Burns from OTC Dermal Pain Relievers

Over-The-Counter Topical Muscle and Joint Pain Relievers: Drug Safety Communication - Rare Cases of Serious Burns

AUDIENCE: Consumer, Health Professional

ISSUE:  FDA is alerting the public that certain over-the-counter (OTC) products that are applied to the skin for the relief of mild muscle and joint pain have been reported to cause rare cases of serious skin injuries, ranging from first- to third-degree chemical burns, where the products were applied. When applied to the skin, the products produce a local sensation of warmth or coolness.These products should not cause pain or skin damage, however, there have been rare cases of serious burns following their use. Some of the burns had serious complications requiring hospitalization

BACKGROUND: OTC topical muscle and joint pain relievers are used to temporarily relieve minor muscle and joint aches and pain. These OTC topical muscle and joint pain relievers are available as single- or combination-ingredient products that contain menthol, methyl salicylate, or capsaicin, and are marketed under various brand-names, such as, Bengay, Capzasin, Flexall, Icy Hot, and Mentholatum. The various formulations include creams, lotions, ointments, and patches.

RECOMMENDATION: Consumers using an OTC topical muscle and joint pain reliever who experience signs of skin injury where the product was applied, such as pain, swelling, or blistering of the skin, should stop using the product and seek medical attention immediately. When recommending OTC topical muscle and joint pain relievers to patients, healthcare professionals should counsel patients about how to use the products appropriately and inform them about the risk of serious burns.

Jimi Hendrix

Today in 1970 Jimi Hendrix was found dead in London.  Jimi was a well know heroin, LSD and marijuana user.  Early the morning of his death he ingested multiple Vesparax (combination barbiturate and hydrozyzine).  His autopsy reported the cause of death to asphyxiation, he choked on his own vomit.  A sad ending to a 27 year-old musical legend.   

Jimi Hendrix and the closing of Woodstock.

Hydrocodone/APAP Recall

Qualitest Hydrocodone Bitartrate and Acetaminophen Tablets 10 mg/500 mg: Recall - Potential for Oversized Tablets

AUDIENCE: Consumer, Health Professional

ISSUE:  Today, Qualitest, a subsidiary of Endo Health Solutions,issued a voluntary, nationwide retail level recall for one lot of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg. Bottles from the affected lot may contain tablets that have a higher dosage of acetaminophen, and as a result, it is possible that consumers could take more than the intended acetaminophen dose. Unintentional administration of tablets with increased acetaminophen content could result in liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than 3 alcoholic beverages a day.

BACKGROUND: Hydrocodone bitartrate and acetaminophen 10 mg/500 mg tablets are indicated for the relief of moderate to moderately severe pain. The affected lot, C1440512A, was distributed between May 14 and Aug. 3, 2012 to wholesale distributors and retail pharmacies nationwide. The lot number can be found on the side of the manufacturer’s bottle. Hydrocodone Bitartrate and Acetaminophen Tablets are approximately 16.51 mm in length, pink, capsule-shaped tablets, with "3600" debossed on one side of the tablet and "V" on the other.

RECOMMENDATION: Consumers who have lot C1440512A should contact Qualitest at 1-800-444-4011. Consumers who are unsure if they have the affected lot number should consult their pharmacy or health care professional. Pharmacists and wholesalers are asked to check their inventories for lot C1440512A, segregate any material from the lot, and to contact MedTurn at 1-800-967-5952 for instructions on product return.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

• Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

Read the MedWatch safety alert, including a link to the Press Release, at:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm319058.htm

Poison Center Visit

There have been questions raised regarding a visit to the Poison Center.  Unfortunately, I do not have any good answers.  Let me talk to the staff at the Poison Center.  From that I can determine group size, time at the center and a good date for a visit.  Thank you for your patience. 

Health Effects of 911

Today is the anniversary of thew World Trade Center attack in New York City.  Today many of the wounds that were opened that day have healed.  The World Trade Center once again towers over the New York skyline.  Last week when I flew into New York we had a incredible view of the Statue of Liberty and the New World Trade Center.  It was inspiring! 

