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NAPLEX 2024 > 81. Toxicology > Flashcards

81. Toxicology Flashcards

1
Q

eWhat are some common C-R packaging?

A

Screw caps
Unit-dose packaging
Card adherence
Safety packaging

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2
Q

Initial overdose management for topical exposure

A

Removed contaminated clothing and wash skin with soap and water for 10 min to remove poison from skin

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3
Q

Initial overdose management for ocular exposure

A

Remove contact lenses and rinse eye(s) with gentle stream of water for at least 15 min

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4
Q

When should 911 be called for overdose?

A

It pt is unconscious, having difficulty breathing, appears agitated or having seizure

If pulseless, do CPR

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5
Q

Activated charcoal is most effective when used within ___

A

1 hr of ingestion

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6
Q

How does activated charcoal work?

A

Adsorbs drug, which prevents GI absorption and systemic tox

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7
Q

What is typical dosing for activated charcoal?

A

1g/kg

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8
Q

Prior to using activated charcoal, the air way should be. ___

A

protected (with intubation if needed) to prevent aspiration

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9
Q

When is activated charcoal contraindicated?

A

When airway is unprotected - unconscious, cannot clear throat, cannot hold head upright
Intestional obstruction
GI tract not intact or when there is decreased peristalsis

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10
Q

Hydrocarbons such as ____ can increase risk of aspirations

A

petroleum products including gasoline and paint thinner

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11
Q

Hepatotoxicity is dose-dependent adverse effect caused by increased metabolism of acetaminophen by CYP___ to ____

A

CYP2E1
NAPQI

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12
Q

How does NAPQI cause liver injury/failure

A

Covalently binds to liver cell proteins and cause liver injury&raquo_space; liver failure

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13
Q

Describe Phase 1 of APAP tox

A

1-24 hrs
commonly asymptomatic or non-specific symptoms, such as N/V

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14
Q

Describe Phase 2 of APAP tox

A

24-48hrs
Labs elevated INR, AST/ALT
Any symptoms from phase 1 usually subside

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15
Q

Describe Phase 3 of APAP tox

A

48-96hrs
Fulminant hepatic failure (e.g. jaundice, coagulopathy, renal failure, and/or death)

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16
Q

Describe Phase 4 of APAP tox

A

> 96 hrs
Pt recovers or receives a liver transplant

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17
Q

How does NAC work for APAP tox?

A

NAC (Acetadote) is free radical scavenger and precursor to glutathione (GSH), ultimately increasing GSH&raquo_space; GSH converts NAPQI to mercapturic acid&raquo_space; safely excreted

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18
Q

NAC formulations

A

PO and IV

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19
Q

Typical dosing for oral NAC vs IV NAC

A

Oral: high dose given once, then lower dose for 17 doses, repeat if emesis occurs within 1 hr of admin

IV: 3 infusions over total of 21 hrs

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20
Q

Symptoms of anticholinergic overdose (atropine, diphenhydramine, dimenhydrinate, scopolamine, Atropa belladonna (Deadly nightshade), jimson weed)

A

Flushing - red as a beet
Dry skin and mucous membranes - dry as a bone
Mydriasis with double/blurry vision - blind as a bat
Altered mental status - mad as a hatter
Fever - hot as a hare

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21
Q

Andexanet alfa (Andexxa) can reverse which anticoags?

A

Apixaban, rivaroxaban

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22
Q

Treatment for anticholinergic overdose

A

Primarily supportive care
Rarely physostigmine is given - inhibits enzyme that breaks down ACh, acetylcholinesterase, which increase ACh and decrease anticholinergic toxicity

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23
Q

Idarucizumab (Praxbind) can reverse which anticoags?

A

Dabigatran

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24
Q

Phytonadione (Vit K) can reverse which anticoags?

