Medication Safe - Dr. Ben Tsutaoka

If it’s made for the eyes it’s got to be safe right.

Sometimes not. When it comes to safe guarding your child, eyedrops need to be treated just like any other medication. If your child is exposed to any medication, call your local poison control center, 1-800-222-1222, immediately.

Glaucoma can effect people of all ages although the elderly are at higher risk. Glaucoma is the leading cause of visual impairment. A commonly prescribed eyedrop called brimonidine could cause serious harm and lead to admission to the hospital if a child were to be accidentally exposed.

A recent article, authored by Drs. Becker, Huntington and Woolf from Cambridge Hospital, Harvard Medical School and Children’s Hospital Boston, was published in Pediatrics, Official Journal of The American Academy of Pediatrics. They looked at brimonidine exposures in children < 6 years old. The data comes from the American Association of Poison Control Centers, 1997 to 2005 and is provided by the 61 member centers.

Of the 176 cases of unintentional brimonidine poisoning, 28 had to be hospitalized for treatment. The most common symptom reported was drowsiness. Less frequently reported but potentially more serious symptoms included included pallor, irritability, low blood pressure, breathing difficulties and prolonged slowing of the heart rate.

Please continue to keep all medications inaccessible to your child.

More details of the study can be found here: http://www.health.am/ab/more/glaucoma-eye-drops-can-harm-kids/.

The published article can be found here: http://pediatrics.aappublications.org/cgi/content/full/123/2/e305.

As the holidays are upon us we want to remind you to be acutely aware that many of the calls received by poison control centers during this time are about children getting into medications brought into the home by visiting relatives. This was alluded to in an earlier post and can be loosely termed the “granny syndrome”  (http://medicationsafe.com/2008/07/13/hang-up-your-pocketbook-an-easy-intervention-for-the-granny-syndrome-grandparents-as-a-risk-factor-in-unintentional-pediatric-exposures-to-pharmaceuticals/).

 The following is an excerpt of an article that appeared in the Tucson Citizen and was an interview of one of our colleagues at The Arizona Poison and Drug Information Center. The full story can be found here: http://www.tucsoncitizen.com/daily/local/103597.php.

Holidays are for family, friends and feasting, but can be dangerous for festive revelers under 5.

According to the Arizona Poison and Drug Information Center at the University of Arizona College of Pharmacy, pediatric poisoning calls increase almost three-fold on Thanksgiving, Christmas and the days immediately bracketing those holidays.

You can blame some of it on Grandpa.

“We know relatives come to visit over the holidays and grandma and grandpa frequently stay in the kids’ room and their medication is in their suitcase,” said Jude McNally, managing director of the poison center. “I can guarantee we will have several kids admitted to pediatric ICU because of a grandparent’s medication over Thanksgiving. It happens every year.”

We want to encourage you to take a couple of minutes when visitors come to make sure their medications are properly secured. Make sure purses and bags containing medications are out of the reach of young children. This can avert a trip to the Emergency Room or a hospital stay.

Your local poison control center can be accessed by calling 1-800-222-1222.

As the cough and cold season is upon us, the Consumer Healthcare Products Association issued a news release regarding a voluntary change in labeling by manufacturers of over the counter pediatric cough and cold medicines to state do not use in children under 4 years of age.

“Children’s over-the-counter (OTC) cough and cold medicines are safe and effective when used as directed, and the leading makers of these medicines are committed to working with the U.S. Food and Drug Administration (FDA) and pediatric experts to ensure that parents and caregivers have appropriate treatment choices for their children. Research shows that dosing errors and accidental ingestions—not the safety of the ingredients themselves when properly dosed—are the leading causes of rare adverse events in young children. As a result, the leading manufacturers of oral OTC pediatric cough and cold medicines are moving forward on both the design and implementation of initiatives aimed at encouraging the appropriate use of these medicines.

After consulting with FDA, the leading manufacturers of these medicines are voluntarily transitioning the labeling on oral OTC pediatric cough and cold medicines to state “do not use” in children under four years of age; these modified labels will continue to provide dosing information for children four and older. In addition, for products containing certain antihistamines, manufacturers are voluntarily adding new language that warns parents not to use antihistamine products to sedate or make a child sleepy. Adult cough and cold medicines are not impacted by the label update.”

