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The drug crosses the placenta and has beenuseful for controlling fetal supraventricular tachycardias order dramamine 50 mg otc medicine stone music festival. It isexcretedinto breast milk but has not been reported to cause problems in nursing infants order dramamine 50mg fast delivery treatment guidelines. Propafenone should be avoidedduring pregnancybecause par- ticularly little information exists about its safety purchase 50mg dramamine fast delivery symptoms ear infection. Propafenone also isexcretedinto breast milk but has not been recognized to cause problemstonursing babies. Moricizine, like propafenone, has not been studiedinpregnant women and should be avoided. How- ever, reports suggest that beta blockers may be associatedwith low birth weights, neonatal bradycardiaand hypoglycemia. The most common antiarrhythmic application of beta blockers, in gen- eral, istocontrol the heart rate during atrial ﬁbrillation. When controlling the ventricular response in atrial ﬁbrillationduring pregnancy, attempts should be made ﬁrst with digoxin and ve- rapamil, turning to beta blockers only if these are ineffective. Most beta blockers are excretedinto breast milk, but it is gener- ally considered safe to nurse full-terminfants while taking beta blockers. However, its impressive end-organ toxicity and its prolonged half-life mandate that itbe used only as a last resort during pregnancy. In addition to the array of “typical” amiodarone-related toxicities, risks speciﬁcally associ- atedwith pregnancy include premature labor, low birth weight, and neonatal hypothyroidism and hyperthyroidism. Amiodaroneap- pears in breast milk, and mothers taking this drug shouldnot breast- feed. Sotalol has not beenused widely or studied adequately during pregnancyand should be avoided. Itisexcretedinto breast milk, and its use during breast-feeding is not known to be safe. The drug does inhibit uterine contractions, which in fact has led to its use in inhibiting premature labor. Verapamil isexcretedinto breast milk but has noknown adverse effects onnursing babies. Itisexcretedinto breast milk and, ideally, should be avoidedinmothers who are breast-feeding. Therefore, this procedure should virtually never be performedduring pregnancy—again, with the exception of alife-threatening arrhythmia for which no other viable treatment option exists. Index acid-base disturbances, 13, 26, 28t reentrant arrhythmia, worsening acidosis, 47, 66 of, 118, 120–121 acute cardiac ischemia, 13 worsening of hemodynamics, 122 acute myocardial ischemia, 26, 75 afterpolarizations. See elimination/half-life from amiodarone, 94, 166 headaches and atrial ﬁbrillation/atrial from adenosine, 109 ﬂutter, 141t from dofetilide, 100 hypoglycemia from moricizine, 79 and beta blockers, 85, 166 from quinidine, 59 from disopyramide, 63 heart, electrical system and mexiletine, in newborn, anatomy, 4 (ﬁg. The particular response to a drug by a patient is driven in one way or another by the concentration of that drug, and sometimes its metabolites, at the effect sites within the body. Accordingly, it is useful to partition the relationship between drug administration and response into two phases, a pharmacokinetic phase, which relates drug administration to concentrations within the body produced over time, and a pharmacodynamic phase, which relates response (desired and undesired) produced to concentration. In so doing, we can better understand why patients vary in their response to drugs, which includes genetics, age, disease, and the presence of other drugs. In other cases, the patient is suffering from several conditions, each of which is being treated with one or more drugs. Given this situation and the many potential sites for inter- action that exist within the body, it is not surprising that an interaction may occur between them, whereby either the pharmacokinetics or the pharmacodynamics of one drug is altered by another. More often than not, however, the interaction is of no clinical significance, because the response of most systems within the body is 1 2 Rowland graded, with the intensity of response varying continuously with the concen- tration of the compound producing it. Only when the magnitude of change in response is large enough will an interaction become of clinical significance, which in turn varies with the drug. For a drug with a narrow therapeutic window, only a small change in response may precipitate a clinically significant inter- action, whereas for a drug with a wide margin of safety, large changes in, say, its pharmacokinetics will have no clinical consequence. Also, it is well to keep in mind that some interactions are intentional, being designed for benefit, as often arises in combination therapy. Clearly, those of concern are the unintentional ones, which lead to either ineffective therapy through antagonism or lower concentrations of the affected drug or, more worryingly, excessive toxicity, which sometimes is so severe as to limit the use of the offending drug or, if it produces fatality, result in its removal from the market. This chapter lays down the conceptual framework for understanding the quantitative and temporal aspects of drug-drug interactions, hereafter called drug interactions for simplicity. Emphasis is placed primarily on the pharmacokinetic aspects, partly because pharmacokinetic interactions are the most common cause of undesirable and, to date, unpredictable