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Episode #6- Barking Up the Wrong Tree (Cinohonism, Quinine & Quinidine)
MP3•Episode home
Manage episode 337597524 series 3382933
Content provided by Ryan Feldman and Ryan Feldman PharmD DABAT. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Ryan Feldman and Ryan Feldman PharmD DABAT or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
- Historical perspective on use of cinchona bark powder for malaria
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973170/
- Evolutionarily pressure of malaria on beta thalassemia (sickle sell) traits
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499995/
- Cinchonism
- Classic toxicities causes by ingestion of quinoline derivatives found in the bark of the cinchona tree
- Brief review- https://pubmed.ncbi.nlm.nih.gov/32644745/
- Etiology
- Powdered cinchona bark
- Used by people to make tonic water, treat restless legs, or viruses
- Prescription quinoline derivatives may cause cause similar effects
- Quinine
- Quinidine
- Hydroxychloroquine
- Chloroquine
- Powdered cinchona bark
- Clinical effects
- Dizzy
- Flushed
- Head ache
- Tinnitus
- Potential for vision loss
- Laboratory assessment
- Hypoglycemia
- Hypokalemia
- Long QRS
- Treatment
- Supportive care for ABCs
- Potential role for epinephrine as preferred pressor from animal data and chloroquine data
- Correct endocrine/metabolic abnormalities
- Hypertonic sodium for wide QRS (be careful of worsening hypokalemia)
- Consider multi dose activated charcoal
- Supportive care for ABCs
- More on toxicity/studies from the episodes
- Incidence of caridac arryhmias in patients taking quinine alone
- Padmaja UK, Adhikari P, Periera P. Experience with quinine in falciparum malaria. Indian J Med Sci. 1999 Apr;53(4):153-7. PMID: 10695226.
- Negative inotropic effects of quinidine
- Hoffmeister HM, Hepp A, Seipel L. Negative inotropic effect of class-I-antiarrhythmic drugs: comparison of flecainide with disopyramide and quinidine. Eur Heart J. 1987 Oct;8(10):1126-32. doi: 10.1093/oxfordjournals.eurheartj.a062178. PMID: 3119341
- Occular toxicity, can be permanent
- Treatment is debated, not clear what is preferred , HBO used often
- Vision may recover centrally first, than peripheral
- Vision loss usually delayed from initial symptoms
- Quinine >15 associated w/ more ocular tox- https://pubmed.ncbi.nlm.nih.gov/3983356/
- Hall AP, Williams SC, Rajkumar KN, Galloway NR. Quinine induced blindness. Br J Ophthalmol. 1997;81(12):1029. doi:10.1136/bjo.81.12.1029
- Dyson EH, Proudfoot AT, Prescott LF, Heyworth R. Death and blindness due to overdose of quinine. BMJ 1985; 291:31–3.
- Otooxicity -A hall mark toxicity of tinnitus appears to be caused by
- Additionally, vasoconstriction and local prostaglandin inhibition within the organ of Corti contributes to decreased hearing.
- Microstructural lengthening of the outer hair cells of the cochlea and organ of Corti occurs.
- Jastreboff PJ, Brennan JF, Sasaki CT. Quinine-induced tinnitus in rats. Arch Otolaryngol Head Neck Surg. 1991 Oct;117(10):1162-6. doi: 10.1001/archotol.1991.01870220110020. PMID: 1910705
- Jung TT, Rhee CK, Lee CS, Park YS, Choi DC. Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am. 1993 Oct;26(5):791-810. PMID: 8233489.
- Jung TT, Rhee CK, Lee CS, Park YS, Choi DC. Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am. 1993 Oct;26(5):791-810. PMID: 8233489.
- Roche RJ, Silamut K, Pukrittayakamee S, et al. Quinine induces reversible high-tone hearing loss. Br J Clin Pharmacol. 1990;29(6):780-782. doi:10.1111/j.1365-2125.1990.tb03704.x
- Jarboe JK, Hallworth R. The effect of quinine on outer hair cell shape, compliance and force. Hear Res. 1999 Jun;132(1-2):43-50. doi: 10.1016/s0378-5955(99)00031-3. PMID: 10392546.
