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Toxicology > Accidental Drug Ingestion & Overdose: Approach to Treatment > Flashcards

Accidental Drug Ingestion & Overdose: Approach to Treatment Flashcards

1
Q

What should be the initial approach to pharmacological intoxications?

A

Obtaining an appropriate history
Immediate stabilization and triage
Performing a thorough physical exam
Initiating treatment: decontamination, detoxification, symptomatic and supportive care of the patient

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2
Q

What are the big 6 that should be looked at on presentation?

A 
Temperature
Pulse
Respiration
Blood pressure
Pulse oximetry
ECG
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3
Q

What 5 things should be evaluated on presentation?

A 
Airway
Breathhing
Circulation
Dysfunction of neurologic system
Exam
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4
Q

What diagnostics should be done on presentation?

A

Blood tests
Urine for UA, culture, drug tests
Imaging

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5
Q

What measures might be taken to achieve stabilization?

A 
Oxygen
Intubation
Fluids
Dextrose
Calcium
Temperature support
Anti-seizure medications
Anti-emetics
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6
Q

What is the goal fro decontamination?

A

Inhibit or minimize further toxicant absorption

To promote excretion or elimination of the toxicant from the body

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7
Q

What are the decontamination techniques?

A 
Ocular
Dermal
Inhalation
Injection
Gastrointestinal
Forced diuresis
Surgical removal
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8
Q

How much of the ingested material can early emesis remove?

A

Up to 80%

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9
Q

What does productive emesis require?

A

The presence of food or liquid in the stomach

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10
Q

When should you induce emesis?

A

Most effective within 1 hour of ingestion
Useful up to 2 hours after ingestion
Unknown time of ingestion in an asymptomatic patient
When ingestion of a product known to stay in the stomach for a long time occurs

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11
Q

True of False: apomorphine is not recommended in cats, but it can be used in dogs

A

True

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12
Q

Why can apo be used in dogs?

A

CRTZ is largely controlled by dopamine receptors, so apo typically induces emesis

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13
Q

What should be used in cats to induce emesis and why?

A

Xylazine or dexmedetomadine because the CRTZ has alpha 2 receptors

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14
Q

When does emesis occur with apo?

A

Within 4-6 minutes

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15
Q

What can apo cause?

A

CNS depression

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16
Q

What is xylazine?

A

Centrally mediated α2-adrenergic agonist

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17
Q

What does xylazine use often result in?

A

Profound CNS and respiratory depression

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18
Q

What can CNS and respiratory depression be reversed by?

A

Atipamizle or yohimbine

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19
Q

What is used as an at home emetic?

A

3% hydrogen peroxide

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20
Q

True or False: hydrogen peroxide can be used in cats

A

False. It is not recommended because it can result in hypersalivation, hemorrhagic gastritis, protracted hematemesis

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21
Q

When is hydrogen peroxide more effective?

A

When a small amount of food is present in the stomach

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22
Q

When do you not want to induce emesis?

A 
Depressed patients
Decreased consciousness
Seizures or are likely to seizure
In symptomatic patients 
In patients with underlying disease predisposing them to aspiration pneumonia or complications associated with emesis induction
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23
Q

What are contraindicated toxins to using emesis?

A

Corrosive and caustic material
With hydrocarbon toxicant ingestion
Petroleum distillates
Other volatile materials that may result in aspiration pneumonia

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24
Q

What is multidose administration of activated charcoal indicated in?

A

Enterohepatic recirculation
Drugs with a long half-life
Delayed release products

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25
Q

True or False: additional doses of activated charcoal should contain cathartic.

A

False

26
Q

What is activated charcoal relatively ineffective against?

A 
Ethanol
Methanol
Isopropyl alcohol
Acetone
Petroleum distillates
Pine oil
Ammonia
Xylitol
Cyanide
27
Q

What is activated charcoal dependent on?

A

Timing of administration

28
Q

What is the benefit of multidose activated charcoal?

A

It has been found to significantly decrease the serum half-life of certain drugs

29
Q

Why should cathatics no be used in additional doses of activated charcoal?

A

Increased risks for dehydration and secondary hypernatremia via fluid losses from the GI tract

30
Q

What are contraindications for administration of activated charcoal?

A 
Shock
Dehydration
Electrolyte disturbances
Those with excessive free water loss
Uncontrolled vomiting
Caustic substance ingestion
Compromised airway
Neurologic deficits
31
Q

What are cathartics designed to do?

A

Increase the speed and transit time of the GI tract

Promote fecal excretion of the toxin

32
Q

What is the most commonly used cathartic? Why?