interactions and also because most of this book is devoted almost exclusively to this aspect and indeed to one of its major components, drug metabolism. Some pharmacodynamic aspects are also covered, however, for there are many similarities between pharmacokinetic and pharmacodynamic interactions at the molecular level and because ultimately one has to place a pharmacokinetic interaction into a pharmacodynamic perspective to appreciate the likely therapeutic impact (1–5). Absorption, which applies to all sites of administration other than direct injection into the bloodstream, comprises all processes between drug administration and appearance in circu- lating blood. Disposition comprises both the distribution of a drug into tissues within the body and its elimination, itself divided into metabolism and excretion of unchanged drug. Disposition is characterized independently following intra- venous administration, when absorption is not involved. Increasingly, aspects of potential drug interactions are being studied in vitro not only with the aim of providing a mechanistic understanding but also with the hope that the findings can be used to predict quantitatively events in vivo, and thereby avoid or limit undesired clinical interactions. To achieve this aim, we need a holistic approach whereby individual processes are nested within a whole body frame—that is, constructs (models) that allow us to explore the impact, for example, of inhibition or induction of a particular metabolic pathway on, say, the concentration–time profile of a drug in the circulating plasma or blood, which delivers the drug to all parts of the Introducing Pharmacokinetic and Pharmacodynamic Concepts 3 Figure 1 Schematic representation of processes comprising the pharmacokinetics of a compound. Absorption comprises all events between drug administration and appearance at the site of measurement. Distribution is the reversible transfer of the drug from and to other parts of the body. Elimination is the irreversible loss of the drug either as unchanged compound (excretion) or by metabolism. Disposition is the movement of the drug out of blood by distribution and elimination. This approach also allows us to better interpret the underlying events occurringinvivofollowingadruginteraction. To appreciate this last statement, consider the events shown in Figures 2 and 3 and the corresponding summary data given in Table 1. As can be seen, these clinical studies show clear evidence of an interaction, with both actually involving the same mechanism, enzyme induction, but the effect is clearly expressed in different ways. To understand why this is so, we need to deal first with the intravenous data and then with the oral data—that is, to separate disposition from absorption. For many purposes, because distribution is often much faster than elimi- nation, as a first approximation the body can be viewed as a single compartment, of volume V, into which drugs enter and leave. This is an apparent volume whose value varies widely among drugs, owing to different distribution patterns within the body. The larger the volume, the lower the plasma concentration for a given amount in the body. The other important parameter controlling the plasma concentration (C)–time profile after an intravenous bolus dose (the disposition 4 Rowland Figure 2 The half-life of the oral anticoagulant warfarin is shortened and its clearance increased when given as a single dose (1. The peak and duration in elevation of the prothrombin time, a measure of the anticoagulant response, are both decreased when rifampin is coadminis- tered. Figure 3 Enzyme induction of alprenolol metabolism following pentobarbital treatment produces minimal changes in events in plasma following intravenous administration of alprenolol 5 mg to subjects (.
It prevents convulsions by relieving the irritation purchase dramamine 50mg on-line medicine 0636, but has not sufficient antispasmodic effect to control the convulsions generic 50mg dramamine treatment regimen. The many conditions with the adult woman it is beneficial 50mg dramamine with amex medicine 81, especially to those in the latter months of pregnancy where there are present false pains, nervous twitching, reflex cough, explosion of irascibility; where there is fretfulless, peevishness, impatience and discontent; where there is morbid sensitiveness to pain; where there are sudden fits of temper during menstruation with muscular twitchings. Therapy—This agent in hot infusion is emetic, a stimulating diaphoretic, and it promotes the menstrual flow when suppressed from cold. In suppression of the secretions from Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 35 acute cold it is a useful remedy. If drank during an alcohol sweat or Turkish bath, its influence is greatly increased. In acute rheumatism it will prove of service, It is a mild stomachic and general tonic in half-ounce doses of the cold infusion, and it seems to mildly stimulate digestion. In acute colic in infants, with nervous excitability and tendency to spasm, a few drops may be dropped into a half glass of water and a teaspoonful given every ten minutes with immediate relief. In flatulent colic and in colic accompanying diarrhea, the discharges of a greenish, feculent character with reflex nervous irritation or increased nervous susceptibility, it is a specific remedy. In constant worry and fretfulness of very young infants, without apparent cause, it is a soothing remedy of much value. It is excellent during the teething period to allay nervous irritation and soothe pain. It soothes general irritation and quiets imaginary pains, especially if occurring at the menstrual epoch. In amenorrhea with intermittent pains, and sensations of appearing menstrual flow, it is useful. It may be given for the erratic pains and reflex nerve irritations of the last months of pregnancy, the reflex cough and unbearable muscular cramps and twitchings. