Podcasts about Diphenhydramine

 Do you want to be proactive about your health, or do you just shrug your shoulders and figure you play the cards you're dealt? And the big question is, what difference does it make? Today we're going to look at 10 things that contribute to the development of dementia and what, if anything, you can do about it.  I'm Dr.Vickie Petz Kasper. I practiced obstetrics and gynecology for 20 years until I landed on the other side of the sheets   as a very sick patient. When my own body betrayed me, I took a handful of pills to manage my disease and another handful to counteract the side effects. My health was out of control. Through surgery, medications, and lots of prayers, I  regained my strength only to face another  diagnosis.  My doctor challenged me to make radical changes through lifestyle medicine. Now I feel great and I want to help you make changes that make a difference. Healthy Looks Great On You podcast takes you to mini medical school so you can learn the power of lifestyle medicine. If you're ready to take control of your health, you're in the right  place. Whether you're focused on prevention or you're trying to manage a condition. I'll give you practical steps to start your own journey toward better health because healthy looks great on you.   This is episode 155, Ten Must Know Risk Factors for Dementia.  Which ones can you alter, and which ones you just gotta accept. Here's the deal, dementia isn't just one condition with one cause, it's more like a puzzle with pieces that fit together differently for each person. And some of these pieces are fixed, but others, well, they're more like clay that you can reshape. And that's exactly what we're going to dive into today.   What if I told you that some of the choices you're making right now, today, could be tilting the scales either for or against your brain health. It's never too early or too late to make changes that affect your overall health, and that includes your brain health. So, whether you're in your 30s or in your 60s, stick around.  We're about to break down these 10 risk factors for dementia and what you can do about it. Number one on the list is age. Yeah, I know, there's not a thing in the world you can do about it. This is one you have to accept. And if you're a woman, aged 45, your chances of developing dementia during your lifetime are 1 in 5. If you're a man, it's one in 10. And even though I didn't include biologic sex in this list, clearly women are at increased risk, but there may be reasons for that that you can alter. Bottom line is age is the biggest risk factor for dementia and the older you get, the greater the risk. In fact, the chances double every five years after age 65.  To quote Andy Rooney, it's paradoxical that the idea of living a long life appeals to everyone. But the idea of getting old doesn't appeal to anyone. And that's generally true and with good reason. I mean, it's not called over the hill for nothing.  They say you should grow old gracefully. Ha! There's nothing graceful about some of the tolls the years take. And according to George Burns, you know you're getting old when you stoop over to tie your shoelaces and wonder what else could you do while you're down there.  George Burns, remember him? He lived to be 100 years old and was pretty healthy. We're gonna come back to that, so be sure you listen until the end. But age is just one risk factor you have to accept.  But while you're practicing acceptance, here's another one you can't control. Family history.   If someone in your family had dementia, then you are at increased risk. And if more than one somebody in your family had dementia, you're at even more risk. And you know what they say, you can't change the past, but you can change the future. You can start where you are and change the ending. And I want you to remember that quote as we talk through this, because even if you have a strong family history of dementia, your fate is not sealed, but it is at risk. So, think about your family history. You tend to inherit your lifestyle from your family. Okay, not always, but a lot of our habits are ingrained at an early age. We sort of eat the same things and live in similar environments.  Education levels and socioeconomic advantages or disadvantages are often generational, and those things are passed down, but they're not inherited like our genetic code. So I want to challenge you to start where you are and see if there's anything you can do to change the ending.     Number three is similar to family, but not exactly the same. Genetics. Pop quiz, true or false, you can alter your genes.  I want you to stay tuned next week because we are going to talk more about the genetics of Alzheimer's.  The best way to not miss an episode is to subscribe to my newsletter. You can visit my website,  www. healthylooksgreatonyou. com or I put a link in the show notes. I share tips, recipes, and lots of other resources. So why don't you just push pause right now on the podcast and do it before you get busy or forget. Each week on the podcast, I take you to mini medical school And this week, we're going to take a closer look at our  DNA. Don't worry. It's a short course and it's never boring. Do not argue with me. Science is fun if you do it right.  DNA stands for deoxyribonucleic acid. See if you can say that three times really fast. Deoxyribonucleic acid, deoxyribonucleic acid, deoxyribonucleic acid. Now you'll remember it, even if I did annoy you a little bit. I won't say it again. I'll just use the nickname, DNA. So what is it? It's like a double stranded helix, and I'm sure you've seen pictures before. Looks like a twisted ladder. It's a molecule made up of four nucleotides, C G A T. That's cytosine, guanine, adenosine, and thymine, and these little dudes are held together by hydrogen bonds in different combinations. And here's the exciting part. Every cell in your body follows the code that is written into your DNA. It's like an instruction manual. And each person's DNA is unique. That is why human life is so sacred. Because this coding determines your eye color. your hair color, facial features, and ultimate height, as well as whether or not you're born a boy or a girl.  And here's the deal, it's all determined at the moment of conception. When the egg is fertilized, wow, we are indeed fearfully and wonderfully made. Now, inside of each cell, there's this little part called the nucleus, and that's where most of the chromosome forming DNA lives.  And all of this is foundational to understand genetics but not only does your genetic code determine aspects of your health. But your environment, behavior, and lifestyle can impact genetic expression. Meaning genes can be turned off, turned on, regulated up, regulated down, and we call that epigenetics. It can even happen in the womb before you're born. So you really are what you eat, how you act, and what you do. DNA can also be damaged, so gene expression is affected by age, exposures, environment, and other factors that we're going to look at.  But since I mentioned environmental and exposure, let's move on to number four on the list of risk factors for dementia, and that is air pollution. I bet that surprised you. Turns out that pollution causes damage to the nervous system. Things like exhaust from cars in the city or wood burning in the country. And you want to know what else pollutes the air? cigarette smoke. Smoking is a risk factor for dementia as well as a host of other conditions. Your mind may go straight to cancer, but it also increases the risk of heart disease, stroke, diabetes, and even macular degeneration, which can lead to blindness.  And it turns out that number five on the list is uncorrected hearing loss.  and uncorrected vision loss. Remember when I snorted about growing old gracefully? Well, yeah, I'm over here putting in my hearing aids and groping around for my glasses and I don't think any of that is graceful,  but I do it anyway. Now I can't see without my glasses, so they're not optional, But,  uncorrected vision loss does increase the risk of dementia, and the worse the uncorrected vision loss, the worse the risk.   But again, this only applies to people with uncorrected vision loss, and I think most of us wouldn't skip wearing our glasses or contacts, But, I do see a lot of people skip on wearing hearing aids. Now, my husband would argue with this, but I can hear pretty well.  He just talks really soft.  And isn't that what everyone with hearing loss says?  Quit mumbling!  The deal is most people can get by with some hearing impairment. But it does increase the risk of dementia.  Why is that? Well, maybe because you're not processing spoken words and that part of your brain isn't getting used and it shrinks along with everything around it. Or maybe your brain is actually devoting all of its energy to try and understand those mumblers. And it neglects keeping the rest of the brain humming along at full speed.  Experts don't really know exactly why hearing loss is associated with dementia, but it's felt to be responsible for 8 percent of cases. So get over it. Go to the audiologist fork over the cash and get your hearing aids. Your brain's worth it.  Another theory about the impact of hearing loss is interference with social activity. I mean, if you can't hear, you can't participate in conversations or play games or just connect as well. And that leads us to number six, social isolation. We're created to be connected. Isolation is associated with an increased risk of dementia as well as a whole lot of other health conditions. When I say we need each other, I mean we need each other, but I want to make a point. I've talked about the impact of loneliness on this podcast before, and I'll link those episodes in the show notes. It contributes to high blood pressure, heart disease, obesity, anxiety, depression, increased inflammation in the body, and alterations in the immune system. But listen, loneliness and social isolation are not the same.  You can live alone. and not be lonely. And you can be surrounded by people and feel loneliness. It is connection that matters. So phone a friend, text a friend, or even send an email. Even simple things like that matter and they'll appreciate it. According to the National Institute on Aging, one in four people over 65 experience social isolation. Now, I picture someone sitting home alone watching TV. Social isolation decreases the opportunity for engaging activities like playing cards. And it decreases the likelihood of staying fit. Think about how many pieces of home exercise equipment serve as just a place to hang your clothes. Going to the gym is a way to get the body fit and connect socially. People who are socially connected typically smoke and drink less. And of course, that depends on who you hang out with, but clearly, people who are trying to quit benefit from community. We all do. And speaking of quitting, many people observe dry January, and it's a great idea because number seven is alcohol. Drinking alcohol does not increase your risk of Alzheimer's,  but it may worsen it.  But hold your beer. You might remember that Alzheimer's is a type of dementia, but not all dementia is Alzheimer's.  There are several other types of dementia and one uniquely occurs in people who consume heavier amounts of alcohol. It's even called alcohol related brain damage.  Here's what happens. Alcohol causes a loss of white matter. This is where the action happens. Neurons send signals to different parts of the brain and with heavy alcohol use the brain actually shrinks, and with less volume, there's less function.  Alcohol can cause atrophy of the cells, and inhibit the growth of new neurons via a process that we call neurogenesis. Alcohol ages the brain faster and contributes to other diseases that are associated with Alzheimer's dementia and other forms of dementia as well. These conditions are things like high blood pressure and heart disease.   But wait! I thought drinking red wine prevents dementia. And this is a hot topic of research and debate. I mean, when you look at the Mediterranean diet and all those blue zones, most of them are in areas where grapes are grown. And when the fruit of the vine is ripe, well, you know. So the debate continues. And whenever there's controversy, it helps a bit to understand statistics. There's something called a J curve, and the theory was that teetotalers had a slightly increased risk of things like heart disease and brain disease, which, by the way, go together. Then, it decreased with a glass or two of red wine a day, and then the swoop up in the letter J indicated an increased risk with heavy drinking. However, whether or not there's any benefit to consuming red wine is now being challenged. And many experts assert that there is no safe level of drinking.  And if you've ever met my mother, you know she agrees wholeheartedly.  But here's the deal. There is no question that excessive drinking increases the risk of,  you name it. And it's especially harmful in midlife. Besides that, it increases your risk of everything I'm going to mention for number eight on the list, which is head injury.  And it's more common than you might realize. Over 23 million adults over the age of 40 have had at least their bell rung. That's slang for a concussion. It can be from falling, car wrecks, or sports injuries. And the more times your brain gets conked, the greater the risk. That's what we call dose dependent. Preventable? Often. Wear a helmet if you're riding a bicycle, snowmobile, motorcycle, or snowboarding or skiing.  And always, always, always wear your seatbelt. But here's where the rubber meets the road.   And that's number nine, certain chronic medical conditions. And here's the deal. Anything that affects your blood vessels affects your heart and brain. So, things like high blood pressure and diabetes, which damage blood vessels, they aren't good for the old ticker and they aren't good for the noggin either.  Okay, I don't know about you, but I'm ready for some good news.  You too, huh?  Well, how about this? Everything that keeps your blood vessels healthy is affected by lifestyle. If you didn't know that was coming, I'd like to welcome you to your first episode of the Healthy Looks Great On You podcast. But seriously, not smoking, limiting alcohol use, maintaining physical fitness, social connectedness, managing stress and things like depression, as well as eating whole foods.  That's your best weapon to prevent dementia, protect your heart and maximize your overall health.  Now if you already have one of these conditions, hear me.  Sometimes, it's not necessarily too late. Remember You can't go back and change the beginning, but you can start where you are and change the ending. now, let me give you this caveat. Sometimes, it is too late, and conditions are not reversible, and that's often the case. So, prevention is super important.  And also, it's felt that 40 percent of dementia cases can be prevented. That leaves 60 percent that cannot.  Diabetes, high blood pressure, and obesity can be prevented, treated, and sometimes even reversed with lifestyle changes.  I won't go into each one now, but there are lots of episodes that address these six pillars of lifestyle medicine, as well as specific recommendations for each of these conditions. Just head over to my website, www. healthylooksgreatonyou.  com, and browse for them. Included is an episode on preventing cognitive decline, and I'll link this one in the show notes.  But, before we say goodbye Let's say goodnight, because number 10 on the list is sleep.  The first question is, does poor sleep increase the risk of dementia or does dementia interfere with good quality sleep? And the answer is yes, both are true.  On top of that, people have more difficulty sleeping as they age. And here's another conundrum. Do prescription medications for sleep increase the risk of dementia? I mean, if poor sleep is a risk factor, shouldn't we just head to the pharmacy and pick up a bottle of sleeping pills? Well, a recent study showed that certain sleeping medications increase the risk of dementia in white people to the tune of 79%.  Now, that's in people who either often or almost regularly took sleeping medications compared to people who rarely or never took sleeping pills.  And by the way, white people use way more medications for chronic insomnia. Medications like Xanax and Valium. Trazodone, Halcion, Dalmane, Ambien, and Resoril. They're prescribed to white people 10 times more often.  But, despite these risks, 10 percent of older adults regularly take sleeping medication. And, guess what? Women are the biggest users.  Okay, fine, what if you just take over the counter medications like Benadryl, or Diphenhydramine, or Tylenol PM?  The common ingredient, diphenhydramine, has some evidence that it's associated with a higher incidence of dementia.  So what are you supposed to do if poor sleep increases your risk and medication increases your risk too? Well, I'm so glad you asked.  Sleep is complicated, but it's essential. I'll share some previous links to episodes in the show notes if you struggle with sleep. I have some good news. Coming soon, I'm doing a month long series on sleep, so make sure you stay tuned because I'm going to do a series of live webinars, too.  And if you go to my website, there are a couple of downloads that you can snag. Three simple ways to improve your sleep and what to do if you're tossing and turning because your mind won't shut off.  Okay, before we finish, what about George Burns?  Well, he lived with good health and a sharp mind until he was 100 years old. Think he didn't have risk factors? Think again. He started smoking cigars when he was 14 years old, but never cigarettes, and like Bill Clinton's joint, he didn't inhale. He had two to three drinks a day, and sometimes more, but he says he never got drunk. And he had a serious head injury after falling out of the bathtub.  He adored his wife of 38 years and looked forward to joining her in heaven. In the meantime, he exercised daily. He swam, walked, and did sit ups and push ups.  But maybe, just maybe, his biggest strength was the laughter he generated. He says he didn't tell jokes, but rather anecdotes and lies.  But he was a funny guy.  Now, I'm not saying that laughter will keep you from getting dementia or make you live longer, but it sure will put more joy in your life.  So laugh and be healthy, because healthy looks great on you.       The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change. RESOURCES: The Deadly Epidemic of Loneliness From Loneliness to Belonging How to prevent, treat and reverse type 2 diabetes 4 Reasons to control your BP Preventing Cognitive Decline Why is Sleeping so Hard? The Mood Mechanic and the work of sleep Healthy Looks Great on You website Join the email list for all the resources  

