Anthony S Manoguerra's research while affiliated with University of California, San Diego and other places

Publications (65)

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The types and rate of adverse drug reactions experienced by breastfed infants whose mothers are taking medications has not been well defined. This article reviews the literature on adverse drug reactions in infants since a previous review in 2002. Case reports and studies of adverse drug reactions in breastfed infants whose mothers were taking a pr...
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To examine health related quality of life (HRQOL), perceived stress, and coping skills in the 3 preclinical years of a doctor of pharmacy (PharmD) curriculum. Health-related quality of life, perceived stress, and coping strategies were measured using the Short Form-36, Perceived Stress Scale, and Brief COPE. Average annual scores were compared acro...
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The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death. Fatalities that involved a child younger than 12 years and mentioned a cough and col...
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A review of US poison center data for 2004 showed over 9000 ingestions of valproic acid. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and ca...
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Unlabelled: The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with suspected exposures to elemental mercury. An evidence-based expert consensus process was used to create this guideline. It is based on an assessment of current scientific and clinical information. T...
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The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and out-of-hospital management of patients with suspected acute ingestions of atypical antipsychotic medications by 1) describing the process by which an ingestion of an atypical antipsychotic medication might be evaluated, 2) identifying...
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A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and...
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The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of dextromethorphan by 1) describing the process by which an ingestion of dextromethorphan might be managed, 2) identifying the key decision elements in managing...
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A review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce...
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A review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruptio...
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The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with suspected exposure to long-acting anticoagulant rodenticides (LAAR). An evidence-based expert consensus process was used to create this guideline. It is based on an assessment of current scientific and clinical...
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A review of U.S. poison center data for 2004 showed over 12,000 exposures to tricyclic antidepressants (TCAs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce healthcare costs, and reduce life disruptio...
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The American Journal of Emergency Medicine. Recognition of the Editorial Board, 1980's and 1990's.
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In 2003, there were 28,092 human exposures to diphenhydramine reported to poison centers in the US. A related drug, dimenhydrinate, is a less frequent cause of poisonings. Between January 2000 and June 2004, there were 2,534 reported dimenhydrinate ingestions in children less than 6 years of age. An evidence-based expert consensus process was used...
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The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of acetaminophen. An evidence-based expert consensus process was used to create this guideline. This guideline applies to ingestion of acetaminophen alone and is based on an asse...
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A review of national poison center data from 1990 through 2003 showed approximately 10,000 annual ingestion exposures to camphor-containing products. A guideline that determines the threshold dose for emergency department referral and need for prehospital decontamination could potentially avoid unnecessary emergency department visits, reduce health...
Article
Calcium channel antagonists (CCAs) are known to cause significant toxicity in overdose. Determining triage guidelines for CCAs is an important but difficult task. This study was designed to determine if an unintentional overdose of a patient's CCA could result in clinically significant cardiovascular (CV) symptoms (hypotension, bradycardia, conduct...
Article
The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying proc...
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In 2003, U.S. poison control centers were consulted after 9650 ingestions of calcium channel blockers (CCBs), including 57 deaths. This represents more than one-third of the deaths reported to the American Association of Poison Control Centers' Toxic Exposure Surveillance System database that were associated with cardiovascular drugs and emphasizes...
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In 2003, US poison centers were contacted regarding ingestion of β-blockers by 15,350 patients including 3766 (25%) under 6 years of age; 7415 (48%) were evaluated in healthcare facilities and 33 died. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. T...
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From 1983 to 1991, iron caused over 30% of the deaths from accidental ingestion of drug products by children. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the primary author. The entire panel discusse...
Article
The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying proc...
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In 2002, poison centers in the US reported 5816 human exposures to ethylene glycol. A guideline that effectively determines the threshold dose for emergency department referral and need for pre-hospital decontamination could potentially avoid unnecessary emergency department visits, reduce health care costs, optimize patient outcome, and reduce lif...
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Medication use during breastfeeding shortens the duration of breastfeeding often because of overly cautious information given by healthcare providers. No comprehensive review of the literature on infant adverse reactions from drugs in breastmilk has been published. All published studies and case reports on adverse events in infants caused by medica...
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We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K. We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who...