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 36 Administration—It may be necessary to vary the form of the remedy in its administration in certain cases before a marked result occurs. It may act promptly in doses of from one- half to one drop frequently repeated, and it may be necessary to give five drops or more at a dose, but close watch must be kept on its action upon the bowels that it be not too severe and prostrating. The agent has a general tonic influence which so sustains the body forces that considerable violence of cathartic action can be obtained in some cases, without marked depression, but usually this violent action should be avoided. Fluid extracts are usually unreliable and uncertain in their action, some acting promptly, others producing marked irritation and depression, and still others being inert. If the fresh root of the apocynum can be obtained, an infusion of one ounce to the pint of water may be made, and from a teaspoonful to a tablespoonful of this infusion given often and increased or diminished as indicated. A tincture carefully prepared from the fresh root sometimes is the superior preparation. While specific medicine apocynum and the normal tincture of apocynum are both excellent forms of this remedy for administration, there are some cases in which these produce considerable irritation of the stomach and intestinal canal. A distilled extract of apocynum is now supplied, which is nearly tasteless; can be administered in larger closes, and in many cases produces more satisfactory results than any other form, as it has less irritating properties. Physiological Action—Whether this agent acts most directly upon the heart or upon the kidneys has been an unsettled question except to those who have used it in cases where the heart was greatly enfeebled and relaxed, and when dropsy resulted from that condition. It is certainly an excellent heart tonic in such cases, improving the strength of the heart muscle, the character and force of the pulse, and increasing to a most marked extent the arterial tonus. It strengthens the nerve force, improves the respiration, and facilitates oxidation of the blood. Its influence is similar to convallaria or digitalis, and it acts in harmony with cactus, the influence of both being increased. Given in large doses, it stops the Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 37 heart in complete systole, and in small doses slows the beats and strengthens their force. It contains an active principle which acts as does digitalis, with, however, these differences, that it is not cumulative, and when administered in a medicinal dose it does not give rise to any inconvenience excepting some headache. Froment has reported ten instances of diverse cardiac disease in which the pulse was slowed, the rhythm was made regular, the arterial tension was raised, and edema disappeared; in certain cases it acted when strophanthus and tincture of convallaria had failed. It seems to be useful in certain febrile conditions where the frequency of the pulse gives rise to anxiety, notably so in pulmonary tuberculosis, although a large dose may increase the diarrhea if present. Wood conducted independent experiments to determine the physiological action of this remedy, under the auspices of the National Academy of Science. His observations have confirmed my early and later statements concerning the direct influence of apocynum upon the heart. He states that, notwithstanding all early observations were made with reference to the action of this drug upon the kidneys, his experiments prove that its influence is directly upon the circulation. Injected into the veins of a dog, there was a marked slowing of the pulse with a rise in the blood pressure, usually, but in some cases the slowing of the pulse was so great and so immediate as to prevent any rise of blood pressure. These effects, he asserts, are in every way similar to the action of digitalis, and he is impressed that there is a marked similarity between the action of this drug and digitalis. His experiments made to determine whether the stimulation was directly upon the heart, or upon the circulation, through the vaso-motor mechanism, convinced him that the drug stimulated the cardiac muscle directly, bringing about a cessation of cardiac action, if persisted in, to over-stimulation, the contractions of the heart ceasing in permanent systolic spasms. His studies further show that despite the enormous stimulation of the heart, the circulation through the kidneys is diminished rather than increased. This he attributes to a narrowing of the lumen of the blood vessels of the kidney. He believes that the increased flow of urine under apocynum is due to the regulation of the circulation at large, a condition similar to that induced by digitalis. The pulse is slowed by the action of the remedy through stimulation of the cardiac inhibitory centers of the medulla. