3) Dyshemoglobinemias

Question 1

What are the therapeutics for Hyperbaric oxygen

Answer 1

Prevents lipid peroxidation (?) and delayed neurologic sequelae in CO poisoning

Question 2

What is the mechanism for Nitrites

Answer 2

Turns RBC hemoglobin to methemoglobin; CN moves from Fe(3+) on cytochromes to those in RBCs creating cyanomethemoglobin

Question 3

What are the miscellaneous for Nitrites

Answer 3

Dangerous in concurrent CO poisoning

Question 4

What is the mechanism for Sodium thiosulfate

Answer 4

Enhances normal metabolism of cyanide via rhodanase

Question 5

What is the mechanism for Hydroxycobalamin (Cyanokit)

Answer 5

Binds with cyanide –> cyanocobalamin (B12)

Question 6

What are the therapeutics for Hydroxycobalamin (Cyanokit)

Answer 6

Smoke inhalation victims not improving with supportive care, cyanide exposure, nitroprusside at risk patients

Question 7

What are the miscellaneous for Hydroxycobalamin (Cyanokit)

Answer 7

Give concurrently with sodium thiosulfate

Question 8

What is the mechanism for Methylene blue (Urolene Blue)

Answer 8

Cofactor of NADPH reductase; gains electron, donates directly to reduce methemoglobin

Question 9

What are the therapeutics for Methylene blue (Urolene Blue)

Answer 9

Methemoglobinemia >20-30%, or with symptoms

Question 10

What are the important side effects for Methylene blue (Urolene Blue)

Answer 10

Hemolytic anemia (weak oxidizing capability)

Question 11

What are the other side effects for Methylene blue (Urolene Blue)

Answer 11

Painful at injection site, dyspnea, restlessness, tremor, precordial pain, and apprehension