Contributor: Megan Hurley, MD Educational Pearls: Fevers Tylenol Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated Can limit the amount of amniotic fluid produced Can lead to growth restriction Can cause premature closure of the ductus arteriosus Cough Cough drops Humidifier Guafenesine and dextromethorphan (Mucinex) is not well studied but is probably ok with caution in certain circumstances such as post-tussive emesis causing poor PO intake and weight loss Congestion Flonase (Fluticasone nasal spray) Nasal rinses Humidifier 1st generation anti-histamines (Diphenhydramine, Doxylamine, etc.) However, these tend to have more side effects such as fatigue, drowsiness, and dizziness Concider switching to a 2nd generation (Cetirizine, Loratidine, etc.) during the day Disease specific treatments Flu (A and B) gets tamiflu (Oseltamivir) Covid gets paxlovid (Nirmatrelvir/ritonavir) Antibiotics for suspected pneumonia Additional recommendations Elevating the head of bed Nasal strips Stay well hydrated Tea Ice chips Echinacea Zinc Rest Avoid NSAIDs Pseudophedrine Afrin (Oxymetazoline) Combined meds in general References Antonucci, R., Zaffanello, M., Puxeddu, E., Porcella, A., Cuzzolin, L., Pilloni, M. D., & Fanos, V. (2012). Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Current drug metabolism, 13(4), 474–490. https://doi.org/10.2174/138920012800166607 Black, E., Khor, K. E., Kennedy, D., Chutatape, A., Sharma, S., Vancaillie, T., & Demirkol, A. (2019). Medication Use and Pain Management in Pregnancy: A Critical Review. Pain practice : the official journal of World Institute of Pain, 19(8), 875–899. https://doi.org/10.1111/papr.12814 D'Ambrosio, V., Vena, F., Scopelliti, A., D'Aniello, D., Savastano, G., Brunelli, R., & Giancotti, A. (2023). Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36(2), 2253956. https://doi.org/10.1080/14767058.2023.2253956 Summarized by Jeffrey Olson MS3 | Edited by Meg Joyce, MS1 & Jorge Chalit, OMS3  

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressants like amitriptyline Atropine Antipsychotics like olanzapine Antispasmodics - dicyclomine Jimsonweed Muscaria mushrooms Mechanism of action involves competitive antagonism of the muscarinic receptor Symptomatic presentation is easily remembered via the mnemonic: Dry as a bone - anhidrosis due to cholinergic antagonism at sweat glands Red as a beet - cutaneous vasodilation leads to skin flushing Hot as a hare - anhidrotic hyperthermia Blind as a bat - pupillary dilation and ineffective accommodation Mad as a hatter - anxiety, agitation, dysarthria, hallucinations, and others Clinical management ABCs Benzodiazepines for supportive care, agitation, and seizures Sodium bicarbonate for TCA toxicity due to widened QRS Activated charcoal if patient present < 1 hour after ingestion Temperature monitoring Contact poison control with questions Physostigmine controversy Acetylcholinesterase inhibitor Black box warning for asystole and seizure Contraindicated in TCA overdoses Crosses blood-brain barrier, so useful for TCA overdoses Indicated only in certain anticholinergic overdose with delirium Disposition Admission criteria include: symptoms >6 hours, CNS findings, QRS prolongation, hyperthermia, and rhabdomyolysis ICU admission criteria include: delirium, dysrhythmias, seizures, coma, or requirement for physostigmine drip References 1. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080/15563650.2017.1342828 2. Nguyen TT, Armengol C, Wilhoite G, Cumpston KL, Wills BK. Adverse events from physostigmine: An observational study. Am J Emerg Med. 2018;36(1):141-142. doi:10.1016/j.ajem.2017.07.006 3. Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2006;44(3):205-223. doi:10.1080/15563650600585920 4. Shervette RE 3rd, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979;63(4):520-523. 5. Woolf AD, Erdman AR, Nelson LS, et al. Tricyclic antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233. doi:10.1080/15563650701226192 Summarized by Jorge Chalit, OMSIII | Edited by Jorge Chalit  

Guest: Douglas Jones, MD A recent study was done to show the side effects of diphenhydramine for allergic reactions, and one of the main detriments was that it could impair the patient by making them tired or sleepy. Another finding was that it doesn't work that quickly, so in turn, giving diphenhydramine in a severe allergic reaction could cause more harm than good. To learn more on what you should know before using diphenhydramine in allergic reaction situations and possible better solutions, tune in with Dr. Douglas Jones, Board-Certified Allergist and Immunologist with the Tanner Clinic in Layton, Utah.

Bottom Barrel Scraping - Marketing Bad PublicityWebsite: http://www.battle4freedom.comNetwork: https://www.mojo50.comStreaming: https://www.rumble.com/Battle4Freedomhttps://www.facebook.com/share/v/tnm2ouEsWTtoVrnx/?mibextid=ox5AEWRep. Thomas Massie - TikTok Ban is a worse cure than the diseasehttps://www.dailymail.co.uk/news/article-13189443/Candace-Owens-french-lady-brigitte-macron-born-man.htmlCandace Owens says she'll stake her 'entire reputation' on debunked theory that French First Lady Brigitte Macron is a manThe conservative commentator took to Twitter to tout the controversial theory, hours after outlining it on an episode of her Candace Owens Podcast on MondayThe false theory goes that French First Lady Brigette Macron, 70, was actually born Jean-Michel Trogneux, before eventually transitioning at the age of 30It further states that she did not give birth to any of her three children, and that her first husband, a 69-year-old banker said to have died a recluse in 2020https://www.dailymail.co.uk/sport/nfl/article-13194339/Aaron-Rodgers-conspiracy-theories-Sandy-Hook-school-shooting.htmlAaron Rodgers 'shared deranged conspiracy theories about the 2012 Sandy Hook school shooting not being real in private conversations with journalists'... claiming the children 'never existed' and were 'all actors'Kennedy confirmed he spoke with Rodgers about possibly being his VP pickRodgers has a long history of flirting with debunked conspiracy theories https://www.dailymail.co.uk/news/article-13190363/Las-Vegas-teens-brawl-outside-casino-Santa-Fe-Station-Shutdown.htmlShocking moment dozens of Las Vegas teens brawl outside casino during 'Santa Fe Station Shutdown' eventhttps://www.dailymail.co.uk/news/article-13192277/new-jersey-father-arrested-teen-photo-paulsboro-school.htmlNew Jersey father is arrested for storming into a classroom and confronting a teenager he accused of harassing his daughter by sharing photosAaron Thomas, 38, charged with assault and making terroristic threats He stormed class at Paulsboro High School, New Jersey, to confront teen studentVideo showed Thomas exchanging words and scuffling with the studenthttps://www.dailymail.co.uk/news/article-13193851/Parents-Michigan-girl-hits-boy-school-bus-video.htmlParents' horror as sickening footage shows fifth-grade girl beating six-year-old boy on Michigan school bus as kids cackle and record on their phoneshttps://www.dailymail.co.uk/news/article-13193839/parents-california-school-board-secret-lgbtq-club.htmlFurious parents rip California school board after elementary teacher set up 'secret' LGBTQ club for children without informing themThe unidentified teacher teaches third-grade at Pleasant Grove Elementary UBU - stands for 'you be you' was club's named open to grade third through sixth On March 5, parents voiced their concerns for the school's lack of transparencyhttps://www.dailymail.co.uk/news/article-13194009/Nex-Benedict-cause-death-suicide-trans-Oklahoma-overdose-medical-examiner.htmlNex Benedict cause of death revealed by medical examiner as SUICIDE: Trans teen took fatal cocktail of antihistamine and anti-depressants, medical examiner rulesThe medical examiner said Nex Benedict died by suicide from a drug overdoseTheir death was cause by a combination of of Diphenhydramine and Fluoxetinehttps://www.dailymail.co.uk/news/article-13189159/New-wife-debt-married-pay-not.htmlMy new wife never told me she is $160K in debt - now we are married she wants me to clear it for herA bride, 29, revealed to her new husband, 24, on their wedding day that she is in serious debtThe groom revealed in a March 11 Reddit post that he didn't know what to do He currently has $120,000 in investments and $30,000 in his savingshttps://www.dailymail.co.uk/news/article-13192041/deep-sea-explorer-amelia-earhart-plane-donate-smithsonian.htmlDeep sea explorers didn't realize they'd 'found' Amelia Earhart's missing plane for 68 DAYS due to corrupted computer file...and now hope to RAISE iconic aircraft and donate it to SmithsonianDeep Sea Vision CEO Tony Romeo and his brother Lloyd claimed to have found Amelia Earhart's plane in JanuaryBut the image of their discovery was very nearly deleted when they thought the file was corrupted