- Incidence of caridac arryhmias in patients taking quinine alone
54 episodes
MP3•Episode home
Manage episode 337597524 series 3382933
Content provided by Ryan Feldman and Ryan Feldman PharmD DABAT. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Ryan Feldman and Ryan Feldman PharmD DABAT or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
- Historical perspective on use of cinchona bark powder for malaria
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973170/
- Evolutionarily pressure of malaria on beta thalassemia (sickle sell) traits
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499995/
- Cinchonism
- Classic toxicities causes by ingestion of quinoline derivatives found in the bark of the cinchona tree
- Brief review- https://pubmed.ncbi.nlm.nih.gov/32644745/
- Etiology
- Powdered cinchona bark
- Used by people to make tonic water, treat restless legs, or viruses
- Prescription quinoline derivatives may cause cause similar effects
- Quinine
- Quinidine
- Hydroxychloroquine
- Chloroquine
- Powdered cinchona bark
- Clinical effects
- Dizzy
- Flushed
- Head ache
- Tinnitus
- Potential for vision loss
- Laboratory assessment
- Hypoglycemia
- Hypokalemia
- Long QRS
- Treatment
- Supportive care for ABCs
- Potential role for epinephrine as preferred pressor from animal data and chloroquine data
- Correct endocrine/metabolic abnormalities
- Hypertonic sodium for wide QRS (be careful of worsening hypokalemia)
- Consider multi dose activated charcoal
- Supportive care for ABCs
- More on toxicity/studies from the episodes
- Incidence of caridac arryhmias in patients taking quinine alone
- Padmaja UK, Adhikari P, Periera P. Experience with quinine in falciparum malaria. Indian J Med Sci. 1999 Apr;53(4):153-7. PMID: 10695226.
- Negative inotropic effects of quinidine
- Hoffmeister HM, Hepp A, Seipel L. Negative inotropic effect of class-I-antiarrhythmic drugs: comparison of flecainide with disopyramide and quinidine. Eur Heart J. 1987 Oct;8(10):1126-32. doi: 10.1093/oxfordjournals.eurheartj.a062178. PMID: 3119341
- Occular toxicity, can be permanent
- Treatment is debated, not clear what is preferred , HBO used often
- Vision may recover centrally first, than peripheral
- Vision loss usually delayed from initial symptoms
- Quinine >15 associated w/ more ocular tox- https://pubmed.ncbi.nlm.nih.gov/3983356/
- Hall AP, Williams SC, Rajkumar KN, Galloway NR. Quinine induced blindness. Br J Ophthalmol. 1997;81(12):1029. doi:10.1136/bjo.81.12.1029
- Dyson EH, Proudfoot AT, Prescott LF, Heyworth R. Death and blindness due to overdose of quinine. BMJ 1985; 291:31–3.
- Otooxicity -A hall mark toxicity of tinnitus appears to be caused by
- Additionally, vasoconstriction and local prostaglandin inhibition within the organ of Corti contributes to decreased hearing.
- Microstructural lengthening of the outer hair cells of the cochlea and organ of Corti occurs.
- Jastreboff PJ, Brennan JF, Sasaki CT. Quinine-induced tinnitus in rats. Arch Otolaryngol Head Neck Surg. 1991 Oct;117(10):1162-6. doi: 10.1001/archotol.1991.01870220110020. PMID: 1910705
- Jung TT, Rhee CK, Lee CS, Park YS, Choi DC. Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am. 1993 Oct;26(5):791-810. PMID: 8233489.
- Jung TT, Rhee CK, Lee CS, Park YS, Choi DC. Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine. Otolaryngol Clin North Am. 1993 Oct;26(5):791-810. PMID: 8233489.
- Roche RJ, Silamut K, Pukrittayakamee S, et al. Quinine induces reversible high-tone hearing loss. Br J Clin Pharmacol. 1990;29(6):780-782. doi:10.1111/j.1365-2125.1990.tb03704.x
- Jarboe JK, Hallworth R. The effect of quinine on outer hair cell shape, compliance and force. Hear Res. 1999 Jun;132(1-2):43-50. doi: 10.1016/s0378-5955(99)00031-3. PMID: 10392546.
- Incidence of caridac arryhmias in patients taking quinine alone
54 episodes
All episodes
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