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RC Test 1 > B4.014 Prework 1 Adverse Drug Reactions > Flashcards

B4.014 Prework 1 Adverse Drug Reactions Flashcards

1
Q

most common cause of acute liver failure in the Western world

A

acetaminophen

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2
Q

pathogenesis of APAP toxicity

A

hepatic necrosis secondary to cascade of signaling events resulting in mitochondrial injury and cell death

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3
Q

early APAP toxicity symptoms

A

none other than anorexia, nausea, or vomiting

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4
Q

24-48 hours after APAP poisoning

A

elevated PT or INR

increases transaminase levels

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5
Q

48 hours-7 days after APAP poisoning

A 
increase in intracranial pressure
hepatic encephalopathy
coma
multi-organ failure
renal injury
sepsis
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6
Q

therapeutic dose of APAP

A

4g in 24 h

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7
Q

very early stage treatment of APAP overdose

A

gastric lavage to remove tablets from stomach

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8
Q

antidote to APAP overdose

A

acetylcystein (NAC)
within 8-12 hours
adjust dose according to nomogram (plasma level and time postingestion)
may need IV glucose

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9
Q

long term treatment for APAP overdose

A

liver transplant

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10
Q

what is salicylate

A

anti-inflamm

common drug of overdose

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11
Q

signs of salicylate overdose

A

tinnitus (ringing of ears)
dizziness
hyperpyrexia (high temp)
coma, convulsions, resp failure w increasing dose

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12
Q

pathogenesis of salicylate overdose

A

metabolic acidosis due to accumulation of salicylic acid

  • uncoupling of oxidative phosphorylation
  • accumulation of keto acids
  • impairment of renal excretion of acids
  • depletion of bicarb reserve
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13
Q

treatment for salicylate overdose

A

gastric lavage if practical
correct hyperthermia by external cooling
resp distress with mechanical ventilation with O2
oral or IV fluids w/ glucose and electrolytes
dialysis if renal function impaired

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14
Q

how can you promote excretion and counter acidosis caused by salicylate overdose?

A

give sodium bicard

alkalize the urine

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15
Q

toxidrome for cocaine/amphetamines

A

tachycardia
hypertension
seizures
mydriasis

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16
Q

other symptoms of cocaine/amphetamine overdose

A

CNS stim and muscle rigidity or hyperactivity
v-tac or v-fib
circulatory failure
coma

17
Q

what treatment is contraindicated in cocaine/amphetamine overdose?

A

beta blockers

18
Q

how do you maintain BP with cocaine/amphetamine overdose?

A

fluids

vasopressors may be hazardous

19
Q

how are convulsions controlled?

A

diazepam IV

succinylcholine if convulsions interfere with respiration

20
Q

opioid triad/ toxidrome

A

unconsciousness
miosis (pin point pupils)
slow, shallow respiration

21
Q

other symptoms of opioid overdose

A

cyanosis
hypotension
spasms of GI tract
death (resp depression or coma)

22
Q

general treatments for opioid overdose

A

maintain vitals
gastric lavage/ induce emesis
maintain body warmth and adequate fluid intake

23
Q

opioid antidote

A

naloxone (naltrexone)

need to give repeat doses because of short duration of action

24
Q

examples of opioids

A

morphine
fentanyl
tramedol

25
Q

most important consequences of tricyclic antidepressant (TCA) overdose

A

blockade of myocardial fast sodium channels (QRS prolongation, tall R wave in aVR)
inhibition of potassium channels
direct myocardial depression

26
Q

TCA overdose symptoms

A

anticholinergic effects: tachycardia, dry mouth, nausea, confusion, urine retention
seizures

27
Q

what types of cardio toxicity manifestations accompany TCA overdose

A

abnormal conduction
arrhythmias (prolonged QT)
hypotension

28
Q

treatment for TCA overdoes

A

maintain airways and assist ventilation
diazepam for seizures
give sodium bicarb to maintain arterial pH between 7.45-7.55 to reverse cardiac membrane depressant effects (magnesium if severe)

29
Q

counter indicated drugs for TCA overdose

A 
class 1A antiarrhythmic drugs
make torsade worse
30
Q

suprapharmalogical effects of beta blocker overdose

A 
first degree heart block
hypotension
bradycardia
AV block
intraventricular conduction disturbances
31
Q

ECG findings in beta blocker overdose

A

normal QRS duration (widens with massive intoxication)

increased PR intervals

32
Q

other symptoms of beta blocker overdose

A

CNS toxicity: convulsions, coma, resp arrest
bronchospasm in pts w preexisting asthma
hypoglycemia and hyperkalemia

33
Q

treatment for beta blocker overdose

A

glucagon for bradycardia and hypotension

sodium bicarb for conduction defects

34
Q

sotalol poisoning

A

torsade de pointe polymorphous ventricular tachycardia associated w QT prolongation
treated with: isoproterenol, magnesium

35
Q

what can cause serotonin syndrome

A 
SSRIs alone, or in combo with:
MAOIs
TCAs
amphetamines
opioids
36
Q

common signs of serotonin syndrome

A 
altered mental status
fever
agitation
myclonus (muscle jerks)
hyperreflexia
ataxia
diaphoresis (sweating)
37
Q

serotonin antagonists

A

cyproheptadine

propranolol

RC Test 1 (19 decks)

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