But today there are many people who still suffer the effects of the attack.  Post traumatic stress syndrome has effected many.  The inhalation of ash and dust has also lead to a myriad of toxicologic issues.  Asthma rates have skyrocketed.  Lungs diseases have increased.  It remains early for anyone to judge cancer rates.

There are many hysterical reports about the dire effects of the dust from 911.  There are an equal number of reports castigating those that suffer.  Here is a non-biased report on the health effects as written by the NYC health department.  New York City Health Department link. It is a short read to remind all of us of the long term toxicologic effects that will be forever tied to the attack. 

Yes many of the wounds of that day have healed, but many remain. 

Opioid Prescribing

By now all pharmacists should be aware that accidental deaths secondary to drug use are on the rise.  The number of people that die each day, directly or indirectly, from drug use is alarming.  OxyContin has gotten the reputation as both a leading cause of drug abuse, "Hillbilly Heroin", and as a effective tool in the treatment of chronic pain.  But how can it be both?  Can a drug be both a life sustaining treatment and cause the death of those patients that use it?  The Milwaukee Journal Sentinel has been running an occasional series of articles on prescription pain killer use and conflict of interest.  Sunday's article was especially compelling. Here is the link to the article.   

The concern for patient safety has lead many emergency rooms to restrict the prescribing of opioid pain killers. "ERs in Milwaukee County restricting opioid prescriptions" (link).   Appropriately prescribed to the correct patient within the appropriate healthcare framework, opioid pain killers can be life changing.  But life in the ED finds the wrong patients in the wrong healthcare setting.  

An interesting pair of articles. 

Medication Error

People really do mix up their meds an end up in emergency rooms.  Just ask Tom Brokaw (New York Daily News link).

International Espionage

Georgi Markov was a well-known Bulgarian novelist and playwright.  He was also a communist dissident that escaped to England.   While in England he was a broadcaster with the broadcasting from BBC World Service where he frequently targeted the communist party. 

 On September 7, 1978 Georgi Markov was waiting for a bus when he felt a sting in his thigh.  That evening he became very ill and he died three days later.  Initially death was declared due to septicemia.  On autopsy a small pellet was found in his thigh.  After investigation the cause of death was changed to murder.  Murder by ricin, delivered through a pellet that was implanted under the skin by a specially designed umbrella.   

The most frequent exposure to ricin in the US is through the ingestion of castor beans in small children.  Fortunately, castor beans are very hard, extremely difficult to chew and hard to digest.   Seldom are children every injured. 

 

Here is a brief paper on Georgi Markov that explains the toxicity of ricin.

 

Underage Drinking, Alcohol Poisoning and Legal Immunity

That is the title of today's blog entry from the American Association of Poison Control Centers.  Do you think underage drinkers should be arrested and prosecuted for consumption after calling 911 in a medical emergency?  Check out this posting.

Bites and Stings

While it is exciting to think of rattlesnake bites and jellyfish stings, bee stings cause a far greater number of deaths.  According to this morning Milwaukee Journal-Sentinel a 46 year old Mequon man died yesterday after being sting by a bee.  This is a reminder that while it is fun to learn about the exotic, it the what is just outside the door that effects us every day.  Do you know what to do when a bee sting happens?  Check this out: Insect Sting Kills Mequon Man.

Antivenoms, another adverse effect, your bill!

http://www.foxnews.com/health/2012/09/05/scorpion-sting-leaves-arizona-woman-with-huge-bill-and-bite/?test=latestnews

The sting of an Arizona scorpion (Centuroides sp.) is not that big of a deal, maybe some localized swelling and pain, hardly ever a significant systemic effect. The news story describes a $53,000 hospital bill for a woman who received scorpion antivenom for what looks like a very trivial injury. Her pain probably could have been treated with some local anesthetic and morphine...total cost maybe a couple hundred dollars vs. thousands! If the antivenom were needed to save her life, then Yes, give and worry about the cost later. If they just gave a $40,000 med to manage pain that could have been managed in a more conventional manner, well then that $40,000 cost seems too excessive.  seems like the whole story is not being told here

Recalls and Bratwurst

Recalls....  It seems that everyday we read about a car being recalled due to safety.  Or it was a crib because the slats were too far apart.  Some recalls may be small, others massive.  So companies recall their products when there is a potential for harm.  Others wait until the harm is done and the FDA issues the recall. 

