Block 3 materials (poisoning) Flashcards by isabelle courtney

Severe GI distress leading to necrotizing gastroenteritis with hematemesis and bloody diarrhea, dyspnea, shock and coma –– typically seen in children who have ingested iron tablets

Iron Poisoning

Treatment
deferoxamine, deferasirox, deferiprone (iron chelators)

gastric aspiration
carbonate lavage

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Acetaminophen poisoning

N-acetylcysteine (replenish glutathione)

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Organophosphates or AChE inhibitor poisoning

Atropine & Pralidoxime

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Antimuscarinic/anticholinergic agent poisoning

Physostigmine

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Benzodiazepine poisoning

Flumazenil

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Arsenic poisoning

Dimercaprol (British anti-Lewisite(BAL) & Succimer

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B-blocker poisoning

Atropine
Glucagon
Saline

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Carbon monoxide poisoning

100%O2 & or hyperbaric O2

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Copper poisoning

copper chelators: penicillamine, trientine

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Cyanide poisoning

Hydroxocobalamin
Nitrites & sodium thiosulfate

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Dabigatran poisoning

Idarucizumab

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Digoxin poisoning

Digoxin Fabs

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Direct factor XA inhibitors (i.e apixaban) poisoning

Andexanet alfa

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Heparin poisoning

Protamine sulfate

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Mercury poisoning

Dimercaprol & Succimer

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Lead poisoning

Penicillamine
Calcium disodium EDTA
Dimercaprol (British anti-Lewisite(BAL))
Succimer
(PEDS)

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Methanol & Ethylene glycol poisoning

Fomepizole > ethanol, dialysis

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Methemoglobin poisoning

Methylene blue
Vitamin C

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Methotrexate poisoning

Leucovorin

Opioid poisoning

Naloxone

Salicylate & TCA poisoning

Sodium bicarbonate (NaHCO3

Warfarin poisoning

Vitamin K & Fresh frozen plasma

Lethargy, bradycardia, hypotension, cool skin, flaccid muscles, decreased gag reflex, miosis, respiratory and CNS depression, seizures

Morphine poisoning

Rx: Naloxone

impaired judgment, mydriasis, tactile hallucinations (bugs crawling), paranoia, angina, coronary vasospasm, sudden cardiac death

Cocaine poisoning

Rx: Benzodiazepines, mixed a/B blockers (HTN/Tachycardia)

: restlessness, irritability, anxiety

Nicotine intoxication Rx: NRT, bupropion, varenicline, clonidine

Respiratory failure, severe anion gap metabolic acidosis, & ocular damage

Methanol poisoning Rx: Fomepizole (long acting alcohol dehydrogenase inhibitor)

: acute: gastroenteritis, hypotension, metabolic acidosis, garlic breath, rice water stools, torsade's, seizures; chronic: pallor, skin pigmentation, alopecia, stocking glove neuropathy, myelosuppression

Arsenic poisoning Rx: Dimercaprol (British anti-Lewisite (BAL)), Succimer, Penicillamine, or activated charcoal

: mild anorexia, N/V, delayed jaundice, hepatic and renal failure

Acetaminophen poisoning Rx: N-acetylcysteine (replenish glutathione)

tachycardia, hypertension, hyperthermia (hot, dry skin), delirium, hallucinations, mydriasis

Atropine poisoning Rx: Physostigmine & control cardio/hyperthermia

major psychosis, serotonin syndrome, hyperpyrexia, acute renal and hepatic failure, cardiac arrhythmia, coronary vasospasm, seizures, cardiac arrest, death

Amphetamine poisoning Rx: Benzodiazepine

pink/cherry red skin, bitter almond breath, cardiovascular collapse, seizures, coma

Cyanide poisoning Rx: Activated charcoal Hydroxocobalamin Nitrites and Sodium thiosulfate

renal failure, urine crystals, increases anion and osmolar gap, CNS excitation

Ethylene glycol poisoning Rx: alkalinization via fomepizole (ADH inhibitor) > ethanol, hemodialysis

respiratory depression, hyperpyrexia, prolonged QT (Na+ channel inhibition), convulsions, coma

TCA poisoning Rx: NaHCO3 (stabilizes cardiac cell membrane), activated charcoal

Chronic: pallor, skin pigmentation (rain drop pattern), alopecia, Stocking glove neuropathy, & myelosuppression

Arsenic poisoning Rx: Penicillamine Activated charcoal Dimercaprol (British anti-Lewisite (BAL)) Succimer

Drugs contraindicated in hemodialysis

A : Amphetamines V : Verapamil O : OP Poisoning , Opioids I : Imipramine D : Digitalis Dialysis : Diazepam

Carbamazepine Ethylene glycol Lithium Methanol Metformin Phenobarbital Salicylate Theophylline Valproic acid Poisoning requires which type of treatment?

Hemodialysis

Amphetamine poisoning

Rx: 1) Benzodiazepines: sedation and control of seizures 2) Ammonium chloride

Cheese Reaction: TCA & MAO Inhibitors

Tyramine (cheese, wine, smoked meats) –– is metabolized by MAOA in the intestines and is not absorbed Phentolamine is the drug of choice for ‘cheese reaction’

Lubiprostone Classification: Cl- channel activator Mechanism of Action: activates the type 2 Cl- channels in the small intestine –– increasing Cl- rich fluid content into the intestine stimulating intestinal motility and shortens intestinal transit time Clinical Indications: women with IBS (predominantly constipation) Adverse Effects: category C (pregnancy)

Any drug that increases 5-HT 1) Activity (neuromuscular;clonus hyperreflexia, hypertonia, tremor, seizure) 2) autonomic instability (eg, hyperthermia, diaphoresis, diarrhea) 3) altered mental status

Serotonin syndrome Rx: Cyproheptadine (5-HT2 receptor antagonist)

Hypertensive crisis: Eating tyramine-rich foods (eg, aged cheeses, cured meats, wine, chocolate) while taking MAOIs

Rx: Phentolamine

Neuroleptic malignant syndrome: Malignant FEVER: Myoglobinuria, Fever, Encephalopathy, Vitals unstable, Enzymes (eg, CK), muscle Rigidity (“lead pipe”)

Rx: Dantrolene, dopaminergics (eg, bromocriptine, amantadine), benzodiazepines; discontinue causative agent

Tricyclic antidepressant toxicity: Respiratory depression, hyperpyrexia, prolonged QT Tricyclic’s: convulsions, coma, cardiotoxicity (arrhythmia due to Na+ channel inhibition

Supportive treatment, monitor ECG, NaHCO3 (prevents arrhythmia), activated charcoal

Disulfiram Reaction (Enzyme: Aldehyde Dehydrogenase):

MOA: Disulfiram inhibits aldehyde dehydrogenase, leading to the accumulation of acetaldehyde when ethanol is consumed. Adverse effects: 1) Flushing 2) headache/nausea 3) palpitations, deterring alcohol consumption.

Smoking Cessation Medication Target: Nicotinic acetylcholine receptors ● Moa: Acts as a (alpha 4 beta 2) partial agonist at these receptors, reducing craving and withdrawal symptoms. ● Clinical uses: Smoking cessation Adverse effects: 1) mood changes 2) vivid dreams.

Varenicline:

Bupropion MOA: Clinical uses: Adverse effects: Toxicity

atypical antidepressant (NE-DA reuptake inhibitor) MOA: inhibits NE and DA reuptake Clinical Indications: 1) depression 2) smoking cessation Adverse Effects: 1) seizures 2) HTN Toxicity: 1) stimulant effects (tachycardia, insomnia), 2) headache/seizures in patients with eating disorders

Bupropion