Block 3 More, why?? Flashcards
What is the poison control number?
1-800-222-1222
or text POISON to 797979
Sympathomimetic toxidromes are caused by what? Tx?
Caused by caffeine, cocaine, amphetamines, alcohol/drug withdrawal
Tx = BZD
Cholinergic toxidromes are caused by what? Sx?
Cholinesterase inhibitors, nerve gas, pesticides
SLUDGE
Salivation, lacrimation, urination, diarrhea, GI distress, emesis
Muscarinic + Nicotinic effects
Anticholinergic toxidromes are caused by what? Sx? Tx?
Diphenhydramine, OAB rx, Atropine, glypyrollate
Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, and heart runs alone
Tx = BZD or physostigmine (dont use if you dont know what rx went in)
What does RADAR stand for?
Recognition Assessment Definitive Diagnosis Advice Reporting
PR prolongation
QRS prolongation
QTC prolongation
Antidepressants
Non DHB CCB
TCAs
Which Rx cause the AE?
TCA - QRS prolongation
Antidepressants - QTC prolongation
Non DHB CCB - PR prolongation
Anion Gap elevations is due to what?
Methanol, propylene glycol, ethylene glycol, salicylate
SDT vs UDS, which one provides quantitative values?
SDT
What are some poor candidates to use with activated charcoal?
Inorganic
Polar
Charged
Can only adsorb to something in dissolved liquid phase
PHAILS
Pesticides, hydrocarbons, acids/alkali, iron, lithium, solvents
Single and multiple dosing strategy for activated charcoal?
Single = 1mg/kg
Multiple = 0.25-0.5mg/kg every 1 to 6 hrs
Activated charcoal CI?
Pt in stupor phase, coma, convulsing unless they have endotracheal tube
Who should get whole bowel irrigation?
Any delayed/sustained release products
Large amounts of metal
Xenobiotics w/ slow absorption phase
Hemodialysis is beneficial for xenobiotics that have..
Low or High Vd Single or multiple PK parameters Low or high protein binding capacity Small or High weight Water soluble or insoluble
Low Vd (<1L/kg) Single PK Low protein Small weight (<5000 Daltons) Water soluble
What class do organophosphates and carbamates belong to?
Cholinesterase inhibitors
What groups are found in the organophosphates and carbamates?
Organo - oxygen + leaving group that attaches to O2 or phosphorous + 2 side chains
Carbamates - N methyl group + NCOO
How do you manage organophosphate toxicity?
BZD for seizures
Atropine (only works on ACh receptors); so no effect on paralysis, fasciculations
Alternatives to atropine: glycopyrrolate (only works for periphery), ipratropium, scopolamine
Pralidoxime (2-PAM), give atropine prior
How does pralidoxime (2-PAM) work?
It attaches the N-OH group to the organophosphate’s P group (where the R20 was)
Kappa receptor is responsible for what action of opioids?
Miosis + sedation
Mu1 receptor is responsible for what action of opioids?
Analgesia, everything else is Mu2
Which opioid lowers seizure threshold?
Tramadol
Tramadol interacts with what Rx?
Antidepressant meds
Tramadol is a (mu/kappa) agonist. Oxycodone..?
Tramadol - mu
Oxycodone - both
Which opioids are metabolized by CYP2D6?
Codeine + Tramadol
Tolerance to _________ develops slower than analgesia and euphoria for opioids
Respiratory depression
RF for opioid overdose?
> 50MME/day
> 90 days of use
Naloxone is a (mu/kappa) antagonist
Mu antagonist
Protein binding and acceptable ranges of APAP and NSAIDs?
APAP - low protein, 10-30
Aspirin - high protein, 15-30
Other NSAIDs - high protein, doesnt say :/
Metabolism of APAP
Most go through non CYP metabolism
Small % goes through CYP2E1 which forms NAPQI, which glutathione attaches to. In overdose situations, glutathione is depleted and NAPQI attaches to hepatocytes
Staging of APAP toxicity?
1 = no hepatic damage, basic AE, days 0-1
2 = AST/ALT >1000, URQP, 5% of cases, days 1-3
3 = AST/ALT >10,000, hepatic failure, danger zone for death is days 3-5
4 = recovery
Limitations of Rumack-Matthew Nomogram?
No guidelines for <4hrs
Altered mental status or patient history is too unreliable to plot correctly
Limited evidence in children
Limited evidence in ER formulation
Aspirin toxicity AE?
Inhibits the citric acid cycle - Metabolic acidosis
Uncouples oxidative phosphorylation - Ketoacidosis
Direct stimulation of the respiratory center - Respiratory alkalosis
Clinical triad of ASA toxicity?
Hyperventilation
Tinnitus (cochlear toxicity)
GI irritation
What are the non-DHP CCB?
Verapamil + Diltiazem
(DHP/Non-DHP CCB) inhibit both SA + AV nodes. What does the other one do primarily?
Non-DHP
Tends to act as a peripheral vasodilator
In the event of a CCB overdose, how is insulin affected?
Less insulin release
Can you use dialysis on CCB overdose?
No, they are highly protein bound
Non DHP CCB toxic effects
Bradycardia
Hyperglycemia
Lactate production + metabolic acidosis
DHP CCB toxic effects
Reflex tachycardia
Higher doses, bradycardia
Treatment option for Non DHP CCB or BB?
Activated charcoal, maybe more better for XR formulation
Atropine (treats bradycardia) Glucagon (increases adenylate cyclase) Calcium chloride/gluconate Sodium bicarb (for QRS, not for urine alkalization) Vasopressors High dose insulin IV fat emulsion
Digoxin toxicity AE?
Bradycardia
Hyperkalemia
Arrhythmias
Digoxin toxicity treatment?
Activated charcoal, even past the 1-2hr mark
Atropine
DigiFab (40mg reverse 0.5mg of digoxin)
Can you use BB for cocaine overdose?
No
Just treat with ASA, O2, BZD, nitroglycerin