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 38 His final conclusions are that apocynum is a powerful stimulant to the circulation, and one of which great practical use can be made. However, because of its irritating action upon the stomach, he thinks its use will be limited, but we do away with this objection entirely, first by the administration of the specific medicine in small doses and, second, by the use of the distilled extract, as stated, which is devoid of irritating properties. Felix-Kramer of Germany has made the following statements: “The active principle of apocynum, according to Liebreich and Langaard, is a glucoside called apocynin, the action of which is, like that of digitalis, a cardiac poison. Like strophanthus, nereum oleander, and vinca minor, the plant belongs to the Apocynaceae family. The reports on this remedy so far as I have been able to follow them are unanimous in designating it as a cardiac tonic and diuretic. According to Gwovdinski, of Kiev, apocynum cannabinum is known in Virginia as a household remedy and is used by some American physicians by preference as a diuretic. According to Alesejew the effect of the remedy appears, in proper cases, in two or three days. If no remedial action appeared in five days Alesejew made no further use of the remedy. Af ter larger doses he met at times gastric disturbances and pains in the cardiac region. He found that apocynum cannabinum acts more readily and energetically on the innervation of the heart than digitalis, but the effect of the latter is a more persistent one. He would, therefore, use the remedy at shorter intervals, especially in cases of arrhythmia. His dosage is somewhat higher: Eight to ten drops of the fluid extract two to three times a day.
Unfortunately generic 50mg dramamine fast delivery medicine 0636, I cannot tell you whether it would work or not generic 50 mg dramamine visa medications 3 times a day, because use of it caused me to feel nauseous buy dramamine toronto medications emts can administer. My body tends to react oddly to many supplements so this is no suggestion that it might do the same for anyone else. The seeds did not grind up very much, so the flavor did not strongly permeate the shake. Since the seeds stayed nearly whole, I had to drink them down and not expect the shake to be real smooth. It really was not unpleasant that way like I thought it would be, it did not taste bad, merely a bit odd. If it had not made me feel sick, I could have tolerated it on a daily basis and not minded. Dill seed can be added to bread along with onion granules for a very flavorful and tasty bread. I am not sure if Dill Pickles will do the trick or not, but vinegar and salt do preserve well, so there is a good chance that they would (and vinegar is another potentially helpful item). I was not able to find information on dosage amounts, so I just used a teaspoonful, but there is no telling whether that is enough, or even if smaller amounts would do. Dandelion Dandelion because usually it is an herb that is referenced for its high iron content. There were repeated references to its use in diabetes remedies, and warnings about monitoring blood sugar if it is used, especially in conjunction with glipizide and other similar medications. I also found that whenever someone mentioned lowering of blood sugar, lowering of cholesterol was frequently mentioned alongside it. Research has shown that cholesterol levels are often related to blood sugar abnormalities, so this is logical. Those two functions often decrease in diabetics, making food digestion more problematic. One of the reasons lemon juice or vinegar is recommended is to help replace low stomach acid levels, so this affect would not be a negative one unless you have a tendency to heartburn, or gallbladder disease already. Dandelion also is thought to be a diuretic, which may affect people with kidney or circulatory problems - in a positive or negative way, depending on your condition. Many herbalists suggest it may be easier on the body than prescription diuretics because it also contains high levels of potassium, which most diuretics leech out of the body. Because of its potential varied effects, please consult your doctor before you try it, and then monitor results very carefully. Use the following radiation detox formula to detox and sweep any radiation factors or alpha ray particles from the system. Increase fiber in the diet and this will sweep excess toxins and any radiation compounds from the intestine. For 30 minutes after meals allow you pancreas to focus on digestion and this will help the pancreas work well. According to the American Diabetes Association, nearly 21 million people in the United States have diabetes, with about 90 to 95% having type 2 diabetes. As a result, glucose builds up in the blood instead of entering cells, which causes cells to be deprived of energy. If high glucose levels in the blood persist, it may damage the eyes, heart,kidneys, or nerves. Natural Remedies for Type 2 Diabetes There are some natural treatments that are being explored for type 2 diabetes. If you are interested in trying a natural treatment in addition to standard treatment, be sure do so only under the close supervision of a qualified health professional. Also inform your physician about any herbs, supplements, or natural treatments you are using, because some may interact with the medications you are taking and result in hypoglycemia unless properly coordinated. Consider keeping track of your herbs, vitamins, and