Contributor: Jorge Chalit, OMS II Educational Pearls: Migraine pathophysiology Primarily mediated through the trigeminovascular system Serotonin, dopamine, and calcitonin gene-related peptide (CGRP) Trigeminovascular system is linked to the trigeminal nucleus caudalis, which relays pain to the hypothalamus and cerebral cortex One effective treatment for acute migraines is -triptan medications 5-HT1D/1B agonists such as sumatriptan Often combined with NSAIDs and dopamine antagonists (as antiemetics) in migraine cocktails Diphenhydramine (Benadryl) was shown to be ineffective in a randomized controlled trial comparing it with placebo and a dopamine antagonist antiemetic.  The -triptan medications carry significant risk for peripheral vasoconstriction and are therefore avoided in cardiovascular disease One serotonin agonist specifically approved for use in vascular disease Lasmiditan - 5-HT1F agonist Slightly different mechanism of action avoids peripheral vasoconstriction CGRP antagonists are also used in patients who are unresponsive to -triptans References 1. Friedman WB, Cabral L, Adewunmi V, et al. Diphenhydramine as adjuvant therapy for acute migraine. An ED-based randomized clinical trial. Ann Emerg Med. 2016;67(1):32-39.e3. doi:doi:10.1016/j.annemergmed.2015.07.495 2. Lasmiditan (Reyvow) and ubrogepant (Ubrelvy) for acute treatment of migraine. (2020). The Medical letter on drugs and therapeutics, 62(1593), 35–39. 3. Robbins MS. Diagnosis and Management of Headache: A Review. JAMA - J Am Med Assoc. 2021;325(18):1874-1885. doi:10.1001/jama.2021.1640 4. Vanderpluym JH, Halker Singh RB, Urtecho M, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA - J Am Med Assoc. 2021;325(23):2357-2369. doi:10.1001/jama.2021.7939 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII

The Hat Man can wait. Take a chill while we Benadrill some knowledge into your brains

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Diphenhydramine Trade Name Benadryl Indication Allergy, anaphylaxis, sedation, motion sickness, antitussive Action Antagonizes effects of histamine, CNS depression Therapeutic Class Allergy, cold and cough remedy, antihistamine, antitussive Pharmacologic Class Antihistamine Nursing Considerations • May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache • Anticholinergic effects (dry mouth, blurred vision, constipation, sedation) • Assess purpose of medication prior to giving it • Assess allergies, sleep patterns, cough and lung sounds • Patient should avoid other over-the-counter cough and cold remedies

Aaron El Sabrout & Freddy Cleveland ( https://toreachpoise.itch.io/ ) ( Escape the Bullpen, Issue #33 ) Quake & Vespidazed ( https://quakeroc.itch.io/ ) ( DIPHENHYDRAMINE, Issue #33 ) And don't forget to check out the show Saturday at 2-4pm EST at indiepocalypse.com/radio! Get episodes the Monday after they air at indiepocalypse.com/patreon or a month later in podcast places --- Support this podcast: https://anchor.fm/indiepocalypse/support

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/DiphenhydramineBenadrylNursingConsiderations    Generic Name Diphenhydramine Trade Name Benadryl Indication Allergy, anaphylaxis, sedation, motion sickness, antitussive Action Antagonizes effects of histamine, CNS depression Therapeutic Class Allergy, cold and cough remedy, antihistamine, antitussive Pharmacologic Class Antihistamine Nursing Considerations • May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache • Anticholinergic effects (dry mouth, blurred vision, constipation, sedation) • Assess purpose of medication prior to giving it • Assess allergies, sleep patterns, cough and lung sounds • Patient should avoid other over-the-counter cough and cold remedies

In todays episode, I will share some natural approaches to getting better sleep without compromising your health. One of the most common sleep aids is diphenhydramine (also known as Benadryl or Unisom brand names). Diphenhydramine works by blocking histamine activity as well as acetylcholine activity which provokes a drowsy state. Acetylcholine is like a nerve cell manager and when its activity is shut off, the coordination between neurons and the ability to file memories and information in an orderly fashion to be retrieved easily at a moments notice is broken. Now consuming a diphenhydramine-based drug occasionally every 3-6 months isnt likely to have any negative long term implications. However, taken regularly, it can spell disaster for your cognition and memory.

Diphenhydramine (Benadryl) and other first-generation antihistamines are commonly used, despite decades of data that there are safer and effective alternatives.  In this podcast, we review the guidelines / data behind common indications. References at FOAMcast.org Thanks for listening! Lauren Westafer

Stories that include LSD, Datura, Alcohol, and Diphenhydramine!

Trade – Benadryl Class – Antihistamine MOA – Antagonizes h1  histamine receptors Indication – Anaphylactic reaction Contraindication – Acute asthma as Benadryl thickens secretions.Side effects – Drowsiness, Dizziness, headache, excitable state, wheezing, thickening bronchial secretions, chest tightness, palpitations, hypotension, blurred vision, dry mouth, N/V, Diarrhea. Dosing Adult 25-50mg IV/IO/IMPedi 2-12 years – 1-1.25 mg/kg IV/IO/IM

I know that some of you are in a really bad spot.    You're looking for an answer, a short way out of your problems and, and your predicaments.    Some of you openly declare that you don't have time for this thing and what it dealt with quick, fast, and in a hurry.   I do understand. I was in your shoes too. There was so much, I didn't know about having a mental health.   There are people and companies that want to take advantage of that ignorance.    There are others that really don't understand that being drowsy doesn't truly help when you are dealing with a mental health condition.    You have to look at nutrition, environmental stressors, possibly past trauma.    Are you lonely?  Grieving a lost? Or knowing that this isn't the life you envisioned for yourself?   No one medication can fix that kind of hurt and pain.   Medication can help for a limited time. But it has to be the right stuff for you and your body.   In this episode, a look at over the counter medication, and specifically antihistamines.   I also have a housekeeping item that I have concerns about the future of non-invasive podcasting.    As many of you know, I do not accept advertising or affiliate marketing type income. I feel that it would be a conflict of interest for me to speak about a treatment option or service only to have an ad about a competitor pop up.   Some of the services that carry the podcast will have an ad in front of or at the end of the show. I have no control over the ad, type of add or placement.   There is a new technology coming down the road where ads with a photo can be injected into an audio podcast. My understanding is that Spotify is very interested in that tech, but the others will follow.    I guess you can call them ad-based audiograms.    Anyway, it makes me sad. The places and platforms where you can exchange information without ad intrusions are shrinking. I'm not anti-advertising. I'm anti-being besieged by the constant commandment to buy, buy and buy some more.    If you need support contact the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Resources Mentioned:  State of Florida bill that will study the use of alternative medication for anxiety conditions.   Can Benadryl be used for Anxiety? Post from VeryWell Mind, providing clear reasons for and risks about using it.   Medline Plus information page on Diphenhydramine, what it is, the accepted uses for the product and warnings about side effects.   National Health Service UK information page on Diphenhydramine   Antihistamines: Understanding Your OTC Options from the Family Doctor.org. Disclaimer:  Links to other sites are provided for information purposes only and do not constitute endorsements.  Always seek the advice of a qualified health provider with questions you may have regarding a medical or mental health disorder. This blog and podcast is intended for informational and educational purposes only. Nothing in this program is intended to be a substitute for professional psychological, psychiatric or medical advice, diagnosis, or treatment.

We've been helping folks fight dog cancer since 2008, and over the years we've seen dozens of fads come and go. There's always a new "cure” being touted. The ones that actually DO help tend to stick around. So here we are in 2021, and the latest internet sensational promise we see is a “protocol” that uses Benadryl and Tagamet to “cure” dog cancers. All dog cancers, is the story. Is that a true story, or a hopeful wish? Dr. Nancy Reese, our chief medical editor and resident epidemiologist/veterinarian, turns her big brain to the topic to help us understand why people hope these over-the-counter drugs can help their dogs … and how they actually can support our efforts. Diphenhydramine (brand name Benadryl) and cimetidine (brand name Tagamet) are both antihistamines that work to block histamine receptors on cells. They have their place, in certain cancers. Listen in to find out the why and the how. Links Mentioned in Today's Show: The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Related Links: https://www.dogcancerblog.com/articles/cancer-type/mast-cell-tumors/why-benadryl-for-mast-cell-tumors/ by Dr. Demian Dressler https://www.dogcancerblog.com/articles/cancer-type/mast-cell-tumors/why-use-stomach-medication-for-mast-cell-tumors/ by Dr. Demian Dressler https://dogcanceranswers.com/mast-cell-tumors-what-you-need-to-know-about-your-dogs-cancer/ podcast episode https://dogcanceranswers.com/melanoma-what-you-need-to-know-about-your-dogs-cancer/ podcast episode About Today's Guest, Dr. Nancy Reese: Dr. Nancy Reese is a small animal veterinarian with over 30 years of clinical experience taking care of cats and dogs and other critters in the Sierra Nevada foothills. She is also a perpetual student and researcher, as evidenced by her many degrees. In addition to her Doctor of Veterinary Medicine from the University of California, Davis, she earned a Masters in Preventive Veterinary Medicine at UC Davis and then a Ph.D. in Epidemiology at UC Davis. If you string all her letters out after her name it looks like this: Nancy Reese, DVM, MPVM, PhD. In her spare time, she volunteers to help evacuate and shelter animals caught up in disasters, and she's currently training to help in human search and rescue efforts. Dr. Reese lives in a log cabin with her husband, her 13-year-old golden retriever, and her two 13-year-old cats. Her hobbies include boosting the quality of life and longevity for all animals in her care, hiking, travelling, and cross-country skiing. Oh, and lots of dog walking.  degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. Other Links: To join the private Facebook group for readers of Dr. Dressler's book “The Dog Cancer Survival Guide,” go to https://www.facebook.com/groups/dogcancersupport/ Dog Cancer Answers is a Maui Media production in association with Dog Podcast Network This episode is sponsored by the best-selling animal health book The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Available everywhere fine books are sold. Have a guest you think would be great for our show? Contact our producers at DogCancerAnswers.com Have an inspiring True Tail about your own dog's cancer journey you think would help other dog lovers? Share your true tail with our producers. If you would like to ask a dog cancer related question for one of our expert veterinarians to answer on a future Q&A episode, call our Listener Line at 808-868-3200 www.dogcanceransers.com. Dog Cancer News is a free weekly newsletter that contains useful information designed to help your dog with cancer. To sign up, please visit: www.dogcancernews.com

Podcast summary of articles from the February 2021 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include Echocardiographic findings in PE, cardiovascular emergencies in the COVID era, antibiotics for nasal packing, serotonin syndrome, diphenhydramine for neuroleptic drugs, and board review on monocular vision loss.  Guest speaker is Dr. Paul Koscumb.

