Question Of The Day

Menthofuran is one metabolite of this substance? Pennyroyal oil. The active chemical in pennyroyal oil is pulegone which undergoes bioactivation to menthofurane as well as other reactive intermediates. Pulegone and menthofuran deplete cellular glutathione levels and cause centrilobular necrosis. Woolf A. Essential Oil Poisoning. Clin…

How do the pharmacokinetics differ for sublingual atropine compared to intravenous atropine? Schwartz MD et al. performed a randomized phase 1 crossover trial in healthy volunteers to assess the bioavailability and pharmacokinetics of a single dose of atropine given sublingually. Compared to IV atropine, the…

What is the significance of 2-benzylbenzimidazole (“nitazenes”) compared to other synthetic opioids? 2-Benzylbenzimidazole opioids, also termed “nitazenes” are structurally dissimilar to other opioids. These agents are more potent than fentanyl likely yielding signfiicant negative outcomes in patients. 1.Vandeputte MM, Uytfanghe KV, Layle NK, et al….

What role does temperature play in antimuscarinic toxicity? In a recent case control analysis by Comstock G et al., peak temperature did not differ in patients with and without severe outcomes in the setting of antimuscarinic toxicity. Comstock G et al. Signficance of temperature in…

What is a potential intervention that can be done intra-operatively to halt the progression of injury in the setting of pediatric button battery ingestion retained in the esophagus? Immediate esophageal irrigation in the operating room with sterile 0.25% acetic acid after button battery removal. This…

How do phenothiazine antipsychotic medications prolong the QRS? Phenothiazines are a class of antipsychotics with chemical structures that include three rings that closely resemble the structure of tricyclic antidepressants (TCA).  Phenothiazines bind to the inactivated sodium channels and are associated with a use dependent sodium…

How does clozapine toxicity differ mechanistically and clinically from that of other atypical antipsychotics? Clozapine is an atypical antipsychotic. Mechanistically, clozapine works by antagonizing the dopamine (D1, D2, and D4,), alpha (α1 and α2), serotonin (5-HT1A, 5HT2A, and 5HT1C), muscarinic (M1, M2-5), and GABA (GABAA)…

What is one proposed mechanism for fomepizole adjunct therapy in acetaminophen toxicity? Fomepizole is primarily recognized for its inhibition of alcohol dehydrogenase; however, its inhibition of CYP2E1 makes it a promising adjunct agent in the treatment of acetaminophen toxicity cases with high likelihood of developing…

What valproic acid metabolites are responsible for its hepatotoxic and neurotoxic effects? Valproic acid (VPA) is metabolized in the liver via 3 different pathways – glucuronidation, beta oxidation in the mitochondria, and cytosolic omega (ω and ω1) oxidation. Many metabolites are generated; however, 2-propyl-4-pentenoic acid…

Which four snakes’ venom is used in Neuro Polyvalent Antivenom (NPAV)? Naja kaouthia (Thai monocled cobra), Ophiophagus hannah (king cobra), Bungarus candidus (Malayan krait) and Bungarus fasciatus (banded krait) Weigel B et al. Successful management of monocled cobta (Naja kaouthia) envenomation with neuro polyvalent antivenom….