The full statement can be found here:

http://www.chpa-info.org/10_07_08_PedCC.aspx.

Here’s a news story from MSNBC http://www.msnbc.msn.com/id/27168078/ regarding an article we posted at the end of September from the Annals of Emergency Medicine about opiate abuse and resultant exposures in children.

By JoNel Aleccia

Health writer

updated 4:33 a.m. PT, Mon., Oct. 20, 2008

Nine-month-old Shayla Davidson was a sick little girl, and her mother had no idea why.

Pale, listless and barely breathing, the baby wouldn’t wake up one day last month, even when 25-year-old Nicolle Jones rushed her to an emergency room near Cincinnati.

Medical crews were stumped, too, until they noted that Shayla’s pupils were constricted, a tell-tale sign of opiate poisoning.

“They kept asking me, ‘Did she get ahold of any medicine?’” Jones recalled. “I said, ‘No.’”

In fact, Shayla had ingested medication, a single 60-milligram tablet of oxycontin, a powerful prescription painkiller.

But pediatric specialists at the Cincinnati Children’s Hospital and Medical Center wouldn’t know that until later, after they’d treated the child five times with a strong antidote and performed tests that linked Shayla’s life-threatening condition to the common drug her grandfather takes for back pain.

“I about fell on the floor when they told me,” said Jones, who lives with her parents in nearby Independence, Ky. “My dad keeps his medicines up high. We’re thinking he dropped it.”

Shayla’s fine now, but she’s also lucky, according to a recently released report from the nation’s poison control centers. It shows a rising tide of prescription drug use is threatening unintended users: young children who accidentally ingest the powerful painkillers.

Some 9,179 toddlers and kids under age 6 were exposed to widely prescribed drugs such as hydrocodone, oxycodone and methadone between January 2003 and June 2006, according to a report published online in September in the Annals of Emergency Medicine.

Exposures ranged from a pill snatched quickly from a kid’s mouth to actual ingestion, said Dr. Richard C. Dart, medical director for the Rocky Mountain Poison and Drug Center in Denver, and a co-author of the report.

‘One pill is enough’
Eight children died, 43 suffered life-threatening injuries or serious disabilities and 214 required prolonged medical treatment, all because they mistakenly took strong medications belonging to their parents, grandparents and other adults.

“For opioids, really, one pill is enough,” said Dart. “One pill can kill or at least cause major effects.”

The incidents represent a surge in injuries and near-misses that have made prescription drugs a top cause of child poisonings, second only to carbon monoxide poisoning, said Dart. The study, which used data from the Researched Abuse, Diversion and Addiction-Related Surveillance — RADARS — system, probably underestimates the extent of the problem, he added, because not all poison control centers participated and not all exposures are reported.

“Conservatively, you can say the number is twice that high and probably higher than that,” Dart said. “I knew we would find something, but I was stunned.”

The accidents have been fueled by skyrocketing rates of legal and illegal prescription painkiller use. There were 119 million prescriptions written for hydrocodone in the United States in 2007, up from 112 million in 2006, according to figures from IMS Health, a healthcare information and consulting company. Prescriptions for variations of oxycodone topped 38 million, up from 34 million a year earlier.

At the same time, about 5.2 million people aged 12 and older used prescription pain relievers for non-medical purposes in 2007, latest figures from the federal Office of Applied Studies showed.

Overall, deaths caused by unintentional drug poisonings spiked by nearly 70 percent between 1999 and 2004, according to a report last year from the federal Centers for Disease Control and Prevention, which attributed most of the increase to overdoses of prescription painkillers.

“I think what we’ve noticed over the years is that as the prescription opiate pain reliever base goes up — legitimately and illegitimately — more kids are getting into these pills,” said Dr. Randall Bond, medical director for the Cincinnati Drug and Poison Information Center.

Other drugs, such as heart medications, certain antidepressants and anti-malaria drugs are equally dangerous, Bond added. But they’re not nearly as common as the potent pain relievers.

Not necessarily neglect
About half of the opiate exposures occurred in what Dart described as “complicated” households, those with many adults living together or with histories of drug use or child neglect. The rest occurred in “competent” families with no signs of neglect or abuse, he added.