Here is a recall from a local company near and dear to my heart.  Would you be surprised to find a pen in your bratwurst patty?

Wisconsin Establishment Recalls Frozen Bratwurst Patties

Klement Sausage Company Inc. is recalling approximately 2,920-lbs. of frozen bratwurst patties because they may contain foreign materials—pieces of a plastic pen. 

The products subject to recall include:

·         10-lb. cases containing 4-oz. patties of Klement Sausage Co. Bratwurst Patty

All products were produced on July 6, 2012. The packages bear the establishment number “EST. 2426B” in the USDA mark of inspection and the batch number “21097” on the case label. The products were distributed for foodservice use in Iowa, Kentucky, Minnesota and Wisconsin. 

Consumers with questions about the recall should contact Jeff Klement, the company’s vice president of special projects, at 414-744-2330. ext. 244.

For more information: http://www.fsis.usda.gov/Fsis_recalls/RNR_060_2012/index.asp

Lab safety has come a long way

The concept of "safe laboratory practices" is a relatively recent phenomenon. Most all scientists understand that lab coats, gloves, and safety goggles are important for protecting the health of the researcher, and in most chemistry labs, food and drink are expressly verboten. This is, in large part, due to the efforts of toxicologists to bring our expanding knowledge of carcinogens an harmful agents into public consciousness.

The following image is taken from the journal Organic Syntheses in 1927. At the height of the Roaring Twenties, organic chemists would routinely engage in activities that would horrify chemistry students today, most notably "mouth-pipetting" and smoking. This particular article, which describes a chemical synthesis of hydrogen cyanide, describes a practical application of this second activity:

As you can see, Prof. Ziegler rightly wanted to alert the reader to the potential vaporization of the potently poisonous HCN. This is a rather creative approach to testing the safety of a fume hood, in the absence of the sophisticated equipment we use today. Of course, if you are playing with cyanide and the lab begins to smell like almonds, you're already in deep trouble, smoking or not.

September 4

Question regarding readings; Is there a schedule for when the articles should be read? 

I really don’t have one.  My thought was to post articles you would find interesting.  Or would make good reference material in the future.  They are not required.  Although any faculty may require that an article be read.  So far the articles posted are for you enlightenment.  Hopefully which papers go with which lecture will be obvious.

Clams

Labor Day weekend.  For many it signals an end to summer and a start of fall (football season).  To me it is the perfect time to spend on or in the water.   As part of our holiday weekend we went clamming.  As a product of the Midwest with a sojourn to Texas, clamming is new to me.   Yet somehow we found ourselves wading into Peconic Bay (Peconic Bay lays in the north end of Long Island and empties in the Atlantic Ocean.)   We caught a nice basket of clams.  I learned that like walleye the big ones go back.  As I was consuming our catch, raw with a little lemon juice, I could not help but think about paralytic shellfish poisoning.  What is that saying…? “You can only eat shellfish in a month that ends in R”.  Its September 1, I’m OK!  

Paralytic shellfish poisoning is a food borne illness caused by saxitoxin, a sodium channel blocking neurotoxin, and characterized by tingling or numbness beginning in the perioral area and spreading to the neck and face followed by headache, nausea, vomiting and diarrhea.  Saxitoxin is produced by marine algae, mostly dinoflagellates (genus Alexandrium) which are consumed and bioconcentrated in shellfish.  Implicated sources include saltwater mussels, saltwater clams, oysters and pufferfish.  Toxin containing shellfish are primarily found in the cold water regions on the coasts of northeast and northwest of the U.S.  PSP is a problem in the coastal water of northern New England, but has been reported in the waters off Long Island. 

 
Clamming was fun and the clams were delicious.  Thankfully, it was Labor Day weekend