In this podcast, Dr. Cole Pueringer, a toxicology fellow with the Minnesota Poison Control System (Hennepin Healthcare), discusses various over-the-counter medications and their toxicological potential. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: List at least 3 potentially dangerous over-the-counter (OTC) medications. Discuss the basic clinical presentation and management of the following over-the-counter (OTC) medications: acetaminophen, diphenhydramine loperamide, ibuprofen, and dextromethorphan. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "The Dose Makes the Poison: Over-the-Counter (OTC) Medication" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.    SHOW NOTES: Antihistamines:  Like so many other over-the-counter medications, the dose of antihistamines makes the poison. Sedation is the most common side effect in antihistamine overdose. Some, like diphenhydramine, are more toxic and have profound anticholinergic effects. Sinus tachycardia is one of the first presentations, but remember the phrases: Tachy as a tie, dry as a bone, mad as a hatter, red as a beet, hot as a hare and blind as a bat. Excitatory toxidromes can be confusing, but urinary retention, impaired bowel motility and the absence of diaphoresis will differentiate anticholinergic toxicity from the other excitatory toxidromes. the higher the dose, the more side effects seen, leading to seizures and cardiac toxicity. Physostigmine is an antidote for anticholinergic toxicity. Delirium is the main indication for physostigmine, but it can also be given to prevent intubation and at times to get a more accurate history from the patient. Physostigmine lowers the seizure threshold, so benzodiazepines are usually given prior administration. Most likely they have already been given to treat undifferentiated delirium and excitation. Of note, physostigmine is not the cure all for the toxidrome because it has a very short half life. In the setting of seizures in overdose, very few anticonvulsants are safe. Benzodiazepines are some of the safer GABAergic agents. GABA is our main CNS inhibitory neurotransmitter, it essentially "tones down the nerves". Propofol and some other GABAergic agents can also help with tachycardia and hyperthermia. In these settings, benzodiazepines are given in very high doses. Diphenhydramine causes sodium channel blockade, subsequently decreasing action potential. lowering calcium in the cells, and causing life threatening myocardial depression. Calcium is given in this circumstance, but the mainstay of treatment is sodium bicarbonate. It works by increasing overall sodium availability and the pH. The more acidotic the patient, the more of the drug becomes unbound and available. At higher pH levels, the sodium channel blockade weakens, and more of the drug becomes protein bound. What about other antihistamines? While overdose of other antihistamines will be uncomfortable, the life threatening seizures and cardiac toxicity is unique to diphenhydramine.  Acetaminophen:  Acetaminophen is the highest nationally in morbidity and mortality of all drug overdoses. Most often taken on it's own, it's also mixed into many over-the-counter remedies. In the first 24-hours post-ingestion, the symptoms can be minimal. It's metabolized in the liver, and a small portion is metabolized by CIP 2E1, resulting in the toxic metabolite NAPQI. Normally, glutathione will detoxify NAPQI, but in acetaminophen overdose, glutathione stores are depleted and the excess NAPQI creates havoc in the liver. In a reliable historian with an acute ingestion, the Rumack-Matthew nomogram is employed, and will help guide antidote therapy. Serum acetaminophen levels will not be helpful until 4 hours post-ingestion, unless something that slows GI transit time and absorption has been taken as well. N-acetylcysteine or "NAC", is the antidote for Tylenol. If given within eight hours of ingestion it can prevent any liver toxicity. It can also be started any time a serious ingestion is suspected. Keep in mind, delayed-release Tylenol, certain populations, and conditions can obscure the diagnosis and in those settings the Rumack-Matthew nomogram can no longer be used. Chronic alcoholics who have just stopped drinking and malnourished patients are at higher risk of toxicity. Subacute and chronic ingestion is also very common. Essential lab tests include serum acetaminophen levels, ALT and AST, and INR. One would expect any or all of these to be elevated in significant toxicity. If they are, NAC is given intravenously for nearly 24 hours. NAC won't reverse hepatotoxicity that has already occurred, but will prevent more from happening. Dextromethorphan:  Dextromethorphan, referred to sometimes as "robotripping" or "robo-frying". Taken in excess causes an individual to become disassociated. It is an NMDA antagonist, like ketamine, LSD and PCP. Expect to see the same clinical signs of serotonin excess, as well as dystonia. Patients can alternate dramatically between vacant blank stares, to incredibly violent outbursts. Patient and staff safety is a crucial element in treating this toxidrome. Rotatory nystagmus, a distinctive rapid "clock ticking" of the eyes is diagnostic of this type of ingestion. Loperamide:  When Loperamide, an over-the-counter antidiarrheal, is used in abuse it can lead to death. It acts similar to opioids, slowing down the GI tract but without the central effects, because it is actively expelled from the CNS. In large doses, however, it delivers an opioid-like high. Loperamide can cause respiratory depression, but also persistent arrhythmias. The lethal effects are due to loperamide's potassium channel blocker properties causing profound QT prolongation, sinusoidal waves and can lead to cardiac arrest. Potassium channel blockade is difficult to treat. ACLS drugs, electrolyte normalization like magnesium infusions, and even Narcan can be given, but more than likely these incredibly sick patients will need ECMO. Ibuprofen:  Ibuprofen is, overall, a safe drug. Large quantities of the drug have to be taken for toxic effects. If taking over 200mg/kg if Ibuprofen, a patient is likely to have some GI symptoms and possibly an acute kidney injury. treatment would include possible admission for antiemetics and IV fluids. Ibuprofen is metabolized as a propionic acid anion. If ore than 400mg/kg are taken, it will result in an anion gap metabolic acidosis. At over 600mg/kg, a whole constellation of symptoms results: seizures, hypotension, and cardiac shock. These patients are severely ill and may require ECMO for an extended period of time. At this dosage, a 100kg patient would need to take 300 pills. Which leads to the question, "How did they fit that many pills in their stomach?"  Activated Charcoal:  Finally, a note on activated charcoal. It works great for almost everything, except alcohol ingestion and metals, by binding drugs in the GI tract. Drug absorption is decreased by 60% if given within an hour. It should be avoided if the airway is compromised or if the patient is a risk for seizure. In an intubated patient with recent ingestion, it's given via nasogastric tube. Thank-you for listening.

If you'd like to support our podcast, you can find us on Patreon at patreon.com/milkminutepodcast.Thank you to our sponsor Liquid IV. Use promo code MILKMINUTE to get 25% off your order, plus free shipping:https://glnk.io/koyv/breastfeeding-for-busy-momsThank you to our sponsor Breastfeeding for Busy Momsbreastfeedingforbusymoms.comSHOW NOTES: https://breastfeedingforbusymoms.com/podcast/cold-and-flu-medications-while-breastfeeding/Table of Contents0:30 Welcome to the podcast0:53 Thank you to our sponsor Liquid IV1:38 Listener question of the week4:24 Getting into cold and flu meds4:35 Pay attention to active ingredients5:15 Nasal sprays, decongestants6:30 oxymetazoline and fluticasone8:15 acetaminophen, aka Tylenol10:00 dextromethorphan, cough suppressant12:25 ibuprofen, aka Advil15:40 phenylephrine, Sudafed16:30 guaifenesin, it's an expectorant18:00 On to meds that are probably best avoided18:22 But first, review what's probably OK while breastfeeding18:40 Now, meds to probably avoid18:53 Antihistamines19:25 Doxylamine succinate, aka Unisom (it knocks you out)20:25 Diphenhydramine, aka Benadryl (and others)21:05 Pseudoephedrine, aka Sudafed (and others)21:48 Codeine, aka Tylenol 3 (and others)23:00 Herbs! And other non-med23:15 Heather loves a neti pot!25:25 Herbs and a few supplements, starting with Zinc26:50 Vitamin C28:00 Honey29:30 For more on natural sleep helpers, see ep. 2829:53 Vitamin D (for more on Vit. D, see ep. 31)30:45 Echinacea33:30 Garlic37:05 Elderberries40:15 Thyme (and herbs are awesome!)48:30 Thank you to our sponsor Breastfeeding for Busy Moms49:15 The Milk Minute Awards in the Alcove!50:15 You're all winners! Thank you for listening!ResourcesMaureen's elderberry syrup recipehttps://breastfeedingforbusymoms.com/elderberry-syrup-recipe-freebie/Mountain Rose Herbshttps://mountainroseherbs.com/Starwest Botanicalshttps://www.starwest-botanicals.com/Pacific Botanicalshttps://www.pacificbotanicals.com/Infant Risk Centerhttps://www.infantrisk.com/content/cold-flu-medications-breastfeedingLactMed (Drugs and Lactation Database)https://www.ncbi.nlm.nih.gov/books/NBK501922/Article on elderberries from the National Institute of Healthhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848651/Article about garlin from the National Institute of Healthhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465033/Article on echinacea from National Center for Complementary and Integrative Healthhttps://www.nccih.nih.gov/health/echinaceaCredits and contactThanks to Cherie Louise Turner for editing and production and to Lindsay Brett Carothers for her musical stylings of our intro and outro.Additional music credits, thank you Wataboi and Mazzaccaro from Pixabay.Support the show (https://www.patreon.com/milkminutepodcast)

In this month's EM Quick Hits podcast: Justin Morgenstern on which patients to consider cerebral venous thrombosis in, Maria Ivankovic on diphenhydramine alternatives, Brit Long on abdominal compartment syndrome, Sarah Reid on neonatal "constipation" - when to worry, and Anand Swaminathan on intubating the patient with metabolic acidosis... The post EM Quick Hits 25 Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis appeared first on Emergency Medicine Cases.