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Penetrance values estimate the utilization of poison centers services. For a variety of reasons, penetrance values may vary greatly among geographic areas of population. We examined the relationship between ethnicity and penetrance in our population. We conducted a retrospective review of data from January 1, 2000 through December 31, 2000 from our...
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To evaluate outcomes following toxic mushroom ingestions. Retrospective data analysis. We analyzed American Association of Poison Control Center data for California from 1993 through 1997. A total of 6,317 exposures occurred during the study period. Most (n = 6,229 [99.7%]) were acute exposures, and the rest (0.3%) were chronic; 87.6% (n = 5,536) w...
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Iron is the one of the leading causes of pediatric poisoning deaths in the United States. Most cases of serious iron overdose reported in the medical literature have resulted from adult formulations of iron. To begin evaluating the possibility that differences in toxicity exist between iron preparations, we performed a retrospective evaluation of a...
Article
To determine whether pediatric patients with acute, mild to moderate acetaminophen exposures, treated with home monitoring alone, develop systemic signs of hepatic injury. A prospective, observational study of calls to a regional poison center over a 25-month period was performed. Patients were eligible for the study if they were younger than 7 yea...
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To describe the histopathologic and pharmacokinetic differences of acute iron poisoning between chewable multivitamins with iron and solid iron tablets in a swine model. This was a prospective, randomized, unblinded toxicity study of iron poisoning of two iron formulations in male Yorkshire pigs. Eight swine were randomized to receive 60 mg/kg of i...
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Traditionally, ipecac has been used in the home; however, recently attention has focused on pre-hospital activated charcoal (AC) administration. In an effort to assess the availability of AC and ipecac, we conducted a telephone survey. One-hundred and 18 pharmacies were randomly selected from the 59 counties in California to assess availability of...
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Breath alcohol devices are routinely employed by emergency department personnel to reflect blood ethanol levels. No data have been published using these devices following the ingestion of "alcohol-free" beer that are required to contain < 0.5% alcohol. We performed a prospective, randomized, unblinded study on 8 healthy male volunteers that abstain...
Article
Seafood poisoning has been recognized as a problem in both coastal and inland populations for millennia. Many types of sea creatures from shellfish to the largest fish have been implicated. Severe cases of many different types of seafood poisonings can result in fatalities. While the pathophysiology of the toxins is well known in some cases, others...
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To determine the impact and safety of diverting poisoning calls from 911 to a regional poison center. A prospective six-month review was performed of all calls transferred from 911 dispatchers to a regional poison center for management. Recommendations for management and transport were made by the poison center using existing protocols. Patients we...
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A case of digoxin poisoning following the co-administration of digoxin and clarithromycin in a 28 year old male is described. Since the aetiology of chronic digoxin poisoning is often unclear, clinicians should be aware of the potential drug-drug interaction between digoxin and clarithromycin.
Article
The approach to the use of gastrointestinal decontamination procedures in the treatment of ingested toxins has changed in recent years. Many toxicologists and physicians have taken strong positions either for or against the use of emesis, gastric lavage, activated charcoal, or other procedures. What is the scientific basis for these positions? This...
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Treatment of an acetaminophen overdose with N-acetyl cysteine usually is based on the position of the 4-h acetaminophen (APAP) level on the Rumack-Matthew nomogram; however, there is disagreement on the level at which clinically relevant hepatotoxicity occurs. A retrospective review of all acute adult formulation APAP exposures reported to our pois...
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Activated charcoal (AC) is most effective when administered soon after the ingestion of certain substances. Delays are recognized to occur at times in the administration of AC after arrival of poisoned patients in the emergency department (ED). In addition, it has been recognized that these delays may be avoided if AC administration is begun in sel...
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Case report: Hypermagnesemia is a rare condition that commonly follows excessive therapeutic administration of magnesium sulfate to treat eclampsia of pregnancy. Signs and symptoms of this condition include extreme muscle weakness, loss of deep tendon reflexes, mental status depression, and cardiac dysrhythmias. Clinically significant hypermagnese...
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To assess the state of disaster readiness of poison control centers, a survey questionnaire was sent to all 96 institutional poison control center members of the American Association of Poison Control Centers in the US, both certified and noncertified programs. The data reported are the results and responses from 76 of 96 (79.2%) poison control cen...
