Antidotes, toxicities, and side effects Flashcards
Antidote for acetomenaphin poisoning
N-Acetyl-cysteine
- Also used to loosen mucus in CF patients
- Centrolobular necrosis from NAPQI toxic metabolite from CYP450. CYP450 inducers can worsen disease.
Salicylate poisoning
- Initial respiratory alkalosis at breathing center in brain followed by metabolic acidosis
- Tinnitus, dizziness, cerbral edema
- TX: by alkalanizing the urine: NaHCO3
Amphetamines
- Dilated pupils, tremors, tachychardia
- Acificy urine
- NH4Cl
Organophosphate poisoning
- Atropine immediately and praladoxime if early in course
- Irreversible acetylcholinesterase inhibitor leads to massive muscarinic stumilation
- Bradychardia, vasodilation, dry skin, mental status changes, miosis, salivation, urination
Atropine or muscarinic blockade overdose
- Tx with AChE inhibitors. Neostigmine, physostigmine to cross BBB
- Tachychardia, etc
Beta Blockers
- Treat with glucagon, increase cAMP Gs
- Hypotension, bradychardia
Digitalis
- digitalis fAb, Lidocaine, normalize K, Lidocaine
- Yellow blurry vision, bradychardia, arrythmias and hyperkalemia
Iron
- Deferoxamine, deferasirox
- Stomach ulceration, Naseau and Vomitting, metabolic acidosis
Lead
- Succimer, dimercaperol, EDTA, penicillamine
- Acute: Weakness paresthesia, encephalitis, constipation
- Long term is IQ drop, basophilic stippling, lead lines
Mercury, Arsenic, Gold
- Dimercaperol, succimer
- Arsenic: Diahrrea, vomitting, confusion, headache, blood urine, convulsions, coma. Long term is night blindness
- Inhibits PDH and can lead to lactic acidosis.
Copper Posioning
- Penicillamine
- Wilsons disease from defective copper trasnport resulting in low ceruloplasm levels
- Hematemasis, naseu, and hypotension are common in acute poisonings
Cyanide Poisoning
- Nitrate and Thiosulfate, also hydroxycobalamin
- Amyl Nitrate turns iron in the ferric state which makes them bind cyanide in blood acting like a sink. Hydroxycobaamin directly binds to cyanide gererating cyanocobalamin
- Complexes with cytochromes in ETC leading to defective oxidative phosphorylation and histiotoxic hypoxia
- Acute is siezures, apnea, pulmonary edema, almond smell and red tissues
Methemoglobin
- Methylene blue
- Fe in hemglobin is in ferric state, not ferrous. Methylene blue non-enzymatically reduces back to ferrous.
- G6PD, Oxidizing drugs (nitrates), congenital, newborn distress
Carbon Monoxide
- Hyperbaric oxygen
- Binds tightly to hemoglobin than oxygen and prevents delivery to tissue
- Headache, nasseau, reddening of the skin
- Pulse ox does’t pick up elevted carboxyhemoglobin. Must directly measure carboxyhemoglobin levels
Methanol
- Fomepizole, competitive inhibitor of alcohol dehydrogenase
- Prevents production of toxic metabolites (formic acid)
- Metabolic acidosis
- Blindness, stupor, coma, death at low concentrations
Ethylene glycol
- Fomepizole
- Metabolized to glycolic acids which causes stupor, autonomic dysfunction and metabolic acidosis
- Glycolic acid metabolized to oxalic acid which combines with Ca to cause stones and renal damage.
- May require dialysis at high levels
Opiods
- Naloxone: opiod antagonist
- Naltrexone helps with cravings
- Signs are respiratory depression, miosis
Benzodiazapines
- Flumazenil
- Rarely occurs on own, but maybe in the context of alcohol or barbituates
- Competetive antagonist at benzo A site.
TCA’s
- Alkalanization of urine to increase excretion
- Most commonly die of arrythmias, also see dry mouth, hypotension and siezures
- Alpha and muscarinic blockade (Coma, Cardiac, convulsions)
Heparin
- Protamine
- Heparin activates AT3 to cleave clotting factors. Protamine is an arginine rich compnd that can occupy activated AT3
Warfarin
- FFP and vitamin K
- FFP for rapid clotting factor replacement
- Vitamin K to quench warfarin
tPA, streptokinas,urokinase
- Aminocaproic acid
- Lysine analog that occupies binding and cleavage site of plasmin
Theophyline
- Beta Blockers
- Narrow theraputic window and can be effected by inhibitors (cimetidine, etc)
Torsades
-Magnessium sulfate and cardioversion
Eclampsia
-Magnessium sulfate for siezures
Phenytoin, Carbemazepine, Barbituates
Inducer
Modafanil
Inducer
Rifampin, Griseofulvin,
Inducer
St Johns Wort
Inducer
Chronic Alcohol Abuse
Inducer
Macrolides, INH, Sulfonamides, Ketocolanazole, Ciprofloxacin
Inhibitors (MAGIC RACKS in GQ)
Amiodarone, quinidine
Inhibitor
Gemfibrozil
Inhibitor
Grapefruit juice
inhibitor
Gemfibrozil
Inhibitor
Ritonavir
Inhibitor
Acute Alcohol Abuse
Inhibitor
Flushing
Vancomycin, Niacin, Ca Channel Blockers
Vasospasm
Cociaine, Triptans, Ergot alkaloids
DCM
-Doxyrubicin, andriaomycin, danorubicin
Torsades
Class I and IIIa anti-arrythmics
Agranulocytosis
Chloramphenicol, carbemazepine, cochicine, PTU, Methimazole, Dapsone
Aplastic Anemia
Chloramphenicol, Benzene, NSAIDs, PTU/Methimazole
Direct Coombs Hemolytic Anemia
Penicilin, Methyldopa
G6PD Hemolysis
-Primaquine, Sulfonamide, Nitrates, INH, NSAIDs
Megaloblastic Anemia
-Methotrexate, Sulfonamides, Phenytoin (also birth defects)
Thombotic
-OCP (Smoking and facor V Lieden)
Cough
-ACEI (prevent bradykinin breakdown) angiodemea
Pulmonary Fibrosis
Bleomycin, Busulfan (chemotherapy), amiodarone
Acute Cholestatic jaundice
-Erythromycin
Acute hepatic necrosis
-Halothane (Days) acetomeniphen, valproate, amantadine phyllodes
hepatitis
INH
Pseudomembranous colitis
-Clindamycin, ampicilin
Adrenocortical Insufficency
-Withdrawl steroids
Gynecomastia
Spironolactone and CYP inhibitors (Cimetidine, alcohol, ketocolanazole)
Hot flashes
Tamoxifen, Chlomafine
hyperglycemia
-Steroids, protease inhibitors, thiazides, niacin, tacrolimus
Hypothyroidism
-Amiodarone, sulfonamides, Lithium