Contributor: Ruben Marrero-Vasquez, PharmD Educational Pearls: ACEP and FDA have both issued warnings about the viral Tik Tok Benadryl (diphenhydramine) challenge where individuals voluntarily overdose on diphenhydramine which can cause fatal toxicity Diphenhydramine is typically dosed at 0.5-1 mg/kg in pediatric patients Q4-6 PRN and carries a fatal dose of 20-40 mg/kg but anywhere from 3-5x recommended dose does can cause toxicity Diphenhydramine toxicity causes both central and peripheral anticholinergic toxicity Central anticholinergic toxicity symptoms: delirium, agitation, combativeness, confusion, restlessness, hallucinations, ataxia, tremor and seizures Peripheral anticholinergic toxicity symptoms: tachycardia, dry flushed skin, dry mucus membranes, thick secretions, dilation of pupils, urinary retention, and decreased bowel sounds Pneumatic to help you remember anticholinergic toxidrome: Red as a beet Dry as a bone Blind as a bat Mad as a hatter Hot as a hare Full as a flask Management typically only requires supportive care, agitation from central anticholinergic delirium can be hardest aspect to treat, IV benzodiapines are first line treatment to control and may require large doses to prevent rhabdomyolysis and hyperthermia Diphenhydramine toxicity has been associated with blockade of sodium and potentially potassium channels increasing risk of arrhythmia and seizures. Cardiac changes can include: QRS widening, myocardial depression, QT prolongation and torasades-type ventricular tachycardia. Wide QRS complexes indicate delayed ventricular depolarization caused by sodium channel blockade, bolus of sodium bicarbonate can be used dosed 1-2 mEq/kg followed by continuous infusion Prolonged QT: restoration of low serum potassium and magnesium to high normal range Benzodiazipines should be used as first line therapy for toxin induced seizures Don’t use fosphenytoin or phenytoin sodium channel blockers as they can worsen cardiac conduction References Su M, Goldman M. Anticholinergic Poisoning. UpToDate. https://www.uptodate.com/contents/anticholinergic-poisoning?search=diphenhydramine overdose&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Published October 6, 2020. Accessed December 26, 2020. Summarized by Mason Tuttle            

Diphenhydramine is a first generation antihistamine that is highly anticholinergic. When using medications like diphenhydramine, be sure to watch for side effects like dry eyes, dry mouth, constipation, urinary retention, and CNS changes. Sedation is a primary effect of diphenhydramine. It can be advantageous in certain situations, and detrimental in others. Drugs like donepezil, memantine, laxatives, tamsulosin, and artificial tears can be indicators of anticholinergic side effects from diphenhydramine.

ASCP Host Donna Bartlett interviews author Kyle Frasier about his recent article in The Senior Care Pharmacist. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/diphenhydramine combination medication, rather than his usual acetaminophen. Use of acetaminophen/diphenhydramine for back pain without insomnia may contribute to falls. Pharmacists contacted the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk to the patient of inadvertently purchasing an inappropriate product is reduced. 

Learning Objectives Discuss the use of USP graded ingredients in pharmaceutical preparations and the importance Explain what prompted the FD&C act of 1938 to be enacted In this weeks 483 Friday we're going to be talking about the use of ungraded ingredients in pharmaceutical preparations. First, I'd like to show you a 483 where this was done, then we'll look at a case where non-USP ingredients led to real issues in patients where the drug product contained non-USP graded ingredients. Let's take a look at the first 483: In this 483 it looks like the use of grain alcohol was used to make several products. Of course, using everclear 95% is NOT a USP graded alcohol and is actually meant to be for consumption, but not as a pharmaceutical ingredient. So what's the difference of whether something is USP-graded and a substance that doesn't carry that same grade? First, USP graded ingredients are tested for a number of things including the stability of the ingredient itself. This is the major difference between those ingredients that carry the USP grading and those that do not. First, is there such a product that exists for this pharmacy? Are there USP graded ethanols that could've been used in this product? The answer is yes. There is in fact a USP monograph for ethanol which typically means that alcohol USP can be found in the market that's been tested for impurities and degradation products. So the easiest way to solve the issue for this pharmacy is to simply use USP graded 200 proof alcohol. I would like to note that in this particular 483 it's noted that this pharmacy is a "Producer of Non-Sterile Drug Products". So one thing I can say is that all of their products were being used for topical use and not to be consumed. Nonetheless, the alcohol used was not USP-graded so the point that the final preparation wasn't consumed orally or by given by injection still doesn't necessarily matter. The next question in my mind, if there is no substitute for something that is intended to be laboratory grade, is there a way to qualify this ingredient for use in your drug product. I would say yes, however much research and testing would need to be done prior to its use. How to go about doing that goes beyond what this episode will cover but the possibility is there. Next, let's look at a scenario where using non-USP graded ingredients were used in an injection and actually caused harm to the patient. In 2017, there were two infusions of curcumin compounded with non-USP graded polyethylene glycol (PEG) 40 castor oil. As a result when these injections were administered patients had hypersensitivity reactions to the IV product. Note that in this preparation it actually was administered intravenously, so this was a sterile product. So what happened to these patients and why? The FDA reports: On March 10, 2017, the U.S. Food and Drug Administration received an adverse event report concerning a 30-year-old female patient who experienced cardiac arrest after IV administration of a curcumin emulsion product...The patient reportedly had a history of allergies and was being treated for eczema by a naturopathic doctor. Within minutes of starting the infusion, the patient became pulseless and required CPR. The patient suffered anoxic (depleted oxygen) brain injury and subsequently died. An adverse reaction to infused curcumin solution was identified as a cause of death by the local authorities. FDA investigates two serious adverse events associated with...compounded curcumin emulsion product for injection In a second case where this drug was administered the FDA reports: On May 1, 2017, FDA received an adverse event report concerning a 71-year-old male patient who developed a hypersensitivity reaction after IV administration of (name of facility removed) compounded curcumin emulsion product. The patient had a history of allergies and was being treated for thrombocytopenia (a low platelet count) at a holistic health center. According to information FDA received from the center, within minutes of starting the infusion, the patient developed a cough and erythema (skin reddening). Diphenhydramine (an antihistamine) was administered; however, symptoms escalated to include shortness of breath, itching, and hypotension (low blood pressure). The patient was treated with IV epinephrine and transferred to a nearby emergency room where he was treated and then released. FDA investigates two serious adverse events associated with...compounded curcumin emulsion product for injection What's particularly interesting about this injection is that the ungraded PEG 40 Castor oil sort of has a history with the FDA. In 1937, a sulfinilamide was compounded using diethylene glycol. The Diethylene Glycole (DEG) was used as a solvent to dissolve the sulfinilamide (an antibiotic). Diethylene glycol is now known to cause kidney failure in patients. As a result over 100 people in 15 states died as Far East as Virginia and as far west as California. Diethylene glycol, while it is a great solvent, it's normally used as antifreeze, a deadly poison. Unfortunately, prior to making this oral preparation of sulfinilamide, there were no studies conducted for toxicity and at the time the food and drugs law did not exist. The FDA responded to this disaster with the Food, drug and cosmetic act of 1938 which established quality standards for food, drugs, medical devices and cosmetics manufactured and sold in the United States. Back to our original 483. What you may or may NOT know about polyethelene glycol is that one of its degradation products is diethylene glycol. Perhaps if the PEG castor oil was USP graded or if studies were done prior to dispensing the curcumin injection, the fatality and injury as a result of the injection would never have occurred. Diethylene glycol is a known manufacturing impurity in polyethylene glycol. What's more is that it was found that the polyethylene glycol that was used to make this curcumin preparation had the labeling of "CAUTION: for manufacturing or laboratory use only." Unfortunately, there is currently no USP monograph for PEG 40 castor oil. I cannot stress this enough, using USP graded ingredients is absolutely paramount to compounding a safe and effective product for your patients. If you have the resources to do studies on the individual ingredients that may not have a USP grade then it's possible that you're able to show that the use of such an ingredient is safe to be used in your preparation. It's also important to know the history of the FDA and why some of the laws that have been enacted over the past 100 or so years have been enacted. The last thing I'll say is that just because something CAN be compounded doesn't always mean it SHOULD be compounded. Be sure to do your research on any of the ingredients you're using in the compounding of your preparations.

Learning Objectives Discuss the use of USP graded ingredients in pharmaceutical preparations and the importance Explain what prompted the FD&C act of 1938 to be enacted In this weeks 483 Friday we're going to be talking about the use of ungraded ingredients in pharmaceutical preparations. First, I'd like to show you a 483 where this was done, then we'll look at a case where non-USP ingredients led to real issues in patients where the drug product contained non-USP graded ingredients. Let's take a look at the first 483: In this 483 it looks like the use of grain alcohol was used to make several products. Of course, using everclear 95% is NOT a USP graded alcohol and is actually meant to be for consumption, but not as a pharmaceutical ingredient. So what's the difference of whether something is USP-graded and a substance that doesn't carry that same grade? First, USP graded ingredients are tested for a number of things including the stability of the ingredient itself. This is the major difference between those ingredients that carry the USP grading and those that do not. First, is there such a product that exists for this pharmacy? Are there USP graded ethanols that could've been used in this product? The answer is yes. There is in fact a USP monograph for ethanol which typically means that alcohol USP can be found in the market that's been tested for impurities and degradation products. So the easiest way to solve the issue for this pharmacy is to simply use USP graded 200 proof alcohol. I would like to note that in this particular 483 it's noted that this pharmacy is a "Producer of Non-Sterile Drug Products". So one thing I can say is that all of their products were being used for topical use and not to be consumed. Nonetheless, the alcohol used was not USP-graded so the point that the final preparation wasn't consumed orally or by given by injection still doesn't necessarily matter. The next question in my mind, if there is no substitute for something that is intended to be laboratory grade, is there a way to qualify this ingredient for use in your drug product. I would say yes, however much research and testing would need to be done prior to its use. How to go about doing that goes beyond what this episode will cover but the possibility is there. Next, let's look at a scenario where using non-USP graded ingredients were used in an injection and actually caused harm to the patient. In 2017, there were two infusions of curcumin compounded with non-USP graded polyethylene glycol (PEG) 40 castor oil. As a result when these injections were administered patients had hypersensitivity reactions to the IV product. Note that in this preparation it actually was administered intravenously, so this was a sterile product. So what happened to these patients and why? The FDA reports: On March 10, 2017, the U.S. Food and Drug Administration received an adverse event report concerning a 30-year-old female patient who experienced cardiac arrest after IV administration of a curcumin emulsion product...The patient reportedly had a history of allergies and was being treated for eczema by a naturopathic doctor. Within minutes of starting the infusion, the patient became pulseless and required CPR. The patient suffered anoxic (depleted oxygen) brain injury and subsequently died. An adverse reaction to infused curcumin solution was identified as a cause of death by the local authorities. FDA investigates two serious adverse events associated with...compounded curcumin emulsion product for injection In a second case where this drug was administered the FDA reports: On May 1, 2017, FDA received an adverse event report concerning a 71-year-old male patient who developed a hypersensitivity reaction after IV administration of (name of facility removed) compounded curcumin emulsion product. The patient had a history of allergies and was being treated for thrombocytopenia (a low platelet count) at a holistic health center. According to information FDA received from the center, within minutes of starting the infusion, the patient developed a cough and erythema (skin reddening). Diphenhydramine (an antihistamine) was administered; however, symptoms escalated to include shortness of breath, itching, and hypotension (low blood pressure). The patient was treated with IV epinephrine and transferred to a nearby emergency room where he was treated and then released. FDA investigates two serious adverse events associated with...compounded curcumin emulsion product for injection What's particularly interesting about this injection is that the ungraded PEG 40 Castor oil sort of has a history with the FDA. In 1937, a sulfinilamide was compounded using diethylene glycol. The Diethylene Glycole (DEG) was used as a solvent to dissolve the sulfinilamide (an antibiotic). Diethylene glycol is now known to cause kidney failure in patients. As a result over 100 people in 15 states died as Far East as Virginia and as far west as California. Diethylene glycol, while it is a great solvent, it's normally used as antifreeze, a deadly poison. Unfortunately, prior to making this oral preparation of sulfinilamide, there were no studies conducted for toxicity and at the time the food and drugs law did not exist. The FDA responded to this disaster with the Food, drug and cosmetic act of 1938 which established quality standards for food, drugs, medical devices and cosmetics manufactured and sold in the United States. Back to our original 483. What you may or may NOT know about polyethelene glycol is that one of its degradation products is diethylene glycol. Perhaps if the PEG castor oil was USP graded or if studies were done prior to dispensing the curcumin injection, the fatality and injury as a result of the injection would never have occurred. Diethylene glycol is a known manufacturing impurity in polyethylene glycol. What's more is that it was found that the polyethylene glycol that was used to make this curcumin preparation had the labeling of "CAUTION: for manufacturing or laboratory use only." Unfortunately, there is currently no USP monograph for PEG 40 castor oil. I cannot stress this enough, using USP graded ingredients is absolutely paramount to compounding a safe and effective product for your patients. If you have the resources to do studies on the individual ingredients that may not have a USP grade then it's possible that you're able to show that the use of such an ingredient is safe to be used in your preparation. It's also important to know the history of the FDA and why some of the laws that have been enacted over the past 100 or so years have been enacted. The last thing I'll say is that just because something CAN be compounded doesn't always mean it SHOULD be compounded. Be sure to do your research on any of the ingredients you're using in the compounding of your preparations.

