Ch 20: Emergency Preparedness, Toxicology, and Antidotes Flashcards
decontamination with activated charcoal
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.
apap od
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.
apap blood levels
should be drawn and plotted on rumack-matthew nomogram. determines risk of hep to.
opioid od
resp depression and sedation. naloxone is antidote. no ADRs with naloxone (except withdrawal sx in od)
anticholinergics od
supportive care. sometimes physostigmine, which degrades aceylcholinesterase (breaks down ACh) to inc ACh and reduce antiAch tox
benzo od
flumazenil (romazicone), may precipitate seizures in benzo-dependent pts. also off-label for non-benzo hypnotic od but not routinely rec
BB od
supportive care. glucagon 2nd. high dose insulin with glucose 3rd. lipid emulsion (lipid sink) 4th.
CCB od
supportive care. ca (cl or gluconate) IV. same as BB od
cyanide (smoke inhalation, nitroprusside in high doses for long durations) od
hydroxocobalamin (cyanokit). na thiosulfate + na nitrite (nithiodote)
ethanol od
thiamine (b1) to prevent wernickes
ethylene glycol (antifreeze), diethylene glycol, methanol od
fomepizole (antizol) preferred. ethanol 2nd
5-FU, capecitabine od
uridine triacetate (vistogard, xuriden)
heavy metals: arsenic, copper, gold, lead, mercury, thallium od
arsenic, gold, mercury, lead: dimercaprol. copper: penicillamine. lead: succimer (chemet), dimercaptosuccinic acid (DMSA). htallium: ferric hexacyanoferrate (prussian blue or radiogardase)
insulin or hypoglycemic od
dextrose injection or drip. glucagon 2nd. sulfonylurea induced hypoglycemia: octreotide (sandostatin)
isoniazid od
pyridoxine (vit b6), benzos, barbiturates.
iron od
deferoxamine (desferal) - contraindicated in severe renal disease, deferiprone (ferriprox), deferasirox (exjade, jadenu) for iron overload from blood transufions.
organophosphates (OPs) like insecticides aka cholinergics od
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
mtx od
leucovorin (folinic acid) levoleucovorin (fusilev), glucarpidase (voraxaze) for rescue in cancer or accidental od.
methemoglobinemia od
methylene blue (provayblue) - contraindicate in pts with g6pd deficiency. avoid admin with SSRIs/SNRIs
nicotine od
supportive care. atropine for sx bradycardia. benzos if seizures.
paralytics od (rocuronium, vecuronium, pancuronium) od
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
salicylates od
bicarb to alkalinize urine to dec drug reabsorption and inc the excretion of salicylates and other weak acids
stimulant od from amphetamines (ADHD and wt loss drugs) or cocaine, caffeine, ephedrine, theophylline, MDMA (ecstasy)
supportive care, benzos if agitation or seizures
snake bites antidote - eastern coral snake, texas coral snake, copperhead snake, rattlesnake
crotalidae polyvalent immune FAB (crofab) for copperhead/rattlesnake. antivenin micrurus fulvius for coral snake. crotalidae immune fab (anavip) for rattlesnake.
snake bites antidote - eastern coral snake, texas coral snake, copperhead snake, rattlesnake
crotalidae polyvalent immune FAB (crofab) for copperhead/rattlesnake. antivenin micrurus fulvius for coral snake. crotalidae immune fab (anavip) for rattlesnake.
SLUDGE sx
cholinergic od. salivation, lacrimation, urination, diarrhea, GI distress, emesis