“For good families, if you have patient opioids in the household, you’d be surprised how fast a kid can get ahold of these,” Dart said.

Some of the children in the report drank liquid methadone stored in refrigerators. Others encountered dropped drugs while crawling or toddling, and still others got into a grandparent’s purse or suitcase and found untended bottles of pills.

“Those caps are only child-resistant,” Dart said. “They just slow down a child.”

Once a child ingests a strong painkiller, the effects can be quick — and deadly. The drugs generally act by depressing respiration, so a youngster affected may simply stop breathing.

In Shayla Davidson’s case, it was fortunate that her family noticed her behavior during the day.  “If the child had gotten into it right before bed, she might never have woken up,” said Bond.

Nicolle Jones, Shayla’s mother, said her family always took precautions with medications, but they’ve made them even stronger. They keep the drugs in a locked cabinet and there’s a new hook on the bathroom door.

“Oh my God, my dad felt so bad that she got hold of one of his medicines,” Jones said. “It was a scary situation. I could have lost my baby.”

The following is a story from the Los Angeles Times:

http://www.latimes.com/features/health/la-he-drugside15-2008sep15,0,150748.story

By Melissa Healy
Los Angeles Times Staff Writer

September 15, 2008

Prescriptions for painkillers — left over from surgeries, orthopedic injuries or dental work — frequently languish, unfinished, in family medicine chests.

Supplies of anti-anxiety medications, including the benzodiazepines known by their commercial names Xanax and Ativan, take up shelf space because they are prescribed for episodic use. And as a growing number of adults are diagnosed with ADHD, their stimulant medication often sits alongside that of their children with attention difficulties.

Unwittingly, parents who leave these medications unsecured and unmonitored are tempting their children — and their children’s friends — to try drugs they have heard and read about at school, in movies and on the Internet. In a teenager’s calculation, the price is right and the risks — of scoring the drugs at least — are low.

For parents, the antidotes to youthful rebellion and the impulse to dangerous experimentation may be complex and elusive. But making it harder for kids to lay hands on drugs with high addiction potential and growing allure among their friends, say experts, is quite simple:

Lock ‘em up. (No, not the kids. The drugs.)

“In total, nearly half the prescription drugs being abused by teens originate in the homes of passive pusher parents,” concluded National Survey of American Attitudes on Substance Abuse” released last month by Columbia University’s National Center on Addiction and Substance Abuse. CASA Executive Director James Califano called parents who fail to lock up prescription medications — or who fail to ask the parents of their kids’ friends to do the same — “problem parents.”

Experts also urge parents to dispose of prescription drugs that remain unused after their purpose has been served. The Office of National Drug Control Policy warns against flushing them down the toilet — which sends them into public water supplies — but recommends disposing of them in a coffee canister or other tightly closed opaque container, under coffee grounds or kitty litter to make exploration less appealing.

If prescription medications need to be retained for future use, experts say parents should keep an inventory of them and secure them, either under lock and key or by keeping them where a curious child won’t find them.

The stakes are high — not only for teens and young adults but for their younger siblings. The Centers for Disease Control and Prevention reported recently that deaths from drug use among people age 15 to 24 doubled from 1999 to 2004 — with the overwhelming majority involving prescription painkillers. Last week, the Annals of Emergency Medicine reported 9,147 cases of accidental ingestion of opiates by children under 6 — for whom such medications can be lethal even at very small doses — in a 3 1/2 -year period starting January 2003. In eight cases, death was the result.

The authors — a trio of University of Colorado Medical School researchers — believe the “poisoning of young children from prescription opioid occurs regularly,” and suggests the number of children who actually found and took pain pills left out is probably much higher, since they only surveyed a portion of U.S. poison control centers to gather their data.

“The word is getting out to teens and their parents that prescription medications are dangerous when used improperly, but plenty of risk remains,” says Dr. Linda Lawrence, president of the American College of Emergency Physicians. “Adults need to monitor closely all medications in the house, and apply the same sense of caution that they would to any potentially dangerous substance.”

The following  information is part of a press release from the Home Safety Council.