New Moderna vaccine results; Boxed Warning for benzodiazepines; Point-of-care COVID-19 antibody test; Diphenhydramine overdoses linked to TikTok ‘Challenge'; And FDA grants Nucala new approval. Also we look at this week's developments in drugs in the pipeline.

Listen to FDA Drug Safety Podcast on Drug Safety Communication titled "FDA warns about serious Problems with high doses of the allergy medicine diphenhydramine (Bendaryl).

YouTube Video Version: https://youtu.be/ZNA_NtcutYY Chubbyemu Video: https://youtu.be/NaAFOrudj0g References: The Pharmacology and Use of H1-Receptor-Antagonist. N Engl J Med 1994; 330:1663-1670 Advances in H1-Antihistamines. N Engl J Med 2004; 351:2203-2217 Cardiac arrest caused by diphenhydramine overdose. Acute Med Surg. 2018 Oct; 5(4): 380–383. IV Lipid Emulsion Infusion in the Treatment of Severe Diphenhydramine. Am J Case Rep. 2019 May 29;20:758-763. Diphenhydramine with Intraventricular Conduction Delay Treated with Hypertonic Sodium Bicarbonate and IV Lipid Emulsion. West J Emerg Med. 2014 Nov; 15(7): 855–858. Diphenhydramine in a 26-year-old Woman. J Emerg Nurs. 2008 Dec;34(6):543-4. --- Support this podcast: https://anchor.fm/chubbyemu/support

Tanım Dramamine veya Gravol olarak da bilinen Dimenhidrinat, pozisyonel vertigo ile kaynaklanan mide bulantısı, kusma ve baş dönmesini önlemek için kullanılan bir ilaçtır. Dimenhidrinat % 53-% 55,5 difenhidramin ve en az % 44-% 47 8-kloroteofilin içeren tuz formunda Diphenhydramine ve 8-chlorotheophylline’dan oluşan bir kombinasyon ilaçtır. Dimenhidrinat’ın antiemetik özelliklerinin öncelikle difenhidraminin vestibüler sistemdeki H1 histamin reseptörlerinin …

Tanım Dramamine veya Gravol olarak da bilinen Dimenhidrinat, pozisyonel vertigo ile kaynaklanan mide bulantısı, kusma ve baş dönmesini önlemek için kullanılan bir ilaçtır. Dimenhidrinat % 53-% 55,5 difenhidramin ve en az % 44-% 47 8-kloroteofilin içeren tuz formunda Diphenhydramine ve 8-chlorotheophylline'dan oluşan bir kombinasyon ilaçtır. Dimenhidrinat'ın antiemetik özelliklerinin öncelikle difenhidraminin vestibüler sistemdeki H1 histamin reseptörlerinin antagonizması tarafından üretildiği düşünülürken, uyarıcı etkilerin 8-kloroteofilinin adenozin reseptör blokajı tarafından üretildiği düşünülmektedir. 8-kloroteofilinin eklenmesi başlangıçta difenhidraminin yatıştırıcı etkilerine karşı koymak için tasarlanmıştı. Büyük dozlarda kullanıldığında, dimenhidrinatın halüsinasyonlar, heyecan, koordinasyon bozukluğu ve oryantasyon bozukluğu ile karakterize ingilizcesi "High" olarak tabir edilen bir duruma neden olduğu gösterilmiştir. Dimenhydrinate, difenhidramin ve teofilin içeren bir antiemetik ilaç kombinasyonudur. Kanser kemoterapisine bağlı bulantı tedavisinde etkili değildir. Dimenhidrinat, mide bulantısı, kusma, baş dönmesi ve baş dönmesini bastırmak için beyindeki ve iç kulaktaki belirli sinirlerin uyarılmasını doğrudan engeller. Diphenhydramine ve dimenhydinate, açısal veya doğrusal hızlanma hareketlerinden kaynaklanan vestibüler nöronal uyarımı azaltır. Bazı antihistaminiklerin antiemetik, anti-hareket hastalığı ve anti-vertigo etkilerini uygulama mekanizması tam olarak bilinmemektedir, ancak bunların merkezi antikolinerjik etkileri ile ilgili olabilir. Vestibüler uyarımı azaltırlar ve labirent fonksiyonunu baskılarlar. Medüller kemoreeptif tetikleme bölgesi üzerindeki bir etki de antiemetik etkiye dahil olabilir. Dimenhidrinat, insan beyninde geniş çapta dağılmış olan histamin H1 reseptöründe yarışmacı bir antagonisttir. Dimenhidrinatın antiemetik etkisi muhtemelen beyindeki vestibüler sistemdeki H1 antagonizminden kaynaklanmaktadır. Etki Başlangıcı: IV: hemen; IM: 20 ila 30 dakika; Ağızdan: 15 ila 30 dakika Etki süresi: 1 - 4 saat Yarılanma Ömrü (t½): 5-8 saat Metabolizma: Karaciğerde (Sitokrom P-450 sistemi) Atılım: İdrar Ticari İsim: ANTI-EM 50 MG TABLET (12 TABLET) DRAMAMINE 50 MG 12 TABLETDRAMAMINE 50 MG/ML ENJEKSIYONLUK COZELTI ICEREN 5 AMPUL ENDİKASYON – KONTRAENDİKASYON Mide bulantısı, kusma ve / veya baş dönmesi: Yol tutması, radyasyon hastalığı, ameliyat sonrası iyileşme, diğer ilaçların kullanımı, Mènière hastalığı ve diğer labirent rahatsızlıkları ile ilişkili bulantı, kusma ve / veya baş dönmesinin tedavisi ve önlenmesi. Endikasyon dışı kullanım: Gebelikte bulantı ve kusma Kontraendikasyonlar:  Dimenhidrinata, bileşenlerine (difenhidramin veya 8-kloroteofilin) veya formülasyonun herhangi bir bileşenine aşırı duyarlılık; bir monoamin oksidaz inhibitörü ile tedaviyi takip eden 14 gün içinde eşzamanlı kullanım veya kullanım; dar açılı glokom; kronik akciğer hastalığı; Prostatik hipertrofi; 2 yaşından küçük hastalar Uygulama Yol tutması, mide bulantısı / kusma veya baş dönmesi: Ağızdan: 4-6 saatte bir 50-100 mg (maksimum: 400 mg / gün) IM, IV: 4 saatte bir 50 mg; maksimum: 4 saatte bir 100 mg Yol tutması: Ağızdan: Gerektiğinde her 4 saatte bir 50 ila 100 mg (maksimum: 400 mg / gün); Uzun etkili formülasyon: 8 ila 12 saatte bir 100 mg (maksimum: 300 mg / gün) Rektal: Gerektiğinde her 6 ila 8 saatte bir 50 ila 100 mg Ameliyat sonrası bulantı / kusma: Oral: işlemden önce 50 ila 100 mg, ardından işlem sonrası 50 ila 100 mg; gerektiği kadar tekrarlayın (maksimum: 400 mg / gün) IM, IV: tedaviden önce 50 mg, ardından işlem sonrası 50 mg; gerektiği kadar tekrarlayın (maksimum: 400 mg / gün) Radyasyon hastalığı: IM, IV: 50 ila 100 mg tedaviden 30 ila 60 dakika önce; 50 mg tedaviden 1.5 ve 3 saat sonra. Dozu gerektiği kadar tekrarlayın (maksimum: 400 mg / gün) Rektal: 50 ila 100 mg tedaviden 30 ila 60 dakika önce; gerektiği kadar tekrarlay...

ASCP Host Donna Bartlett interviews author Kyle Frasier about his recent article in The Senior Care Pharmacist. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/diphenhydramine combination medication, rather than his usual acetaminophen. Use of acetaminophen/diphenhydramine for back pain without insomnia may contribute to falls. Pharmacists contacted the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk to the patient of inadvertently purchasing an inappropriate product is reduced. #EvidenceBasedPodcast 

ASCP Host Donna Bartlett interviews author Kyle Frasier about his recent article in The Senior Care Pharmacist. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/diphenhydramine combination medication, rather than his usual acetaminophen. Use of acetaminophen/diphenhydramine for back pain without insomnia may contribute to falls. Pharmacists contacted the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk to the patient of inadvertently purchasing an inappropriate product is reduced. #EvidenceBasedPodcast  See omnystudio.com/listener for privacy information.

