Ch 20: Emergency Preparedness, Toxicology, and Antidotes

Question 1

decontamination with activated charcoal

Answer 1

used with some PO drugs. most effective <1 h of ingestion to prevent GI absorption. dose is 1 g/kg. multiple doses not usually rec. avoid when airway is unprotected d/t risk of aspiration.

Question 2

apap od

Answer 2

phase 1 (first 1-24 h) usually asx or nonspecific sx. later phases have s/s of hep tox, which is dose dependent. n-acetyl-p-benzoquinone (NAPQI) is the toxic metabolite that covalently binds to and cause injury to liver cells. n-acetylcysteine (NAC) is the antidote to be given quickly. it inc glutathione, to inc glutatione-s-transferase, to convert NAQI to mercaptic acid for excretion.

Question 3

apap blood levels

Answer 3

should be drawn and plotted on rumack-matthew nomogram. determines risk of hep to.

Question 4

opioid od

Answer 4

resp depression and sedation. naloxone is antidote. no ADRs with naloxone (except withdrawal sx in od)

Question 5

anticholinergics od

Answer 5

supportive care. sometimes physostigmine, which degrades aceylcholinesterase (breaks down ACh) to inc ACh and reduce antiAch tox

Question 6

benzo od

Answer 6

flumazenil (romazicone), may precipitate seizures in benzo-dependent pts. also off-label for non-benzo hypnotic od but not routinely rec

Question 7

BB od

Answer 7

supportive care. glucagon 2nd. high dose insulin with glucose 3rd. lipid emulsion (lipid sink) 4th.

Question 8

CCB od

Answer 8

supportive care. ca (cl or gluconate) IV. same as BB od

Question 9

cyanide (smoke inhalation, nitroprusside in high doses for long durations) od

Answer 9

hydroxocobalamin (cyanokit). na thiosulfate + na nitrite (nithiodote)

Question 10

ethanol od

Answer 10

thiamine (b1) to prevent wernickes

Question 11

ethylene glycol (antifreeze), diethylene glycol, methanol od

Answer 11

fomepizole (antizol) preferred. ethanol 2nd

Question 12

5-FU, capecitabine od

Answer 12

uridine triacetate (vistogard, xuriden)

Question 13

heavy metals: arsenic, copper, gold, lead, mercury, thallium od

Answer 13

arsenic, gold, mercury, lead: dimercaprol. copper: penicillamine. lead: succimer (chemet), dimercaptosuccinic acid (DMSA). htallium: ferric hexacyanoferrate (prussian blue or radiogardase)

Question 14

insulin or hypoglycemic od

Answer 14

dextrose injection or drip. glucagon 2nd. sulfonylurea induced hypoglycemia: octreotide (sandostatin)

Question 15

isoniazid od

Answer 15

pyridoxine (vit b6), benzos, barbiturates.

Question 16

iron od

Answer 16

deferoxamine (desferal) - contraindicated in severe renal disease, deferiprone (ferriprox), deferasirox (exjade, jadenu) for iron overload from blood transufions.

Question 17

organophosphates (OPs) like insecticides aka cholinergics od

Answer 17

atropine and pralidoxime or in combo (duodote, ATNAA). OPs block acetylcholinsterase which inc ACh. atropine is anti-ACh to blood effects of ACh to reduce SLUDGE sx of ACh. pralidoxime treats the muscle weakness and relieves paralysis of resp muscles secondary to tox

Question 18

mtx od

Answer 18

leucovorin (folinic acid) levoleucovorin (fusilev), glucarpidase (voraxaze) for rescue in cancer or accidental od.

Question 19

methemoglobinemia od

Answer 19

methylene blue (provayblue) - contraindicate in pts with g6pd deficiency. avoid admin with SSRIs/SNRIs

Question 20

nicotine od

Answer 20

supportive care. atropine for sx bradycardia. benzos if seizures.

Question 21

paralytics od (rocuronium, vecuronium, pancuronium) od

Answer 21

neostigmine methylsulfate (bloxiverz) for roc, vec, pan. sugammadex (bridion) for roc and vec. to revere neuromuscular blockade for adults undergoing surgery. admin with atropine or glycopyrrolate to prevent bradycardia

Question 22

salicylates od

Answer 22

bicarb to alkalinize urine to dec drug reabsorption and inc the excretion of salicylates and other weak acids

Question 23

stimulant od from amphetamines (ADHD and wt loss drugs) or cocaine, caffeine, ephedrine, theophylline, MDMA (ecstasy)

Answer 23

supportive care, benzos if agitation or seizures

Question 24

snake bites antidote - eastern coral snake, texas coral snake, copperhead snake, rattlesnake

Answer 24

crotalidae polyvalent immune FAB (crofab) for copperhead/rattlesnake. antivenin micrurus fulvius for coral snake. crotalidae immune fab (anavip) for rattlesnake.

Question 25

snake bites antidote - eastern coral snake, texas coral snake, copperhead snake, rattlesnake

Answer 25

crotalidae polyvalent immune FAB (crofab) for copperhead/rattlesnake. antivenin micrurus fulvius for coral snake. crotalidae immune fab (anavip) for rattlesnake.

Question 26

SLUDGE sx

Answer 26

cholinergic od. salivation, lacrimation, urination, diarrhea, GI distress, emesis