21 Random Final Questions Part 2 Flashcards
What is the Vulnerable Elders Survey?
Self-rating of health from poor to excellent
What positive outcomes are you looking for in patients who have HTN/CHF?
Increased exercise tolerance. Reduced MI risk
What positive outcomes are you looking for in patients who have Depression?
More independent. Greater activities. Better relationships
What positive outcomes are you looking for in patients who have Arthritis?
Better conditioning. Improved mobility. More independent
For Vital Sign Toxidromes, which drugs cause Bradycardia?
PACED. Propranolol. Anticholinesterases. Clonidine, CCBs. Ethanol. Digoxin
For Vital Sign Toxidromes, which drugs cause Tachycardia?
FAST. Free base cocaine. Anticholin, Antihistamine, Amphetamines. Sympathomimetics. Theophylline
For Vital Sign Toxidromes, which drugs cause Hypotension?
CRASH. Clonidine, CCBs. Reserpine and other anti-HTN. Antidepressants. Sedative/hypnotics. Heroin (opiates)
For Vital Sign Toxidromes, which drugs cause Hypertension?
CT-SCAN. Cocaine. Theophylline. Sympathomimetics. Caffiene. Anticholinergics, Antihistamines. Nicotine
What are some toxins with Delayed Absorption?
Carbamazepine. Concretions (Iron, ASA, Theophylline). Atropine
What are some toxins with Delayed Mechanism?
Anticoagulants. MAO-I. Sulfonylureas. Thyroid hormones
What are some toxins with Toxic Metabolites?
APAP. Methanol
What are some common drugs not picked up during a drug screen?
Clonidine. Carbon monoxide. CCBs. B-blockers. Digoxin. B-agonists. Iron. Colchicine
What are the ADRs with Ipecac?
Mallory-Weiss tear. Drowsiness, lethargy, and diarrhea in children
What are some poorly bound substances that Activated Charcoal won’t work with?
Lithium, Iron, Cyanide, Ethanol
When does Charcoal Fail?
PHAILS. Pesticides. Hydrocarbons, heavy metals, > 1 hour. Acids, Alkali, Alcohols, Aspiration risk. Iron, Intestinal obstruction. Lithium, Lack of gag reflex. Solvents, Seizures
When can Whole Bowel Irrigation be used?
COINS. Carbamazepine, Cocaine body packers, Charcoal, CCBs. Opiates. Iron, Lead (heavy metals; useful b/c charcoal can’t). Antidepressants. Sustained-release/enteric-coated preparations
What antidote is used for APAP?
N-Acetylcysteine
What is considered a toxic dose of APAP?
> 140mg/kg (> 200mg/kg in kids < 6 yo)
During APAP overdose, what time frame do you see the peak abnormalities including anorexia, nausea, confusion, coma, JAUNDICE, coagulopathies?
72-96 hours
What are the indicators of poor outcome with APAP overdose?
Development of acute liver failure, PT > 100 seconds, Grade 3 or 4 encephalopathy, Cerebral edema, Renal failure (SCr > 3.4), and Metabolic acidosis (pH < 7.3)
When looking at the nomogram chart for probable hepatic toxicity with APAP, what are the limitations?
Extended-release Tylenol. Chronic supratherapeutic ingestion. If charcoal administered prior to 4 hours
When is N-Acetylcysteine indicated?
Serum APAP concentration following acute ingestion is above the “possible hepatic toxicity” line on the Rumack-Matthew nomogram. Estimated single ingestion > 150mg/kg or there is a delay in acquiring a serum APAP concentration. Time of ingestion is not known and serum APAP > 10mg/mL. Evidence of hepatotoxicity and history of supratherapeutic APAP ingestion
When is IV N-Acetylcysteine indicated?
Patient vomiting. Continuous GI decontamination. GI bleed, obstruction. Encephalopathy or already existing acute liver failure. Neonatal/infant poisoning. Acetadote used (20 and 48 hour regimens (48 given if presenting late to clinic or possible increased enzymes already))
What are the steps in ASA and Salicylate toxicology?
Stimulation of the respiratory center in the brainstem causes rapid and deep respiration –> Respiratory alkalosis –> decreased bicarbonate. Uncoupling of oxidative phosphorylation –> increases oxygen consumption, metabolic acidosis, less bicarbonate available to neutralize –> combined acidosis
