Showing papers by "Jonathan C Knott published in 2006"

Risk and Severity of Akathisia Following Administration of Metoclopramide in the Emergency Department

Abstract: Background Metoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide-induced akathisia in the emergency department. Aim To determine the risk and severity of metoclopramide-induced akathisia. Method This was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale. Results 232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10). Conclusion This study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.

Potential Interactions between Drugs Taken by Emergency Department Patients of an Australian Hospital

Abstract: Background While drug interactions are reported to be common, there are no published reports of the prevalence of such interactions among Australian emergency department (ED) patients. Aim To determine the prevalence and characteristics of potential drug interactions among Australian ED patients, the drugs most frequently involved and identify high-risk patient groups. Method An analytical cross-sectional survey of 409 patients who were taking at least two drugs. Drug lists were compiled from a range of resources. Analyses of potential interactions were made using Micromedex Drug-Reax software. Multivariate analysis was used to determine factors associated with potential drug interactions. Results 855 potential drug interactions were identified among 254 (62.1%, 95%CI 57.2–66.8) patients. The mean number of potential interactions among all patients was 2.1 ± 2.7 per patient. The most common potential interactions were between angiotensin converting enzyme inhibitors and loop diuretics (11.3% of patients at risk), beta-blockers and antidiabetics (7.3%) and frusemide and aspirin (9.1%). Drugs most commonly involved were aspirin (27.7% of potential interactions), beta-blockers (11.1%) and warfarin (9.9%). Only the number of drugs taken correlated significantly with the number of potential interactions (p < 0.001). Conclusion The possibility of potential drug interactions should be considered when prescribing and ED pharmacists should target patients on multidrug regimens for specific evaluation.