supplements with the Supplement Diary and giving your doctor a copy. Those studies have shown that North American ginseng may improve blood sugar control and glycosylated hemogobin (a form of hemoglobin in the blood used to monitor blood glucose levels over time) levels. There are many promising studies suggesting chromium supplementation may be effective, but they are far from conclusive. For example, a small study published in the journalDiabetes Care compared the diabetes medication sulfonylurea taken with 1,000 mcg of chromium to sulfonylurea taken with a placebo. After 6 months, people who did not take chromium had a significant increase in body weight, body fat, and abdominal fat, whereas people taking the chromium had significant improvements in insulin sensitivity. Another study published in the same journal, however, examined the effect of chromium on glycemic control in insulin-dependent people with type 2 diabetes. People were given either 500 or 1,000 mcg a day of chromium or a placebo for six months. There was no significant difference in glycosylated hemoglobin, body mass index, blood pressure, or insulin requirements across the three groups. It helps regulate blood sugar levels and is needed for normal muscle and nerve function, heart rhythm, immune function, blood pressure, and for bone health. Some studies suggest that low magnesium levels may worsen blood glucose control in type 2 diabetes. There is also some evidence that magnesium supplementation may help with insulin resistance. For example, a study examined the effect of magnesium or placebo in 63 people with type 2 diabetes and low magnesium levels who were taking the medication glibenclamide. After 16 weeks, people who took magnesium had improved insulin sensitivty and lower fasting glucose levels. High doses of magnesium may cause diarrhea, nausea, loss of appetite, muscle weakness, difficulty breathing, low blood pressure, irregular heart rate, and confusion. It can interact with certain medications, such as those for osteoporosis, high blood pressure (calcium channel blockers), as well as some antibiotics, muscle relaxants, and diuretics. Three groups took 1, 3 or 6 g of cinnamon a day and the remaining three groups consumed 1, 3 or 6 g of placebo capsules. In another study, 79 people with type 2 diabetes (not on insulin therapy but treated with other diabetes medication or diet) took either a cinnamon extract (equivalent to 3 g of cinnamon powder) or a placebo capsule three times a day. After four months, there was a slight but statistically significant reduction in fasting blood glucose levels in people who took the cinnamon (10. For more about cinnamon, read Cinnamon and Blood Sugar and Is Cinnamon a Proven Diabetes Remedy? There is some research showing that people with type 2 diabetes have suboptimal zinc status due to decreased absorption and increased excretion of zinc. Food sources of zinc include fresh oysters, ginger root, lamb, pecans, split peas, egg yolk, rye, beef liver, lima beans, almonds, walnuts, sardines, chicken, and buckwheat. Researchers isolated a number of active phytosterol compounds from the gel that were found to reduce blood glucose and glycosylated hemoglobin levels. For more information about aloe vera, read the Aloe Vera Fact Sheet Low- Calorie Diet Can Save from Type 2 Diabetes, Says Study Type 2 diabetes can be overturned with the intake of low-fat diet, confirm the researchers. Professor Roy Taylor of Newcastle University stated that an eight week of low calorie diet plan can save a person from taking high medication for diabetes. Taylor who headed the study said that type 2 diabetes has always been considered as a lifelong syndrome.
Preterm labor was attributed to the oxytocin-like effects of diphenhydramine (not listed in the Physicians’ Desk Reference) (Brost et al order dramamine 50mg with visa medications used for fibromyalgia. It is known that considerable amounts of these drugs cross the placenta to reach the fetus purchase dramamine without prescription symptoms before period. One case report is published regarding overdose of trifluoperazine (including misoprostol) during pregnancy (Bond and Van Zee purchase dramamine 50mg line symptoms 89 nissan pickup pcv valve bad, 1994). Fetal death was the final outcome, but the authors noted misoprostol as the probable cause of fetal death. Antipsychotic overdose therapy includes nonspecific supportive therapy because there is no specific antidote. These drugs cross the placenta and achieve a near-therapeutic fetal concentration. Large doses of these drugs cause hypersedation in the nonpregnant adult and would be expected to have the same effect on the gravid woman and fetus. Thioridazine and trifluoperazine half-lives in the post-absorptive period are 26–36 h and 7–18 h, respectively (Baselt, 1978). The course of pregnancy following anorectic agent over- doses has not been published. Oral doses of 50–75 mg produce anxiety, agitation, dizziness, and hallucinations (Dietz, 1981). Higher doses (85–400 mg) are associated with severe headaches, hypertensive crisis, and occasionally vomiting (Frewin et al. The course of pregnancy following hormonal agent overdoses has not been published. Nonspecific supportive therapy should be given because no specific antidote to hormonal agents is available. Near-therapeutic amounts of these drugs cross the placenta and can be detected in the fetus. The effects of a poten- Anticonvulsant overdoses 271 tially