The entire press release can be found here:

http://www.earthtimes.org/articles/show/new-home-safety-councilr-research-shows-the-majority-of-families,301941.shtml 

WASHINGTON, March 4, 2008 /PRNewswire/ — According to the national nonprofit, Home Safety Council, accidental poisoning is the second leading cause of home injury death in the United States. Yet, a new survey by the Council found that only one percent of U.S. adults ranked poisoning at the top of the list when asked to identify their leading home safety concern, proving the need for aggressive home poisoning prevention education.

The nationwide Safe Haven survey was commissioned by the Home Safety Council to gauge the public’s perceptions and actions related to the top home injury dangers. Poison-related findings also show that less that one-fifth (18 percent) of U.S. adults have put safety locks on cabinets or have posted the Poison Control Help number near phones — two of the key actions recommended by the Home Safety Council to reduce the risk and severity of poisoning injuries.

“Perhaps the most important finding from the Safe Haven research is that parents and other caregivers aren’t doing nearly enough to protect themselves and their families from serious home poison dangers,” said Dr. Angela Mickalide, Director of Education and Outreach for the Home Safety Council. “Poison Prevention Month is a helpful reminder for all of us to take action against this major health problem.”

The most critical actions the Home Safety Council recommends taking now are to: read product labels and lock away those with the words “Caution,” “Warning,” or “Danger” on the label; keep dangerous products away from food and drinks; properly use and maintain fueled appliances; install a Carbon Monoxide alarm near sleeping areas; and put the Poison Control Help number (1-800-222-1222) and other emergency numbers next to every phone and store them in cell phones directories.

About Home Safety Council

The Home Safety Council (HSC) is the only national non-profit organization solely dedicated to preventing home-related injuries that result in nearly 20,000 deaths and 21 million medical visits on average each year. Through national programs, partnerships and the support of volunteers, HSC educates people of all ages to be safer in and around their homes. The Home Safety Council is a 501(c)(3) charitable organization located in Washington, DC.

Contact: Valerie Pope Brand Resources Group, Inc. 703-739-8344 Home Safety Council

Everyday at the Poison Control Center we get numerous calls from incredulous parents that their toddler got into a bottle of pills. Here’s a news story I ran across from 2005 that gives a great example showing that these caps are not “childproof”.

The original news story can be found here: http://www.cbsnews.com/stories/2005/08/24/earlyshow/living/ConsumerWatch/main793212.shtml

(CBS) Sometimes, it’s tough for adults to open medicine bottles. But just how quickly would a bunch of kids be able to open them up? The Early Show Consumer Watch correspondent Susan Koeppen wanted to find out, so she put these safety caps to the test.

She gathered a group of preschoolers, ages 3 to 4, at a day care center in New York City.

Koeppen gave them seven bottles to open. The bottles were emptied and sanitized, but mouthwash, iron pills, drain cleaner, Tylenol, aspirin, dish washer detergent and cough syrup were some the products that had been stored in these bottles.

Then, with the parents watching, Koeppen conducted the experiment and the kids were able to open three of the bottles — including the one for the iron pills. These pills are one of the most deadly and poisonous products in the group.

It took one second for 4-year-old Steven to open that bottle. He also popped the top off a red bottle, which had contained drain cleaner — a substance as lethal as arsenic.

Dr. Shari Platt, head of the pediatric emergency department at New York Presbyterian Hospital, has studied child resistant caps and she says more than a million children are accidentally poisoned every year — often by household products and medicines that came in child-resistant containers.

“Parents think the safety cap is going to give them 100 percent security,” Platt says. “They don’t realize how easily children can get into these medicines, but they do.” Every seven minutes, a child under the age of five goes to the emergency room because of an unintentional poisoning.

“The law strikes a balance between keeping the youngest kids who mouth everything they get their hands on with the need for the elderly to access their pills or other medicines,” says Scott Wolfson, of the CPSC.

But some of the parents in Koeppen’s test group say the government standard isn’t strong enough. They saw firsthand that they couldn’t rely on child safety caps to keep kids safe.

“It’s very much an eye opener to me,” one mother says. “You realize that you have to be very prudent about keeping things away from your children. It could be life-threatening.

“A recent study showed that children as young as 2 were able to open bottles with child resistant caps. So parents need to realize these caps are not child proof, just child resistant.

For poison control centers in your area call 1-800-222-1222.