A

Warfafrin

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25
Protamine can reverse which anticoags?
Heparin, LMWH
26
Prothrombin complex concentrate (Kcentra) can reverse which anticoags?
warfarin, factor Xa inhibitors
27
Treatment for antipsychotic overdose
Primarily supportive care Bezntropine can be given for dystonias and bicarbonate can be given if QRS-interval widening
28
Treatment for BZD overdose
Flumazenil - can cause seizures when used in pts on BZD chronically Sometimes used off label for non-BZD hypnotic overdose (e.g. zolpidem) but not routinely recommended
29
Treatment for beta-blocker overdose
Glucagon (if unresponsive to symptomatic treatment) High dose insulin with glucose may be used in pts refractory to glucagon Lipid emulsion to enhance elimination of some lipophilic drugs
30
Treatment for CCB overdose
Same as beta-blockers: Glucagon (if unresponsive to symptomatic treatment) High dose insulin with glucose may be used in pts refractory to glucagon Lipid emulsion to enhance elimination of some lipophilic drugs PLUS calcium (chloride or gluconate): IV only, avoid fast infusion, monitor ECG, do not infuse calcium in same line as phosphate-containing solutions
31
Treatment for cyanide (smoke inhalation, nitroprusside in high doses/long durations/renal impairment) overdose
hydroxocobalamin (Cyanokit) Sodium thiosulfate + sodium nitrite (Nithiodote)
32
Treatment for digoxin, oleander, foxglove overdose
Digoxin immune fab (DigiFab) Each DigiFab 40mg vials binds ~0.5mg digoxin; when amt ingested or digoxin level is unknown, max adult dose is 20 vials Interferes with digoxin levels drawn after it has been given
33
Treatment for ethanol (alcoholic drinks) toxicity
If suspected chronic alcohol user, administer thiamine (vit B1) to prevent Wernicke's encephalopathy (neurological damage) Can cause increase anion gap
34
Treatment for heavy metal (arsenic, copper, gold, lead, mercury, thallium) toxicity
Dimercaprol: aresenic, gold, mercury Dimercaprol + CaNa2 EDTA OR Succimer (Chemet) + DMSA: Lead Penicillamine: copper Ferric hexacyanoferrate ("Prussian blue" (Radiogardase)): Thallium
35
Treatment for hydrocarbon (petroleum products) toxicity
Do not induce vomiting Keep pt NPO d/t aspiration risk
36
Treatment for insulin or other hypoglycemic toxicity
Dextrose injection or infusion (drip), oral glucose (do not administer if unconscious) Glucagon (when IV or PO dextrose cannot be administered) SU-induced hypoglycemia: octreotide (Sandostatin)
37
Teratment for isoniazid toxicity
Pyridoxine (Vit B6), BZD and/or barbituates For acute neurotox (seizure, coma), administer IV pyridoxine PO pyridoxine 10-50mg used daily with isoniazid to prevent neuropathies
38
Treatment for iron and aluminum toxicity
Deferoxamine (Desferal): iron and aluminum
39
Treatment for organophosphates (OPs) including industrial insecticides) toxicity
OPs block ACE which increase ACh levels and causes cholinergic "SLUDD" symptoms salivation, lacrimation, urination, diarrhea/defecation Atropine - anticholinergic which blocks effect of ACh to reduce SLUDD symptoms Pralidoxime (Protopam) - treats muscle weakness and relieves paralysis or respiratory muscles by reactivating cholinesterase that was inactivated by exposure to OPs Atropine and pralidoxime combo can be used (DuoDote)
40
Treatment for methotrexate toxicity
Leucovorin (folinic acid), levoleucovorin (Fusilev), glucarpidase (Voraxaze) - rescue after high dose in cancer treatment, after accidental overdose or to reduce tox wand counteract effects of impaired elimination
41
Treatment for methemoglobinemia from topical benzocaine (in OraGel or teething products), dapsone, nitrates, or sulfonamides
Methylene blue (ProvayBlue) Note: contraindicated in pts with G6PD deficiency; avoid admin with SSRIs and SNRIs
42
Treatment for neostigmine, pyridostigmine toxicity
Pralidoxime (Protopam) - counteracts muscle weakness and/or respiratory depression secondary to overdose of ACE meds used to treat myasthenia gravis Atropine or glycopyrrolate can be given to prevent bradycardia from neostigmine
43
Early symptoms of nicotine (including e-cig) toxicity
Abd pain, nausea, diaphoresis, tachycardia, tremors
44
Later symptoms of nicotine (including e-cig) toxicity
Bradycardia, dyspnea, lethargy, coma, seizures
45
Treatment for nicotine (including e-cig) toxicity
Supportive care (e.g. atropine for symptomatic bradycardia, BZDs used for seizures)
46
what can be used to reveres paralytics (e.g. rocuronium, vecuronium, pancuronium)
Neostigmine methylsulfate (Bloxiverz): rocuronium, vecuronium, pancuronium Sugammadex (Bridion): rocuronium, vecuronium
47
Treatment of salicylate toxicity
Salicylates are acidic. Sodium bicarbonate is alkalinizing agent, can alkalinize urine >> decrease drug reabsorption and increase excretion of salicylates and other weak acids
48
Treatment of stimulant overdose (amphetamines including ADHD and weight loss drugs, cocaine, ephedrine, caffeine, theophylline, MDMA (ecstasy))
Supportive care for agitation or seizures (BZD)
49
Treatment of toxic alcohols (ethylene glycol (antifreeze), diethylene glycol, ethanol) toxicity
Can cause increase anion gap Fomepizole is preferred; ethanol (2nd line)
50
Treatment of TCA overdose
Overdose can quickly cause fatal arrhythmias Sodium bicarbonate - to decrease widened QRS complex Supportive care for agitation/seizures (BZD) if present Vasopressors may be needed for hypotension
51
Treatment for valproic acid or topiramite-induced hypoammonemia
Levocarnitine (Carnitor)
52
If opioids and acetaminophen were both ingested, ___ should be given first
naloxone
53
What can be signs of opioid overdose?
Somnolence, shallow labored breathing, pinpoint pupils Naloxone should be administered
54
What can be used to determine if NAC should be given in APAP toxicity?
Rumack-Matthew nomogram
55
Tachycardia, seizures or severe agitation can be from multiple causes. Give ___
BZD
56
QT prolongation can be caused by ___. Check ECG and give ___ if QRS is widened.
TCAs sodium bicarbonate
57
Antidote for animal bites
Rabies vaccine (RabAvert, Imovax Rabies) + human rabies immune globulin (HyperRAB S/D, Imogam Rabies HT)
58
Antidote for black widow spider bites
Antivenin for Latrodectus mactans
59
Antidote for scorpion stings
Antivenin immune FAB Centruroides (Anascorp)
60
Antidote for snake bites (eastern coral snake, Texas coral snake, copperhead, rattlesnake)
Crotalidae polyvalent immune FAB (CroFab) for copperhead and rattlesnake bites Crotalidae Immune F(ab')2 (Anavip) for rattlesnake bites)

NAPLEX 2024 (74 decks)

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