toxic dose of hormonal agents are unknown, but fetal adrenal suppression should be anticipated based upon known pharmacology and physiology. One overdose of misoprostol and trifluoperazine has been reported (Bond and Van Zaa, 1994). Signs of toxicity included hypertonic uterine contraction with fetal death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acido- sis. The clinical impression was that misoprostol was being used as an illegal abortifa- cient. The clinical details of the course of pregnancy following antidepressant agent overdoses have not been reported and therapy is mostly supportive. The toxic systemic effects (tachycardia, dry mouth, dilated pupils, and urinary retention) as well as the central nervous system effects (agitation, hallucina- tions, and hyperpyrexia) are anticholinergic in nature (Burks et al. For this rea- son, physostigmine (an anticholinesterase) has been used in the diagnosis and antidotal therapy of poisoning with amitriptyline and other tricyclic antidepressants (Burks et al. Large doses of antidepressants are associated with coma in nonpregnant adults and cardiac toxicity has been reported with acute ingestion of high doses of these drugs. Although these drugs cross the placenta to reach the fetus, the effects of a potentially toxic dose are unknown. Half-lives in the post-absorptive period for dox- epin and amitriptyline are 8–25 h and 8–51 h, respectively (Baselt, 1978). Pregnancy outcome following anticonvulsant agent overdoses has been published in one isolated case report. A case of carbamazepine megadose in attempted suicide with more than 10 g of carbamazepine during early preg- nancy resulted in a fetus with a large meningomyelocele and frontal lobe necrosis that was electively aborted. The mother recovered without complication following nonspe- cific therapy and coma for 5 days (Little et al. Damage to the embryo or fetus is probable because the two anticonvulsants listed (phenytoin, carbamazepine) are known human teratogens. Anticonvulsant agents have no specific antidote, and supportive therapy should be given. Near-therapeutic amounts of these drugs cross the placenta and achieve significant concentrations in the fetus. It is known that phenytoin may induce fetal hepatic enzymes, but the effects of a potentially toxic dose are unknown. Phenytoin’s half-life ranges from 8–60 h and is dose dependent because each individual has a threshold plasma concentration beyond which the drug exhibits zero-order kinetics (Arnold and 272 Drug overdoses during pregnancy Gerber, 1970; Kostenbauder et al. Details of the clinical course of pregnancy after overdoses of any of these agents have not been pub- lished. It is known that signif- icant amounts of these drugs cross the placenta to reach near-therapeutic levels in the fetus. Camphorated oil Camphor, a gastrointestinal irritant and central nervous system stimulant, was used in four suicide attempts during pregnancy that have been published (Blackmon and Curry, 1957; Jacobziner and Raybin, 1962; Riggs et al. Uniformly, maternal seizures occurred and should apparently be expected with camphor ingestion. The fourth pregnancy was compromised by preeclampsia, abruptio placenta, and other serious complications, and the infant died less than 1 h after delivery. Clinical experience with camphor overdose is very limited and no specific antidote is available. Therefore, the nonspecific antidote regimen should be given and supportive therapy provided. Even limited experience with gravid women who have ingested cam- phor is sufficient to begin antiseizure medication as a component of the antidote regi- men in anticipation that seizures may ensue. Turpentine and ammonia No details of the course of pregnancy following poisoning with these nondrug chemi- cals have been reported. No specific antidote to these poisons is available and nonspe- cific antidote regimens and supportive therapy should be given. Quinine overdose An attempt to induce abortion should be suspected when quinine overdose is encoun- tered in pregnant women. Among 70 published cases of pregnant women taking quinine at Summary 273 high doses in an attempt to induce abortion suggest the drug may be teratogenic (Dannenberg et al. At least 11 women died as a result of quinine overdose and many who did not expire experienced toxic effects of the drug. No fewer than 41 infants with major congenital anomalies were born to women who took large doses of quinine during pregnancy. Causality cannot be proven using these data because the information comprised of only case reports. Nonetheless, large doses of quinine appear to pose an increased risk of some specific abnormalities that parallel toxicity from the drug often seen in adults. Eighteen of 60 infants (30 percent) born to women who ingested large amounts of quinine during pregnancy were congenitally deaf (Dannenberg et al. Ototoxicity is a common and well-documented complication of quinine therapy in adults. Large doses of quinine during the first trimester of pregnancy are anecdotally associ- ated with major congenital anomalies, including central nervous system anomalies (especially hydrocephalus or otolithic damage), limb defects, cardiac defects, and gas- trointestinal tract anomalies (Nishimura and Tanimura, 1976). No characteristic pattern of anomalies or syndrome was identified, and the association of these anomalies with maternal quinine ingestion remains empirically uncertain, but seems plausible.