Learn about how a psychologist named B.F. Skinner proved that pigeons can be superstitious; the science of histamines and why allergy medications make us sleepy; and the 5 ages of the universe, including the Stelliferous Era we’re in right now. Pigeons Can Be Superstitious — And a Psychologist Once Proved It by Ashley Hamer Superstitious behavior | Comparative Cognition Laboratory | Psychological and Brain Sciences. (2020). Uiowa.edu. https://psychology.uiowa.edu/comparative-cognition-laboratory/glossary/superstitious-behavior  ‌Classics in the History of Psychology -- Skinner (1948). (2020). Yorku.ca. http://psychclassics.yorku.ca/Skinner/Pigeon/  Inglis-Arkell, E. (2011, January 31). How pigeons get to be superstitious. io9. https://io9.gizmodo.com/how-pigeons-get-to-be-superstitious-5746904  Why do allergy medications make us sleepy? by Cameron Duke Basophils - an overview | ScienceDirect Topics. (2013). Sciencedirect.com. https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/basophils Castro, J. (2013, December 16). Why Do Antihistamines Make You Drowsy? Livescience.Com; Live Science. https://www.livescience.com/41999-antihistamines-drowsy-benadryl-allergies.html  Diez-Garcia, A., & Garzon, M. (2017). [Regulation of the phases of the sleep-wakefulness cycle with histamine]. Revista De Neurologia, 64(6), 267–277. https://www.ncbi.nlm.nih.gov/pubmed/28272728  Jutel, M., Blaser, K., & Akdis, C. A. (2006). The role of histamine in regulation of immune responses. Chemical Immunology and Allergy, 91, 174–187. https://doi.org/10.1159/000090280  Thakkar, M. M. (2011). Histamine in the regulation of wakefulness. Sleep Medicine Reviews, 15(1), 65–74. https://doi.org/10.1016/j.smrv.2010.06.004  Regenerative Medicine Partnership in Education. (2020). Duq.edu. http://sepa.duq.edu/regmed/immune/histamine.html  There are 5 ages of the universe, and we're in the Stelliferous Era by Grant Currin Physics offers glimpse into the universe’s dark era. (1997, January 13). University of Michigan News. https://news.umich.edu/physics-offers-glimpse-into-the-universe-s-dark-era/  Adler, D. (2020, March 24). The Degenerate Era: When the universe stops making stars. Astronomy.com. https://astronomy.com/news/2020/03/the-degenerate-era-when-the-universe-stops-making-stars  Subscribe to Curiosity Daily to learn something new every day with Cody Gough and Ashley Hamer. You can also listen to our podcast as part of your Alexa Flash Briefing; Amazon smart speakers users, click/tap “enable” here: https://www.amazon.com/Curiosity-com-Curiosity-Daily-from/dp/B07CP17DJY 

This episode we discuss the active ingredient in Benadryl Diphenhydramine. Diphenhydramine can produce a state of delirium and hallucinations in high doses. Joe discusses the time he tried this..........YOU DONT WANT TO MISS THIS TUNE IN NOW OUT ON DRUGS FAMILIA!!!! --- Send in a voice message: https://anchor.fm/ondrugs/message Support this podcast: https://anchor.fm/ondrugs/support

Lori Barnes Isenberg claimed her husband, Larry Isenberg, died after falling off their boat. Now, however, she has been charged with first-degree murder in his death. Autopsy results show Larry died from excessive amounts of Benadryl, and Lori is accused of giving it to him. Plus, the case of 11-year-old Colorado boy Gannon Stauch, who was reported missing by his stepmother Letecia on January 27. Now, Letecia has been arrested and faces multiple charges, including first-degree murder. With guest Ron Kaye.

Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.  The most effective agent in the cocktail is a dopaminergic agent  Routine IV fluids have not shown efficacy  There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache  Consider trigger point injections for those with migraine attributable to cervical neck pain.  References Jones CW, Remboski LB, Freeze B, Braz VA, Gaughan JP, McLean SA..Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial.  Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26. Friedman BW, Cabral L, Adewunmi V, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016;67(1):32–39.e3. doi:10.1016/j.annemergmed.2015.07.495 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

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In this episode, a look at the Lego Fish Building Kit, a new site called PsyberGuide for mental health apps and a brief overview of some of the over the counter drugs and other medications that could have an effect on your performance. If you need support contact the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Resources Mentioned:  The website PsyberGuide.org reviews mental health and wellness apps. You can select your criteria for treatment and the app will give you what it knows about the app and possible effectiveness. MedLine Plus information sheet on Diphenhydramine which is found in sleep medication, cold and flu medication and other similar products. You can view the brand name over the counter drugs that contain this medication. MedLinePlus has a page listing drugs that can cause impotence. AARP page on 7 Meds that Can Wreck Your Sex Life. Benzodiazepines made the list. Psychology Today - Do You Take Drugs That Might Cause Sex Problems? Diabetes.org page about diabetes, treatment and men. Cleveland Clinic on Diabetes and Female Sexuality; how the diabetes can have multiple influences on women. University of Santa Barbara Sex Info Online page on  Sex and Anxiety Disorders. It lists the many anxiety conditions, medication treatment options and some of the side effect that might happen. Mayo Clinic on Chronic Pain Can Interfere with Sexuality Disclaimer:  Links to other sites are provided for information purposes only and do not constitute endorsements.  Always seek the advice of a qualified health provider with questions you may have regarding a medical or mental health disorder. This blog and podcast is intended for informational and educational purposes only. Nothing in this program is intended to be a substitute for professional psychological, psychiatric or medical advice, diagnosis, or treatment.

Wired as hell because of immediate side effects, unable to sleep and resorting to “Nytol” aka quote unquote “diphenhydramine” in addition to the Trazadone. Would have slept only 2 hours otherwise. This should be an interesting stretch of road.

PROJECT RECLAMATION Episode 28: The Oz Effect In this episode we discuss a bunch of things, and go on possibly more tangents than usual.  We end up arriving at a couple topics that we can’t go too long without touching on, but we finally give them some focus of their own.  We discuss the power and importance of support and your support structure, and we take a little dive into what the Oz Effect is, and how it might effect us. 2:00       NBA Jam https://en.wikipedia.org/wiki/NBA_Jam 2:17       George Clinton https://georgeclinton.com/ 2:30       Washington Wizards https://www.nba.com/wizards/ 5:51       Gorilla Snot http://www.gorillasnot.us/ 16:05    Marshawn Lynch https://en.wikipedia.org/wiki/Marshawn_Lynch 18:23    Sofa King Podcast https://www.sofakingpodcast.com/ 21:06    Olympic Training Center https://trainatchulavista.com/ 35:38    Diphenhydremine https://en.wikipedia.org/wiki/Diphenhydramine 38:52    The Wizard of Oz https://en.wikipedia.org/wiki/The_Wizard_of_Oz_(1939_film) 39:00    Dr. Oz https://www.doctoroz.com/ 39:10    Az Hakim https://en.wikipedia.org/wiki/Az-Zahir_Hakim 39:14    Oz (90s HBO Show) https://www.hbo.com/oz 40:00    The Wizard of Oz https://en.wikipedia.org/wiki/The_Wonderful_Wizard_of_Oz https://en.wikipedia.org/wiki/The_Wizard_of_Oz_(1939_film) 45:00     IZ http://izhawaii.com/biography/ Project Reclamation Links Website: http://projectxreclamation.com Email: projectxreclamation@gmail.com Facebook: https://www.facebook.com/Project-Reclamation-395831667534101/ YouTube: https://www.youtube.com/channel/UCihrXohOFuDTZh1BM_HwiJw Instagram: https://www.instagram.com/projectxreclamation/?hl=en Twitter: https://twitter.com/ProjectReclama2 Jax the dog:  https://www.facebook.com/jax.frickmovicz.9 Page the dog:  https://www.facebook.com/page.frickmovicz.3 Tim's Links YouTube: https://www.youtube.com/channel/UCHCxAUPtoaoagQKW7lOdZSg Facebook: https://www.facebook.com/tim.frick.92 Instagram: https://www.instagram.com/t_k_ultra/?hl=en Twitter: https://twitter.com/TheTimFrick

This episode is about how both over the counter and prescription medication can affect your sexual responses. If you are taking an over the counter medication for insomnia you might be removing your ability to perform the horizontal mambo. Resources Mentioned: Anxiety Disorder Association of America - Fact and Statistics page. Consumer Reports article on taking over the counter sleep medication long term. MedLine Plus information sheet on Diphenhydramine which is found in sleep medication, cold and flu medication and other similar products. Did James Bond have tremors due to the amount of alcohol consumed?  Maybe. National Institute of Health page on Mental Health Medication.  Musician Moby's four hour relaxation music experience. If you're having suicidal thoughts, contact the National Suicide Prevention Lifeline for immediate help: 1-800-273-TALK (8255).   Disclaimer:  Always seek the advice of a qualified health provider with questions you may have regarding a medical or mental health disorder. This podcast is intended for informational and educational purposes only. Nothing in this program is intended to be a substitute for professional psychological, psychiatric or medical advice, diagnosis, or treatment.