A

Sorbitol

Aids in the expulsion of the poison from the GIT

33
Q

What are the side effects of sorbitol?

A 
Vomiting
Dehydration
Secondary hypernatremia
Abdominal cramping or pain
Possible hypotension
34
Q

What is cholestyramine?

A

Chloride salt of basic anion exchange resin that binds with bile acids in the intestines to prevent them from being reabsorbed

35
Q

What should cholestyramine be used with?

A

Toxicants that undergo enterohepatic recirculation or biliary elimination

36
Q

What are the indications for gastric lavage?

A

Toxicants that stay in the stomach for a long time or that form bezoars
Indications when emesis is contraindicated
Toxicants that have a very narrow margin of safety, result in severe clinical signs. approach 50% of the LD50

37
Q

Where should the patient’s head be placed for gastric lavage?

A

Lower than the chest

38
Q

What are indications for fluid therapy?

A 
Excretion of the drug
Aid in perfusion
Prevent dehydration
Encourage diuresis or nephrotoxins
Treat underlying azotemia or electrolyte abnormalities
Vasodilate renal vessels
39
Q

What type of fluid is used for fluid therapy with toxicities that cause hypercalcemia?

A

Balanced crystalloid at 1.5 to 4 times the normal maintenance rate

40
Q

What are colloid fluid therapies indicated in?

A

Low colloid oncotic pressure
Profound hyponatremia
Blood loss or acute hepatic insult

41
Q

Whar are blood product therapies indicated in?

A

Anemia

Coagulopathy to anticoagulants or hepatoprotectants

42
Q

What are examples of GI support?

A

Routine use of antiemetic therapy after emesis induction
Anti-emetics
H2 blocker
Proton pump inhibitors

43
Q

What are toxicants that often result in CNS stimulation?

A 
Amphetamines
SSRI antidepressants
Sleep aids
Tremorgenic mycotoxins
Rodenticides
Methylxanthines
5-fluorouracil
Insecticides
44
Q

What are examples of neurologic support?

A

Sedatives to treat CNS stimulatory signs
Parenteral muscle relaxants
Phenobarnital

45
Q

When tpxocants can have effects like CNS depression or sedation?

A 
Muscle relaxants
Sedatives
Sleep aids
Illicit drugs
Marcocylic lactones
46
Q

What is cerebral edema due to?

A

Primary toxicant

Secondary to uncontrolled, untreated seizures

47
Q

What is used to treat increased intracranial pressure?

A

Mannitol

Hypertonic saline

48
Q

What are examples of anxiolytics or sedatives?

A

Acepromazine

Butorphanol

49
Q

What can be used as a reversal with opioid toxicity?

A

Naloxone

Butorphanol

50
Q

What should be used with sleep aid toxicosis?

A

Flumazenil

51
Q

What can alpha-agonist toxicity be reversed with?

A

Alpha-adrenergic antagonists (Yohimbine, Atipamezole)

52
Q

What toxicities is S-adenosyl-methionine (SAM-e) used in?

A 
Xylitol
Blue-green algae
NSAIDs
Amanita mushrooms
Acetaminophen
Sago palm
53
Q

What is N-acetylcysteine used for?

A

To limit the formation of NAPQI by providing alternate glutathione substrate with acetaminophen toxicosis
Has been anecdotally used for severe hepatotoxicity with sago palm and xylitol

54
Q

What are beta blockers given for?

A

Severe tachycardia

55
Q

What are beta blockers associated with?

A

SSRI, amphetamine, chocolate toxicosis

56
Q

What is Vitamin K therapy used for?

A

Anticoagulant rodenticide toxicity

57
Q

What is intravenous lipid emulsion therapy used for?

A

As an antidote for lipophilic drug toxicosis

58
Q

How does IV lipid emulsion therapy work?

A

Lipid sink
Providing myocytes with energy substrates
Increasing the overall fatty acid pool

59
Q

When is ILE advocated for use?

A

Macrocyclic lactones
Lidocaine
Pyrethrins
Calcium channel blockers

60
Q

What does ILE have anecdotal success with?

A

Baclofen
Cholecalciferol
Beta blockers
Marijuana

61
Q

What are the guidelines for ILE administration?

A

20% ILE bolus
Followed by CRI rate of 0.25 ml/kg/min IV over 30-60 minutes
Additional doses can be administered after 6-8 hours if signs have not resolved and serum is not lipemic

62
Q

What are the possible complications with ILE therapy?

A 
Fat embolism
Fat overload syndrome
Pancreatitis
Worsening of acute respiratory distress syndrome
Coagulopathy

Toxicology (4 decks)

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