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Ciguatera fish poisoning results from the bioconcentration of a variety of toxins produced by marine dinoflagellates. Signs and symptoms vary widely, but it usually presents as gastrointestinal and neurologic complaints beginning shortly after the ingestion of fish containing the toxins. Symptoms may persist for months and sometimes even years. Alt...
Article
To determine the ability of the Hemoccult and Gastroccult tests (SmithKline Diagnostics) to detect blood in vitro in whole-bowel irrigation (WBI) solution. One tablet of ferrous gluconate 324 mg, ferrous sulfate 325 mg, or ascorbic acid 500 mg; or one Materna prenatal vitamin tablet (Lederle Laboratories) was dissolved in 30 mL of Colyte. Colyte al...
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A patient developed a severe cholinergic syndrome from the use of echothiophate iodide ophthalmic drops, presented with profound muscle weakness and was initially given the diagnosis of myasthenia gravis. Red blood cell and serum cholinesterase levels were severely depressed and symptoms resolved spontaneously following discontinuation of the eye d...
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Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg...
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A severe case of phytophotodermatitis occurred in a patient who had spent several hours walking through an area densely populated with Cneoridium dumosum. This patient's co-worker experienced a similar reaction after undergoing patch testing of an area of skin and exposing it to sunlight. Voluntary patch testing by one of the authors produced a rea...
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Aerosolized lacrimating agents are widely employed as "safe" criminal deterrents. The most common active ingredient in these products is 1-chloroacetophenone (CN). Although mild and brief skin and eye irritation is frequently seen following exposure to these compounds, severe reactions can occur. We report a patient who sustained a severe contact d...
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In Reply.— Drs Woolf, Liebelt, and Lovejoy offer an interesting commentary on this study, and we certainly concur with a number of their points. We regret any impression that these data are infallible, an impression which might have been conveyed by our failure to discuss the validity of the American Association of Poison Control Centers (AAPCC) pe...
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The adsorption of amitriptyline, desipramine, doxepin, imipramine, and nortriptyline onto cholestyramine was demonstrated in vitro with use of 1.2 mol/L HCl at 37 degrees C to simulate gastric fluid. Binding to cholestyramine was approximately 80% for each of the tricyclic antidepressants, and this was about the same degree of binding noted with a...
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This analysis of life-threatening and fatal pediatric poisonings was conducted to aid poison prevention educational efforts, guide product reformulations and aversive agent use, reassess over-the-counter status for selected pharmaceuticals, and identify research areas for clinical advances in the treatment of pediatric poisonings. A hazard factor w...
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A 39-year-old woman ingested 59 mL of Super Nail Nail Off (American International Industries, Hollywood, CA) (containing 99% acetonitrile) in a suicide attempt. Following a latent period of approximately 12 hours, the patient developed cyanide poisoning with severe metabolic acidosis, seizures, and shallow respirations. She responded to the adminis...
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Diquat dibromide is a commonly used herbicide. The product label cautions against allowing the material to contact the skin as severe skin irritation is possible as well as absorption of the material into the systemic circulation. Waterproof footwear and clothing should be worn to minimize skin contact. A case of full thickness burns of the feet re...
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A study of 1943 potentially toxic ingestions occurring in children under 6 years of age was conducted by 3 geographically and demographically diverse poison centres to determine the incidence of exposures to poison. Of the total group, 30.1% indicated that the child had experienced a prior poison exposure (12.0% in children under 1 year of age, and...
Article
A 36-year-old man ingested several products, including a topical minoxidil solution. Within two hours of the ingestion the patient was difficult to arouse, tachycardic, and hypotensive with a systolic BP of 90 mmHg. Dopamine was required for two days to maintain his BP. Swan-Ganz catheter measurements demonstrated an increased cardiac output and de...
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Issue: The committee will consider the safety and efficacy of new drug applications, (NDA) 19-658, Claritin Tablet, NDA 20-704, Claritin RediTab, and NDA 20-641, Claritin Syrup. These three Claritin® products (loratadine, Schering-Plough Corporation) are immediate release formulations of the products that are proposed for over-the-counter (OTC) use...

Citations

... The combined position statement of the AACT and EAPCCT concluded that there was no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the ED should be abandoned [4] . This was followed by a guideline released by the AAPCC that suggested ipecac should only be used at home if there would be a delay of 1 h or more before a patient could get to an ED and then only if it could be administered within 30-90 min after the ingestion [25]. The American Academy of Pediatrics recommended removing all ipecac from the home setting and that ipecac should not be used routinely as a home treatment for pediatric poisonings [26]. ...
