Understand the Culture in Which You Practise Hyperthermia: Are ...

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side effects H Y P E R T H E R M I A Are Your Patients at Risk? Stheir medications to provide optimal care and promote health. ummer is upon us and, as ever, we are mindful of the Standards of Practice for communicating with patients and educating them about A recent coroner’s inquest into the death of a patient due to complications from hyperthermia brings into focus a side effect of medications that is rarely considered: loss of the body’s ability to regulate temperature, possibly resulting in hyperthermia. The regulation of a person’s core body temperature occurs in the delicate balance between heat production and heat loss. The goal is to keep the body temperature within an acceptable range. If a person’s body temperature begins to rise towards an unacceptable limit, the body automatically enacts cooling mechanisms (i.e., sweat production for cooling by evaporation). The two most common forms of hyperthermia are heat exhaustion and heat stroke. Of the two, heat stroke is especially dangerous and requires immediate medical attention. Heat stress occurs when a strain is placed on the body as a result of hot weather. Heat fatigue is a feeling of weakness brought on by a high outdoor temperature. Symptoms include cool, moist skin and a weakened pulse. The person may feel faint. Heat syncope is a sudden dizziness experienced after exercising in the heat. The skin appears pale and sweaty but is generally moist and cool. The pulse is weakened and the heart rate is usually rapid. Body temperature is normal. Heat cramps are painful muscle spasms in the abdomen, arms, or legs following strenuous activity. Heat cramps are caused by a lack of salt in the body. Heat exhaustion is a warning that the body is getting too hot. The person may be thirsty, giddy, weak, uncoordinated, nauseated, and sweating profusely. The body temperature is normal and the pulse is normal or raised. The skin is cold and clammy. Heather A. Arnott, B.Sc.Phm, Inspector, OCP Heat stroke (or sunstroke) can be lifethreatening and victims can die from multiple organ failure. A person with heat stroke usually has a core body temperature above 38.2 degrees Celsius. Other symptoms include confusion, combativeness, bizarre behaviour, faintness, staggering, strong and rapid pulse, and possibly delirium or coma. High body temperature is capable of producing irreversible brain damage. This is a medical emergency requiring immediate treatment. General health and/or lifestyle may increase a person’s chance of suffering a heat-related illness. Health factors which may increase risk include: • poor circulation • inefficient sweat glands and changes in the skin caused by the normal aging process • being substantially overweight or underweight • consumption of alcoholic beverages • heart, lung, and kidney diseases • any illness that causes general weakness or fever • high blood pressure, and • other conditions that require changes in diet, for example, a salt-restricted diet may increase the risk of hyperthermia for a person taking diuretics, sedatives, tranquillizers, or certain heart and blood pressure drugs that make them unable to perspire. Lifestyle factors that can increase risk are: • unbearably hot living quarters • lack of transportation which prevents people from seeking respite from the heat in shopping malls, movie houses, and libraries • overdressing -- not feeling the heat, older people may not dress appropriately in hot weather • visiting overcrowded places -- trips should be scheduled during off-peak times, and 18 pharmacyconnection • July/August 2009
• not understanding weather conditions -- older persons at risk should stay indoors on especially hot days. The use of certain prescription medications can also increase an individual’s risk of developing hyperthermia. The drugs implicated in cases of hyperthermia decrease the body’s ability to dissipate heat, and also may impair a person’s perception of increased body temperature (which results in failure to seek relief from environmental factors contributing to the hyperthermia). The medications listed in the chart below have been shown to decrease the body’s ability to regulate internal temperature. In light of the coroner’s findings, pharmacists should be mindful of the standards of practice for educating patients on their medications. As side effect profiles change with continued use of a medication in a clinical setting, it is important for pharmacy managers to be aware that Standards for Pharmacy Managers states that the manager shall ensure that all new, professionally relevant information directed to the pharmacy is immediately available to the staff pharmacists. Additionally, staff pharmacists are reminded that Standard 3 requires that the pharmacist identify, evaluate, interpret, and provide appropriate drug and pharmacy practice information to achieve safe and effective patient care. With this in mind, and particularly in the warmer summer months, additional patient counselling should include general advice regarding prevention and treatment of heat- related symptoms: • Know the signs and symptoms of heat-related illnesses. • Block out direct sun or other heat sources. • Use cooling fans or air conditioning; rest regularly. • Drink lots of water: about one cup every 15 minutes. • Wear lightweight, light-coloured, loose-fitting clothes. • Avoid alcohol, caffeinated drinks, or heavy meals. References: • eTherapeutics (online subscription) • Health Encyclopedia – Diseases and Conditions: www.healthscout.com • US Department of Labor (Occupational Safety and Health Administration) OSHA ‘Quick Card’ – Heat Stress: www.osha.gov • Medline Plus: www.nlm.nih.gov/medlineplus/ency/article000056.htm • www.connpost.com/women/ci_9890519 Anticholinergic drugs benztropine, biperiden, ethopropazine, procyclidine trihexyphenidyl Impair the body’s ability to lower its temperature by perspiring. Phenothiazines chlorpromazine, perphenazine, thioridazine, trifluoperazine, fluphenazine Neuroleptic malignant syndrome (very rare, but potentially fatal, reaction) Butyrophenones Haloperidol Drug-induced hyperthermia Tricyclic antidepressants amitriptyline, imipramine, trimipramine, clomipramine, desipramine, nortriptyline Interfere with heat dissipation mechanisms by increasing body temperature and exerting an anticholinergic effect. Antihistamines, benzodiazepines, alpha-adrenergics, beta blockers, neuroleptics, diuretics Increase the risk of inability to produce sufficient perspiration for body cooling. pharmacyconnection • July/August 2009 19
Page 1 and 2: July/August 2009 Understand the Cul
Page 3 and 4: contents Prescription Delivery Regu
Page 5 and 6: editor’s message Della Croteau, R
Page 7 and 8: lueprint, which is similar to the c
Page 9 and 10: Proposed PharmD Program Update Coun
Page 11 and 12: Systems to Comply with the Regulati
Page 13 and 14: Larry views his MMT practice as an
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Page 17: coroner’s report Coroner’s Inqu
Page 21 and 22: health canada advisories & notices
Page 23 and 24: s Cosmetic Pesticide Ban The new le
Page 25 and 26: pharmacy technician Q&A Susan James
Page 27 and 28: pharmacyconnection • July/August
Page 29 and 30: inspectors’ corner Professional I
Page 31 and 32: The Invisible Environment The invis
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Page 35 and 36: in this case to require him to incu
Page 37 and 38: focus on error prevention Ian Stewa
Page 39 and 40: laws & regulations Drug and Pharmac

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