Doxylamine Succinate

"The toxicology studies on blood reveal the presence alprazolam, and amphetamine at levels likely consistent with the therapeutic range, a metabolite of buproprion and a high level of fentanyl. Phenylpropranolamine and amphetamine are present in the urine. When fentanyl and alprazolam are taken together there may be a synergistic central nervous system depressive effect. Based on the history and circumstances, s currently known, the manner of death is accident."

This paper will demonstrate the author’s ability to prescribe safely from the Nurse Prescribing Formulary (NPF 2009-2011). A prescribing situation undertaken by myself while supervised by my mentor will be discussed. The patients name, address, date of birth and GP details have been changed to ensure patient confidentiality in accordance with the Nursing and Midwifery Council (NMC)(2004). The patient therefore will be referred to under the pseudonym Prince Charming.

Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865).

With the growing reliance on medication therapy as the primary intervention for most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits. Medicines have proven to be very beneficial for treating illness and preventing disease. This success has resulted in a dramatic increase in medication use in recent times. Unfortunately, this increase in use and expansion of the pharmaceutical industry has also brought with it an increase in hazards, error and adverse events associated with medication use.

As the war on drugs continues, more and more lives are being lost to opiate overdoses. Opiates are drugs that contain or are derived from the opium poppy plant. They can be legally prescribed pain medications such as OxyContin or Vicodin or illegal street drugs such as heroin. Whether these drugs are used legally or illegally, there is always the chance of an overdose if not used correctly. According to a 2014 press release from the Center for Disease Control (CDC), “in 2013 more than 16,000 deaths in the United States involved prescription opioids, and more than 8,000 others were related to heroin.”

There has been a sharp and continued rise in the number of deaths related to prescription drug overdoses. Between the years 2004 and 2005, there were five Wyoming residents who died as a result of an accidental overdose of prescription pain medications. Consider the most recent

B’s tolerance to opiates not considered, Mr. B.’s clinical situation not considered (i.e., Mr. B’s age and renal function), and knowledge deficit of opiates. Drilling down the data to identify the root cause of Mr. B’s death is the fifth step in conducting a RCA on Mr. B’s sentinel event. Upon analyzing the data, causative factors, and events leading to Mr. B’s sentinel event, the RCA team determined that the root cause of Mr. B’s death is a medication error. Mr. B was given an overdose of hydromorphone. The final step in a root cause analysis is to implement changes that will mitigate the root cause. Changes include educating the nursing staff about hydromorphone, such as side effects and adverse reactions,

An 59-years-old female patient got admitted to the ED due to head injury laceration, end up with 3 stiches. She stated she struck her head on the doorframe due to using IV cocaine. The patient complains of SOB, dizziness and her head hurt. The patient vital signs were T 97.8 – O2 96 – P70 and BP 114/76. One of the patient medications was Suboxone (, 1 tablet Sublingual.

Most of the researchers on the drug monitoring unit, SAMHSA had mentioned that a major portion of the Ambien ER visits were of people who were already on other medications. Ambien, alone, was not triggering any severe side effects. However, the drug when coupled with other drugs or chemicals was able to trigger severe side effects that resulted in the spike of ER visits during that particular period. This is the principle of Drug interaction, where a certain drug that you take may change its properties based on the othermedications you take. This could amplify the risk associated with the drug, ultimately leading to serious side effects. Ambien, as a drug has severe interactions with other drugs, which are

In the United States, (US) the death from the use of opioid overdose has been increasing drastically. According to the National Institution on drug abuse, the number of deaths from opioids overdose has increased from 10-15k in 2002 to 30-35 in 2015 (NIH, 2015). This epidemic has become a global public health concern (Wermeling, 2013) since the number of death (69,000) has been increasing world widely each year (WHO, 2014). In response to this growing epidemic, community-based programs have been providing opioid antagonist

Higher-than-recommended doses of some over the counter (OTC) cough syrups produce psychoactive (mind altering) effects in which cause them to be abused. Two commonly abused cough syrups include dextromethorphan and promethazine-codeine. Several OTC cold medicines contain dextromethorphan, a cough suppressant and expectorant. When taken in amounts exceeding the recommended dose, it may produce euphoria, dissociation and/or hallucinations. Whereas, promethazine-codeine contains codeine, an opioid that serves a role in cough suppression, as well as promethazine HCl, an antihistamine that produces sedation. When taken in higher-than recommended doses, it may produce relaxation and euphoria.

There are conflicting views on the use of stilnox as a sleeping aid and the use of sleeping aids as the amount of people that have died as result of these drugs is slowly increasing. In America, a study by Scribbs Health, a non-profit organisation, estimates that, “500,000 ‘excess deaths’ have been caused by taking drugs such as Ambien (American equivalent of stilnox) and Restoril”. These deaths are a result of two main factors, unconscious behaviours and suicide. Commiting suicide using a sleeping pill is the preferred method for women as it causes the metabolic pathways throughout the body to start shutting down. These systems include the respiratory, circulatory and nervous systems and the result of such a widespread shut down is death. The drug is attributed with certain behaviours that occur while being unconscious. It has been reported by numerous patients that the drug results in sleep related behaviours such as, sleepwalking and has resulted in many deaths.

This drug is used as an antidepressant. Anxiety, dizziness, blurred vision, dry mouth, diarrhea, and weight gain or loss are common effects of the medications and with aging. But serious effects such as fever; seizures, tremors, chest pain, hepatic necrosis, renal failure, abnormal bleeding, and infection should be cautioned. The dosage of this medication should not be prescribed more than 40 mg daily. Monitoring for mental changes when taking this medication is needed. It should be cautioned to watch for a change in behavior from depression into a mental illness. If this occurs medical attention is needed. Nurses should also assess elderly patients taking diuretics for signs of suggesting syndrome of inappropriate secretion of antidiuretic

Simmonds (2015), implemented in England within National Health Service hospitals, proposed naloxone protocol to be used in adult patients, who are in need of respiratory rescue due to opioid use. In addition, the protocol is approved for the usage in immediate reversal of the effects of acute opioid overdose and or recreational usage. Simmonds proposed a step-by-step guide that started with the recognition of an unusually depressed level of consciousness and respiratory rate of fewer than eight breaths per minute in a patient. Immediately after recognition, oxygen administration at 12 L per minute

In 1997, there was a case study and twelve pediatric zolpidem exposures were reported (CITE). Seven were unintentional (ages 20 mon-5 y) and five were intentional misuse/suicide (ages 12-16 y). The regional poison information center was contacted within 1 h in ten cases with onset of symptoms within 10 to 60 min (mean 31.6 min). One child had no effect with 2.5 mg. As little as 5 mg caused symptoms with minor outcome in six unintentional ingestions (5-30 mg). Minor to moderate symptoms were reported 1-4 h after intentional ingestions (12.5-150 mg). The duration of symptoms in the unintentional cases ranged from less than 60 min up to 4 h (mean 2.4 h) and 6-10 h (mean 7.5 h) in the intentional exposures. Treatment consisted of observation (4),