... Frequently used forms of iron in supplements include ferrous and ferric iron salts such as ferrous sulfate, ferrous gluconate, ferric citrate, and ferric sulfate. Because of its higher solubility, ferrous iron in dietary supplements is more greatly bioavailable than ferric iron [25]. Despite its wide diffusion, most oral iron supplements have been associated with erosive mucosal injury in the upper gastrointestinal tract as well as nausea, vomiting and epigastric discomfort, diarrhoea, and constipation [26]. ...
... Short-term effects of exposure to psychotropic medicines via breastmilk include sedation, irritability, restlessness, diarrhoea and suboptimal weight gain [80,81], but how these relate to long-term neurodevelopment is unknown. Current practice recommendations rest on case series, indicating that opioids, clozapine, amisulpride, combinations of central nervous system depressants, amiodarone, oral retinoids, radio-iodine, topical and systemic free iodine, and chemotherapy pass into breastmilk, risking (at least) short-term transgenerational (mother to child) adverse drug reactions (ADRs) glossary following breastmilk exposure [39,82]. Including breastfeeding in analyses of infant outcomes informs families as to whether the benefits of breastfeeding outweigh the risks of increasing infants' total dose. ...
... Aerosol and liquid contact with CN typically leads to pruritis, localised pain, erythema, rash, purpura, desquamation, vesicles, blistering, second-degree burns, bulla, scaling and subcutaneous oedema. 45 55 59 72-78 Topical OC products used as pain treatments can also cause burning, stinging and erythema, 79 and have also caused contact dermatitis following exposure during food preparation. 80 Severe dermal manifestations appear more common where handheld spray products are used. ...
... The prevalence of serious toxicity tied to the excessive use of iron for pediatric patients is less than that of adult poisoning with iron preparations. While mortality did not occur in any of the 195,780 patients in the United States within the pediatric age group and among those who incorrectly and excessively used iron preparations between 1983 and 1998, 60 of the 147,079 adult cases of poisoning with iron preparations during the same period were mortal [4]. Cases of iron poisoning are now less frequent, yet still preserve their importance. ...
Reference: Iron poisoning
... Multiple studies have assessed causes of stress in health professions students, including Doctor of Pharmacy (PharmD) students. [1][2][3][4][5][6][7][8][9][10] Students in health professions programs can experience excessive amounts of stress from personal situations, academic challenges, and economic hardships, including increased tuition. 2,4 These stressors may have implications on students' academic performance and mental health. ...
... One factor that was identified was the lack of an appropriate device to administer drugs. 9 Spoons and droppers that are most often used by parents are inaccurate. The acetaminophen hepatotoxicity working group of the Food and Drug Administration has recommended improved packaging to facilitate delivery of an appropriate dose as a practical intervention. ...
... 20 In a study evaluating the data of 72 poisoning centers between 1985 and 1989, 60.8% of 3.8 million poisoning cases occurred in children aged 6 years. 23 Ozdemir et al. 24 analyzed 2.251 cases and reported that poisoning is more common in boys aged <5 and in girls aged >13 years. As regards causes of poisoning, accidental poisoning (68.1%) is the most frequent cause. ...
... This case demonstrated that acetone and acetronitrile can be easily confused, and the importance of distinguishing the causative agent and treating appropriately. Although most cases are described as accidental ingestions in the pediatric population, adult consumption as attempted suicide has also been reported [100]. One case of ingestion in adult patient exhibited complication in treatment. ...
... Numerous studies have supported that the Ras signaling pathway, PI3K-Akt signaling pathway, Rap1 signaling pathway, and MAPK signaling pathway were important pathways in tumorigenesis, drug resistance, and progression of EC (30)(31)(32)(33)(34). In addition to several cancer pathways, ANGPT1 is also a significant regulator of cytokine-cytokine receptor interaction, and the PPI network showed that ANGPT1 interacted with CXCL12, FGF2, HGF, PDGFRA, and so on; most of them were the cytokine or cytokine receptor, as well as the regulator for the immune system (35)(36)(37)(38)(39). It has been shown that CXCL12 and FGF2 are adverse markers for UCEC via promotion of the proliferation, migration, and invasion of cancer cells (40,41). ...