ScienceDaily (May 31, 2008) — According to a new study, knowledge of potentially toxic household substances among primary caregivers for young children is alarmingly poor. The results show that less than one-third of primary caregivers for children under the age of six could correctly estimate the toxicity of household poisons.

Led by Rika N. O’Malley, M.D of the Albert Einstein Medical Center, the study involved screening primary caregivers of young children who visited emergency departments, and asked participants to identify toxic items from a list of common household products.

“Young children are at risk of household chemical ingestion and their caretakers often do not have good understanding how toxic those chemicals are,” says O’Malley. “Parental education needs to be focused more on younger caretakers with more children.”

However, the study did identify a number of factors that increased the likelihood of knowledge of household poisons. These include: more education, responsibility for fewer children and an age greater than twenty-three years.

The research provides practical information about poison prevention. The authors believe that education from primary care physicians can target at-risk populations for poison prevention and education.

The study is being presented at the Society for Academic Emergency Medicine’s 2008 Annual Meeting in Washington, D.C. on May 30, 2008. The presentation is entitled “Caregivers of Young Children Do Not Have Basic Knowledge or Familiarity with Potentially Toxic Household Products.”  Abstracts of the papers presented are published in Vol. 15, No. 5, Supplement 1, May 2008 of the official journal of the SAEM, Academic Emergency Medicine.

Wiley-Blackwell (2008, May 31). Most Caregivers Of Young Children Lack Basic Knowledge Of Potentially Toxic Household Products. ScienceDaily. Retrieved June 7, 2008, from http://www.sciencedaily.com/releases/2008/05/080530074233.htm

The following article is from:
http://sev.prnewswire.com/health-care-hospitals/20080128/DC1255028012008-1.html

Leading makers of OTC medicines working to raise awareness of this need among parents, healthcare professionals

WASHINGTON, Jan. 28 /PRNewswire-USNewswire/ — A government report published today by the journal Pediatrics shows that the number of emergency room visits by children attributable to pediatric over-the-counter (OTC) or prescription cough and cold medicines are rare — and of these visits, a vast majority were to due to accidental ingestion. The review was prepared by the U.S. Centers for Disease Control and Prevention.

Linda A. Suydam, president, Consumer Healthcare Products Association, commented on the analysis, stating: “This CDC review puts the overall discussion of pediatric cough and cold remedies into perspective by focusing on concrete data that address the real issue. These medicines are safe when used as directed, and this government review underscores the importance of educating consumers — especially those with small children — on the safe use and safekeeping of medicine.”

CHPA has been working to educate consumers that safe use and safekeeping of all medicines can be critical in preventing adverse events. “Safety and the safe use of our medicines are our top priority, so it is important that we understand the root causes of any adverse event, and raise awareness about storing medicines safely out of the reach of children,” said Suydam.

According to the CDC report, unsupervised ingestions of either prescription or OTC cough and cold medicines account for two-thirds of emergency department visits related to OTC and prescription cough and cold medicines. This examination of emergency room data reinforces and further validates nationwide poison control data. An independent analysis of the American Association of Poison Control Centers’ database also demonstrates that accidental ingestion by children ages 2-5 accounts for two-thirds of non-fatal adverse events. Richard Dart, M.D., director, Rocky Mountain Poison and Drug Center, said: “Today’s review by the CDC is consistent with the findings of an independent panel of medical experts. The risks can be addressed by educating consumers to follow the directions on the package label and perhaps other techniques.”

“CHPA’s member companies remain committed to ensuring that all OTC oral pediatric cough and cold medicines are packaged appropriately,” Suydam emphasized. “The leading makers of these medicines have been moving ahead rapidly on this front, so that child-resistant packaging will be voluntarily added even where it is not required.”

CHPA is also engaging parents in an expanded education campaign focusing on the importance of using and storing all medicines safely. This effort includes an educational web site, OTCsafety.org, which is designed to provide parents, caregivers, and healthcare professionals with helpful reminders on how to use and store OTC medicines safely.

“Real-life experience shows that most parents use these medicines safely and are satisfied with how they treat their child’s cough and cold symptoms,” Suydam said.

CHPA is the 127-year-old-trade association representing U.S. manufacturers and distributors of over-the-counter medicines and nutritional supplement products.

www.chpa-info.org

Website: http://otcsafety.org//
Website: http://www.chpa-info.org/