Journal of Pharmacy Practice

Exposure to a wide variety of chemicals can pose significant hazards to patients, and present health care professionals with scenarios that require proper assessment and treatment. Knowing when a chemical exposure requires emergency medical attention is equally as important as knowing when such assistance is not necessary and that simple treatment measures performed at home will suffice. This current discussion is intended to highlight selected principles and clinical information pertaining to common chemical exposures, but not to replace the full spectrum of information that would be available to health care professionals (and the lay public) by contacting their nearest poison control center. There are several factors that should be considered when assessing the nature of and possible clinical outcomes (and medical needs) from patient exposure to chemicals. Identification of the chemical(s) involved, events leading up to the exposure, route of exposure (e.g., ingestion, dermal, inhalation, ocular), patient medical history and current symptoms, are just a few of the variables that must be ascertained before various treatment approaches can be undertaken.

Poisonous plants are of great concern to any parent or health care practitioner. Household and landscape plants account for 7.1 % of all poisonous exposures in children. Many parents and health care professionals are aware of other potential poisons in the house; however, many times plants are overlooked as a potential poison. Though most plants are associated with only minor symptoms from dermal contact or ingestion, there are some that are associated with significant toxic effects that can be fatal. Poisonous plants are classified as anticholinergic, cardiac glycoside, cyanogenic, central nervous system stimulant/hallucinogens and severe gastrointestinal irritants. Many times these toxic plants produce a multitude of symptoms called a toxidrome. It is important for health care professionals to recognize these toxidromes and be knowledgeable about the proper treatment modalities.

From a strategic 1962 article cataloging the imprints on tablets, capsules and softgels, the art of identification of solid medication dosage form has proceeded to where all prescription medications, including controlled substance, over-the-counter (OTC) drugs, veterinary and homeopathic drug products must be imprinted. Imprints may be comprised of logos, numerical and/or alphabetical information. Imprints are electronically searchable by two computer programs, one of which provides graphics of logos. The public and health, law enforcement and teaching professionals have a need to know when a "stray" tablet or capsule is found what it is with a high degree of accuracy. Imprints may soon be on prescription labels and searchable through various websites on the internet.

Recent worldwide terrorist acts and hoaxes have heightened awareness that incidents involving weapons of mass destruction (WMD) may occur in the United States. With federal funding assistance, local domestic preparedness programs have been initiated to train and equip emergency services and emergency department personnel in the management of large numbers of casualties exposed to nuclear, biological, or chemical (NBC) agents. Hospital pharmacies will be required to provide antidotes, antibiotics, antitoxins, and other pharmaceuticals in large amounts and/or have the capability for prompt procurement. Pharmacists should become knowledgeable in drug therapy of NBC threats with respect to nerve agents, cyanide, pulmonary irritants, radionucleotides, anthrax, botulism, and other possible WMD.

In the current health care arena, patients have a multitude of prescription, over-the-counter, herbal, natural, and nutritional products available to them. A common perception among the public at large is that any medication that does not require a prescription is safe to take. This simply is not the whole truth. Eckerd pharmacists play an important role in preventing accidental poisoning through monitoring of patient use of, and addressing patient inquiries about, any medication-related products.

Cocaine remains the most prevalent drug responsible for emergency department (ED) visits. A majority of acute cocaine toxicity cases involve young, habitual, adult cocaine users and often present with a range of cardiac, neurologic, gastrointestinal (GI) or renal symptoms. In addition, atypical populations (neonates, infants, toddlers, young children and adolescents) are presenting in EDs with varying symptoms that are unknowingly associated with cocaine exposure. Unfortunately, juvenile presentations are generally anecdotal in nature, and while enlightening, are difficult to quantify epidemiologically. Outlining the types of symptom presentation in these young populations may assist healthcare providers in expediting proper treatment for such demographic groups. Therefore, this review examines the current knowledge regarding cocaine's pharmacologic activity as it relates to its potential toxicity, and outlines the clinical manifestations of cocaine exposure and toxicity in adult and pediatric populations. We conclude from the available clinical reports that there must be a higher index of suspicion in the pediatric population to identify exposed infants and children. Improved recognition and identification in both typical and atypical populations will result in better characterization of acute cocaine toxicity.