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King SA, Spangler R, Dezman ZDW, Bontempo LJ. 36-year-old Male with Syncope. Clin Pract Cases Emerg Med 2020; 4:272-276. [PMID: 32926665 PMCID: PMC7434231 DOI: 10.5811/cpcem.2020.6.48419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
CASE PRESENTATION A 36-year-old incarcerated male presented to the emergency department (ED) after an episode concerning for syncope. The patient had nystagmus and ataxia on initial examination. DISCUSSION There is a broad differential diagnosis for syncope, and for patients presenting to the ED we tend to focus on cardiogenic and neurologic causes. This case takes the reader through the differential diagnosis and systemic work-up of a patient presenting to the ED with syncope.
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Affiliation(s)
- Samantha A King
- University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Ryan Spangler
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Zachary D W Dezman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Laura J Bontempo
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Abbott KL, Flannery PC, Gill KS, Boothe DM, Dhanasekaran M, Mani S, Pondugula SR. Adverse pharmacokinetic interactions between illicit substances and clinical drugs. Drug Metab Rev 2019; 52:44-65. [PMID: 31826670 DOI: 10.1080/03602532.2019.1697283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adverse pharmacokinetic interactions between illicit substances and clinical drugs are of a significant health concern. Illicit substances are taken by healthy individuals as well as by patients with medical conditions such as mental illnesses, acquired immunodeficiency syndrome, diabetes mellitus and cancer. Many individuals that use illicit substances simultaneously take clinical drugs meant for targeted treatment. This concomitant usage can lead to life-threatening pharmacokinetic interactions between illicit substances and clinical drugs. Optimal levels and activity of drug-metabolizing enzymes and drug-transporters are crucial for metabolism and disposition of illicit substances as well as clinical drugs. However, both illicit substances and clinical drugs can induce changes in the expression and/or activity of drug-metabolizing enzymes and drug-transporters. Consequently, with concomitant usage, illicit substances can adversely influence the therapeutic outcome of coadministered clinical drugs. Likewise, clinical drugs can adversely affect the response of coadministered illicit substances. While the interactions between illicit substances and clinical drugs pose a tremendous health and financial burden, they lack a similar level of attention as drug-drug, food-drug, supplement-drug, herb-drug, disease-drug, or other substance-drug interactions such as alcohol-drug and tobacco-drug interactions. This review highlights the clinical pharmacokinetic interactions between clinical drugs and commonly used illicit substances such as cannabis, cocaine and 3, 4-Methylenedioxymethamphetamine (MDMA). Rigorous efforts are warranted to further understand the underlying mechanisms responsible for these clinical pharmacokinetic interactions. It is also critical to extend the awareness of the life-threatening adverse interactions to both health care professionals and patients.
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Affiliation(s)
- Kodye L Abbott
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Patrick C Flannery
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
| | - Kristina S Gill
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
| | - Muralikrishnan Dhanasekaran
- Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA.,Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA
| | - Sridhar Mani
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Satyanarayana R Pondugula
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.,Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA
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Peyrière H, Eiden C, Mallaret M, Victorri-Vigneau C. Medical complications of psychoactive substances with abuse risks: Detection and assessment by the network of French addictovigilance centres. Therapie 2016; 71:563-573. [PMID: 27499243 DOI: 10.1016/j.therap.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/06/2016] [Indexed: 12/16/2022]
Abstract
The use of psychoactive substances, whether occasional or regular, can induce a large number of clinical and/or biological complications. These complications may be related to the effects of the active substance itself and/or adulterants, but also to the modalities for use (administrations route, contexts of use). The detection and evaluation of these potentially severe complications are a public health issue. Beyond the assessment of the potential for abuse of and dependence on psychoactive substances, the collection and evaluation of complications related to the use of the substances are one of the roles of addictovigilance centres. In this article, the expertise of the French addictovigilance centres in the detection and assessment of medical complications related to psychoactive substances, adulterants or route of administration of substances is advanced through a few recent examples.
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Affiliation(s)
- Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Michel Mallaret
- Centre d'addictovigilance, centre hospitalier universitaire, 38043 Grenoble, France
| | - Caroline Victorri-Vigneau
- Département de pharmacologie clinique, centre d'addictovigilance, centre hospitalier universitaire, 44093 Nantes, France
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