traumas, I run these bags to gravity with a dial-a-flow following our policy. Medications to Discuss with Your Doctor if You have Open-Angle Glaucoma Oral Steroids As mentioned above, oral steroids can help to reduce inflammation and to reduce the activity of the immune system.
Other side effects in the eye, beyond increased pressure, include cataracts. Not every person develops elevated eye pressures when taking oral steroids. Your risk is higher, however, if you have open-angle glaucoma, so if you are undergoing treatment for glaucoma and have recently been diagnosed with a condition that requires more chronic use of oral steroids, you should discuss this with your ophthalmologist.
He or she may want to monitor you more closely while you are on steroid treatment. And, of course, topical steroid eye drops can increase eye pressure, but if you are using these medications, you should already be under the care of an eye care provider.
Talk to Your Doctor or Pharmacist There are many other medications than can increase the risk of glaucoma in addition to the ones mentioned in this article, so it is always wise to talk with your pharmacist or your eye doctor about your medication regimen. Most pharmacies will give you the opportunity to speak with a pharmacist about your medications.
You should mention that you have glaucoma and ask whether there are any potential issues. Most medications that can adversely affect glaucoma or put you at risk of developing glaucoma apply to persons who have narrow angles or angle-closure glaucoma.
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