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GIR Test 3 > B5.055 Prework 1: Adverse Drug Reactions > Flashcards

B5.055 Prework 1: Adverse Drug Reactions Flashcards

1
Q

therapeutic dose of APAP

A

up to 4 g in 24 hr

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2
Q

most common cause of liver failure in western world

A

APAP overdose

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3
Q

what causes liver failure with APAP overdose

A

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

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4
Q

early signs of APAP overdose

A

none other than anorexia, nausea or vomiting

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5
Q

signs of APAP overdose after 24-48 hours

A

elevated PT or INR

increases transaminases

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6
Q

signs of APAP overdose after 48 hr to 7 days

A

increase in intracranial pressure
hepatic encephalopathy
coma
multi-organ failure

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7
Q

treatment of APAP overdose

A

gastric lavage with charcoal in early stages (rarely possible)
acetylcysteine (NAC) as antidote given in a dose according to nomogram based on plasma levels of APAP
IV glucose is hypoglycemic
long term- liver transplant

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8
Q

symptoms of salicylate oversode

A

tinnitus and dizziness
hyperpyrexia
coma, convulsions, resp failure with increasing dose
metabolic acidosis at later stages

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9
Q

discuss the causes of metabolic acidosis in salicylate overdose

A

uncoupling of oxidative phosphorylation
accumulation of keto acids
impairment of renal excretion of acids
depletion of bicarbonate reserve

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10
Q

treatment of salicylate overdose

A

gastric lavage if practical
correct hyperthermia by external cooling
treat resp depression with mechanical ventilation
administer IV fluids with glucose and lytes
give bicarb to alkalize the urine to promote excretion and help counteract acidosis ***
if renal function is impaired, dialysis to remove salicylates

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11
Q

what level of plasma salicylate indicates toxicity

A

50 mg/dL

3.5 nmol/L

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12
Q

sympathomimetics

A

cocaine

amphetamines

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13
Q

toxidrome for amphetamine abuse

A

tachycardia
hypertension
seizures
mydriasis (pupil dilation)

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14
Q

other symptoms of amphetamine abuse

A

CNS stimulation and muscle rigidity or hyperactivity
circulatory failure
coma
death

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15
Q

treatment of sympathomimetic overdose

A

maintain airway and respiration
control convulsions with diazepam IV
if oral intoxication > give activated charcoal and remove from stomach by lavage or emesis
succinylcholine is convulsions interfere w respiration

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16
Q

contraindications in sympathomimetic overdose

A 
vasopressors hazardous (maintain bp with fluids)
beta blockers
17
Q

opioid toxidrome

A

unconsciousness
miosis
slow, shallow respirations

18
Q

other symptoms of opioid overdose

A

cyanosis
hypotension
spasms of GI tract (spasticity and twitching of the muscles)
death from respiratory depression may occur within 2-4 hours

19
Q

treatment of opioid overdose

A

maintain vitals
gastric lavage if oral ingestion
Naloxone is opioid antagonist (antidote), give repeat doses because short duration of action
maintain body warmth and fluid intake

20
Q

symptoms of tricyclic antidepressant (amitriptyline) overdose

A

anticholinergic effects: tachycardia, dry mouth, nausea, confusion, urine retention
abnormal cardiac conduction, arrhythmias and hypotension

21
Q

describe the cardiotoxic effects of amitriptyline

A

prolonged QT interval
blockade of myocardial fast sodium channels (QRS prolongation, tall R waves)
inhibition of potassium channels (QTc prolongation)
direct myocardial depression
blockade at M1, H1, and a-adrenergic receptors

22
Q

treatment of tricyclic antidepressant overdose

A

maintain airway and assist ventilation
treat seizures with diazepam, pancuronium
give bicarb to maintain arterial pH between 7.45-7.55 to reverse cardiac membrane depressant effects
magnesium in severe cases
antiarrhythmic drugs contraindicated

23
Q

B blocker cardiac disturbances

A 
first degree heart block
hypotension
bradycardia
AV block
intraventricular conduction disturbances
24
Q

ECG findings in b blocker overdose

A

normal QRS duration with increased PR intervals

QRS widening with massive intoxication

25
Q

B blocker CNS toxicity

A

convulsions
coma
resp arrest

26
Q

other symptoms of B blocker overdose

A

bronchospasms in patients with asthma and chronic bronchospastic disease
hypoglycemia
hyperkalemia

27
Q

treatment for b blocker overdose

A

glucagon for bradycardia and hypotension

bicarb for conduction defects

28
Q

sotalol poisoning

A

can induce torsade de pointes

treat w isoproterenol and magnesium

29
Q

common signs of serotonin syndrome

A 
altered mental status
fever
agitation
myoclonus (sudden muscle jerks)
hyperreflexia
ataxia
diaphoresis
30
Q

treatment of serotonin syndrome

A

serotonin antagonists: cyproheptadine, propranolol
dantrolene
supportive therapy

GIR Test 3 (19 decks)

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