Ch 20: Emergency Preparedness, Toxicology & Antidotes

Question 1

True or False: Children are the most common victims of accidental poisoning in the US.

Answer 1

True

Question 2

Common child-resistant (C-R) packaging includes screw caps that require more than a simple turn to open as well as _______.

Answer 2

Unit-dose packaging

Question 3

For a topical exposure, remove any contaminated clothing and run water over the skin for __ minutes.

Answer 3

10

Question 4

For ocular exposure, remove contact lenses and rinse eye(s) with water from tap or hose with a gentle stream for at least __ minutes.

Answer 4

15

Question 5

True or False: With oral ingestion, remove anything in the mouth and collect any suspect containers/emesis to bring to the emergency department.

Answer 5

True

Question 6

What should be the first steps taken if overdose is suspected?

Answer 6

Contact emergency help (911) and assess ABCs (Airway, Breathing, and Circulation)

Question 7

_____ is the mainstay of caring for overdose patients until the medications are cleared by the body.

Answer 7

Supportive Care

Question 8

Activated charcoal can be used for specific types of orally ingested drugs and is an early step in some overdose protocols. Activated charcoal needs to be given quickly and is most effected when used within ___ of ingestion.

Answer 8

One hour

Question 9

Activated charcoal absorbs the drug, which prevents GI absorption and systemic toxicity. The dose of active charcoal is ____. Typically only one dose is administered.

Answer 9

1 g/kg

Question 10

Hepatotoxicity is a dose dependent adverse effect of acetaminophen. Acetaminophen is usually metabolized to a sulfate moiety or glucuronide moiety. However, there is increased metabolism through CYP2E1 to the toxic metabolite called _____.

Answer 10

NAPQI (N-acetyl-p-benzoquinone-imine)

Question 11

_____ is what neutralizes the toxic metabolite of acetaminophen (NAPQI). However, it gets depleted during an acetaminophen toxicity, which is why a treatment is required.

Answer 11

Glutathione

Question 12

There are 4 phases of acetaminophen overdose presentation. During the first phase (____ hours), the patient is commonly asymptomatic or experiencing nonspecific symptoms (N/V, sweating, general discomfort, pale color) and LFTs may be normal.

Answer 12

During the first 1-24 hours

Question 13

During phase 2 of acetaminophen overdose presentation (hours __-__), laboratory evidence of hepatotoxicity present.

Answer 13

Hours 24-48

Question 14

During phase ___ of acetaminophen overdose presentation, there is fulminant hepatic failure (e.g. jaundice, encephalopathy, coagulopathy , hepato-renal syndrome, etc.)

Answer 14

Phase 3

Question 15

The treatment for acetaminophen toxicity is ________.

Answer 15

N-acetylcysteine (NAC)

Question 16

N-acetylcysteine is available in oral and IV formulation (used if patient is unconscious). The oral dose is _____, and should be repeated if emesis occurs within 1 hour of administration.

Answer 16

140 mg/kg x1, followed by 70 mg/kg every 4 hours x17 additional doses.

Question 17

______ is used for an opioid overdose.

Answer 17

Naloxone

Question 18

For anticholinergic drug overdose, such as atropine, diphenhydramine, dimenhydrinate, Atropa belladonna (deadly nightshade), jimsyn weed, scopolamine, the treatment is supportive care combined with which medication?

A. Glucagon
B. Physostigmine
C. Flumazenil
D. Vitamin K
E. Hydroxocobalamin
F. Thiamine
G. Fomepizole
H. Dimercaprol

Answer 18

B. Physostigmine