Seemingly vague, but potentially dangerous... common, but possibly with consequences... ...or maybe just plain frustrating. Let's talk risk stratification, diagnosis, and management. Primary or Secondary? We can make headache as easy or as complicated as we like, but let's break it down to what we need to know now, and what the parents need to know when they go home. Primary headaches: headaches with no sinister secondary cause – like tension or migraine – are of course diagnoses of exclusion (cluster headache is exceedingly rare in children). Secondary headaches: headaches due to some underlying cause -- are what we need to focus on first. The list of etiologies is vast; here is just a sampling: How do I sort this out? Ask yourself three main questions: Is it a tumor? Is it an infection? Is it a bleed? Is it a tumor? Some historical features are high-yield in screening for signs or symptoms consistent with a space occupying lesion. Progression and worsening of symptoms over time Associated vomiting Pain only in the occiput Headache that is worse with Valsalva – ask if coughing, urinating, or defecating affects the headache Does this headache wake the child from sleep? Is it worse in the morning just after getting up? Conversely, the absence of some historical features may increase suspicion of a space-occupying lesion No family history of migraine No associated aura with the headache. Who needs neuroimaging? The short answer is, if the child has an abnormal exam finding, then obtain a non-contrast head CT in the ED.  If you’re worried enough to get imaging, then you should not feel great about sending him to an expedition to MRI. The reassuring point is that for a child with a normal neuro exam, we have time to figure this out. For the recurrent headache, outpatient MRI really is the way to go if at all possible – not only do we forgo unnecessary radiation, but MRI is more likely to reveal the cause – or rule out the concern. Medina et al. in Pediatrics reported on children with headache suspected of having a brain tumor. They stratified patients into low, intermediate, and high risk, based on clinical predictors from the history and physical. All had imaging. They then calculated probability of tumor in each group. The low risk group had a 0.01% probability of tumor. The intermediate group 0.4%, and the high-risk group had only a 4% probability of tumor. The take-home message is that in the stable patient with a normal neurologic exam and no red flags, time is on our side. The American Academy of Neurology's most recent guidelines, published first in 1994 and revised in 2004. 1. Neuroimaging on a routine basis is not indicated with recurrent headaches and a normal neurologic exam 2. Neuroimaging should be considered in children with an abnormal exam. 3. Neuroimaging should be considered in children with recent onset of severe headache, change in the type of headache, or associated features that suggest neurologic dysfunction Is it an infection? This is nothing new: if you think you need to perform a lumbar puncture, then you’re right. Go after the diagnosis when it meets your threshold for testing. The difficulty is in the child who just has a headache, plus or minus symptoms that may be viral syndrome. Dr Curtis et al. in Pediatrics did a systematic review of Clinical Features Suggestive of Meningitis in Children.  In the history, only obvious features were helpful in this study: bulging fontanel in the infant or neck stiffness in the older child.  Both increased the likelihood of meningitis by 8-fold. In the physical examination, the only reliable predictors in this study were poor general appearance or a change in behavior. You will catch those cases, because you would have tuned into meningitis early on -- especially in the unvaccinated. What about all-comers with fever and headache? The presence of a high fever (so greater than 40 °C) only conferred a positive likelihood ratio of 2.9, only marginally predictive. Reassuring is that for temperatures less than 40 °C, the LR was 1 for meningitis. In other words, a fever less than 40 °C was just as likely to be present with or without meningitis. Is it a bleed? Does this child have some underlying disorder? For example, sickle cell disease, hypertension, rheumatologic disease, or some other endocrine or metabolic disease, such as a mitochondrial disorder? In chronically ill children, consider cerebral sinus venous thrombosis, vasculitis, ischemia, or hemorrhage. Arteriovenous malformation (AVM) is the hemorrhage we fear the most. We really don’t know enough about arteriovenous malformations in the brain to say what is the typical presentation. They may be completely asymptomatic, until they rupture. Even the headache presentation is variable. Think, headache PLUS. New headache plus…vomiting. Headache plus…it’s unilateral and new for the patient. Headache plus…a new seizure. Headache plus…focal neuro deficits, that may be transient, due to a vascular steal phenomenon. Two illustrative cases of arteriovenous malformation: 1. An eleven-year-old girl presents to the ED with new headache, nausea, and vomting in the morning, then had a generalized seizure later that day, and presents with a low GCS. She was intubated, CT confirmed the AVM. She had a right frontal intraparenchymal bleed with midline shift. She underwent clot evacuation and extirpation of the intertwined arteries and veins. 2. A nine-year old girl presented to the ED with headache for two days, constant, then one day of nausea and vomiting. On presentation, she was altered, and had slow-reacting pupils. She also underwent evacuation, and only on histopathology did they find a single, arterialized vein. Primary Headache: Presumptive Impression Tension headaches are the most common in children and adults. As in adults, the tension headache is band-like, pressure, tighetening, and often associated with muscle aches in the neck and shoulders. Find out how often they occur, and whether there is any pattern of worsening symptoms, or if the symptoms seem to be related to sleep hygiene, video games, too much digital screen time. Also, screen for lack of exercise, poor diet, stress, and all of the other good questions you usually ask. Treat the cause or counsel about lifestyle modification, and offer PO hydration and an NSAID, like ibuprofen or acetaminophen (paracetamol). Non-pharmacologic techniques like heat packs, rest, stress relief, and a little TLC always help. Be careful not to encourage overreacting to the headache – sometimes we see a pattern of headache, attention, and more headache that can take root. Also look for overuse of medications, which may be the culprit in up to 50% of chronic headaches. Taking NSAIDs 3 or more times per week is associated with medication-induced headache, or cephalalgia medicamentosa. We often fail to identify migraine headaches in children in the ED, likely for two reasons: prevalence of migraine increases with age, and children don’t present exactly like adults. Stewart et al. in Neurology, report a prevalence of migraine in children that increases with age: 3 to 7 years of age was 2%; 7 to 11 years of age, 7%; and 11 to 20 years of age, 20% Pearl: migraines are most commonly bilateral and temporal in children.  They resemble "adult" tension headaches, but are much more severe. We may not be able to sort this out in the ED.  The point here is that migraines in children are more common that we may expect, and they can interfere with school performance, with social development, or even with family dynamics and overall stress burden. Primary Headache Diagnosis: Not (Usually) "Our Thing" You noticed that we treated before we knew exactly the etiology; such is Emergency Medicine. We may not be able to make a specific, definitive primary headache diagnosis in the ED, but we should be aware of the criteria to help counsel patients and families. Tension headache is the most common, but it requires multiple, similar episodes: Migraine headache (without aura) requires less episodes, but more specific features: An aura is a fast-pass to diagnosis of migraine:   Primary Headache Management So how do we treat primary headaches? If you feel this is a mild tension headache, fluids by mouth and a simple NSAID are probably all that is needed, in addition to a heaping dose of reassurance.  Ibuprofen (10 mg/kg/dose q 6h, up to 600 mg) for a short course has the most evidence basis.  Acetaminophen (paracetamol) (15 mg/kg/dose q6 h) for a short course may also be given. Abortive treatments with the triptans may have been tried at home, but if they are coming to see us, we are past the point where triptans will be helpful. For the primary headache that is resistant to NSAIDs, IV therapy may be considered. If you’re going for IV, a nice evidence-based migraine cocktail is the following: 1. A bolus of 20 ml/kg of normal saline, up to a liter 2. Ketorolac (0.5 mg/kg; max, 30 mg) 3. Diphenhydramine (2 mg/kg; max, 50 mg) 4. Prochlorperazine (0.1 mg/kg; max, 10 mg) Dr Kaar et al. in Pediatric Emergency Care evaluated the safety and efficacy of their institution’s standardized pediatric migraine practice guideline in the emergency department, which used ths cocktail, based on the best evidence available. In their retrospective chart review, they found the average visual pain scale drop from 7.8 to 2.1 There were no adverse events reported. So, really you can treat children with migraines very similarly to adults. Other treatments on the horizon (still under investigation) in children include IV adjuncts such as magnesium, valproic acid, and dexamethasone. Aftercare and Recurrence Prevention For everyone who is going home, take just a moment to talk about the importance of sleeping well, eating well, getting exercise, limiting digital screen time, and trying to improve ways of dealing with stress. When all else fails, and the parent has “heard it all”: get them started on a headache diary. Take a piece of paper, fold it in half, and start a template for them to work on in a spiral notebook.  Start a sample entry for them, with the date and time the headache started, what it felt like, what was happening just before, what made the headache better, any dose of medications given, how long it lasted, and what the patient did after. There are even free apps that will track the headache pattern. This is the first thing a neurologist will start them on – and it’s sometimes a selling point to the parent that the time spent waiting for a referral to a neurologist is not waste – they will actually be in better shape and can move things along faster.  It also gives them some sens of control of what can be a draining situation. Summary and Mental Road Map If you were thinking meningitis or acute bleed, especially with fever or meningismus, get a CT first if you see signs of increased intracranial pressure, or if there is an abnormal neuro exam. Otherwise go straight to the lumbar puncture (LP). In the afebrile child with a normal exam, give symptomatic relief, briefly counsel them, and arrange for follow-up. In the afebrile child with an abnormal exam, obtain a CT in the ED. If negative, either admit for MRI if you are still concerned, or consider LP for idiopathic intracranial hypertension (pseudotumor cerebri). Talk with parents early about expectations, and offer them some friendly advice on prevention. Refer patients to the primary care provider or neurologist if the presentation is more involved. After a good history and physical examination in the ED that results in no red flags, we have time on our side. Help the family through the process by explaining the next steps and what can be done in the meantime. Compassion and a plan: sometimes these are our most powerful allies.   References Ajiboye N et al. Cerebral Arteriovenous Malformations: Evaluation and Management. Scientific World J. 2014; vol 2014. Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics. 2015 Feb;135(2):232-8. doi: 10.1542/peds.2014-2432. Chiappedi M, Balottin U. Medication overuse headache in children and adolescents. Curr Pain Headache Rep. 2014 Apr;18(4):404. doi: 10.1007/s11916-014-0404-9. Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T. Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics. 2010;126(5):952-60. Gonzalez LF, Bristol RE, Porter RW, Spetzler RF. De novo presentation of an arteriovenous malformation. Case report and review of the literature. J Neurosurg. 2005 Apr;102(4):726-9. Kaar CR, Gerard JM, Nakanishi AK. The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting. Pediatr Emerg Care. 2016 Jul;32(7):435-9. doi: 10.1097/PEC.0000000000000525. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A, Jarjour I; Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002 Aug 27;59(4):490-8. Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S; American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society.Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society.Neurology. 2004 Dec 28;63(12):2215-24. Medina LS, Kuntz KM, Pomeroy S. Children With Headache Suspected of Having a Brain Tumor: A Cost-Effectiveness Analysis of Diagnostic Strategies. Pediatrics. 2001;108(2):255-63. Richer L, Billinghurst L, Linsdell MA, Russell K, Vandermeer B, Crumley ET, Durec T, Klassen TP, Hartling L. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev. 2016 Apr 19;4:CD005220. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. JAMA. 1992;267:64-69. Tascu A et al. Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases. Romanian Neurosurgery. 2015; 29(23) 1: 85-89. This post and podcast are dedicated to Mark Wilson, PhD, BSc, MBBChir, FRCS(SN), MRCA, FIMC, FRGS for his #FOAMed generosity, candor, humility, and dedication to the care of the acutely ill and injured. Thank you. Pediatric Headache Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology Show Notes Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank's Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. Velez LI, Feng SY: Anticholinergics, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen's Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 150: p 1970-5. Anticholinergic Infographic (B...

This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology Show Notes Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank's Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. Velez LI, Feng SY: Anticholinergics, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen's Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 150: p 1970-5. Anticholinergic Infographic ...

This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology Show Notes Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. Velez LI, Feng SY: Anticholinergics, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 150: p 1970-5. Anticholinergic Infographic (BrianandKloss.com)

...maybe. If you've taken too much DIPHENHYDRAMINE!!!

In the present study, the equine histamine 4 receptor (eH4R) was cloned, sequenced and pharmacologically characterized. The findings were compared to those, obtained with the human H4R (hH4R). Due to its expression in cells of the immune system, the eH4R provides a promising target for the development of novel therapeutic strategies in allergic diseases, such as Recurrent Airway Obstruction (RAO) and allergic dermatitis in the horse. To clone the eH4R, mRNA was isolated from horse white blood cells and cDNA was synthesized by reverse transcription. Specific primers were used to amplify the eH4R sequence, which was then cloned into pJET1.2/blunt vectors. The open reading frame is 1185 bp long and codes for a 394 amino acid protein which shows 72,9 % homology to the human receptor. The cDNA sequence was published in the NCBI GenBank under the accession number HM015200. To pharmacologically and functionally characterize the eH4R and hH4R, their cDNAs were subcloned into the expression vector pcDNA3.1 and either transfected transiently into COS-7 cells or stably into HEK293 cells. Binding-characteristics were examined by homologous und heterologous competition experiments using the antagonist 3H-pyrilamine or the agonist 3H-histamine as radioligand. High affinity binding of histamine could only be detected in hH4R, but not in eH4R transfected COS-7 cells. Nevertheless, histamine was able to inhibit cAMP-production in stably transfected HEK293 cells via the eH4R and the hH4R. The eH4R expressed in HEK293 cells is coupled to the stimulation of ERK1/2, while the hH4R shows already high constitutive activity. The antagonists JNJ7777120, Thioperamide, Pyrilamine and Diphenhydramine display considerable species-specific differences concerning the affinities between eH4R and hH4R and also vary in their intrinsic activities. Thioperamide, known for its inverse agonism at the hH4R showed agonist behaviour in ERK1/2 regulation. In contrast, the non-selective antagonist Diphenhydramin showed inverse agonist behaviour, which was more pronounced at the hH4R than the eH4R. These findings suggest that there are considerable pharmacological and functional differences between the cloned eH4R and hH4R.