Ch 28- Toxicology Flashcards
What is illicit vs licit drugs?
Illegal vs legal
What is a drug?
A substance that has some therapeutic effect when given in appropriate circumstances and dose
What is toxicology poison?
Substance whose chemical action could damage structures or impair function when introduced into body
What is a toxin?
Poison or harmful substance produced by bacteria, animals or plants
What is an overdose?
Drug taken in excess
What is half life?
Amount of time needed for average person to metabolize half of the substance
What is an antidote?
Something that counteracts effect of the poison
What are the routes of entry?
Ingestion, inhalation, injection, absorption
Ingestion
Via GI tract
Consider ingestion if pt: report sudden abd cramps, n/v, diarrhea
Amount of time in stomach may vary from person to person
Activated charcoal to induce vomiting is not indicated
Activated charcoal w/ sorbitol may be indicated
Gastric lavage may be performed at he hospital
Drug “mules” can have ingestion of drugs if container fails
Inhalation
Breathing in substance
Be scene safety aware; inhalation hazard can effect responder
Carbon Monoxide is example of inhaled toxin
Inhalation will be quick to produce s/s
Can produce wide range of s/s—-call poison control if needed
Injection
Toxin entrance into body generally via stings/bites
Can produce local or systemic reaction
Includes misuse of IV drugs
Absorption
Poison gaining access through skin
Can be caused by pesticides like organophosphate
What is a toxidrome?
Syndrome like symptoms associated with/ class or group of similar poisonous agents
LOOK AT PAGES 1664 AND 1665 TABLES 28-1 AND 28-2
What is drug misuse?
Use of drug that causes physical, psychological, economic, legal or other social harm to the user or others affected by user’s behavior
What is habituation?
Physical or psychological dependence on a drug
What is physical dependence?
Physiologic state of adaptation to a drug caused by chronic use, usually characterized by tolerance to the effects of the drug and withdrawal if use of the drug is stopped, especially abruptly
What is tolerance?
Physiologic adaptation to the effects of a drug; requires increasingly larger dosages to achieve same effect
What is withdrawal syndrome?
Predictably set of s/s usually involving altering CNS activity; occur after abrupt cessation of a drug or rapid decrease in the usual dosage of a drug
What is drug addiction?
Chronic disorder characterized by compulsive use of substance that results in physical, psychological, economic, legal., or social harm to user. Continues to use substance despite the harm
What is antagonist?
Molecule that blocks the ability of a given chemical to bind to its receptor, preventing biologic response
What is potentiation?
Enhancement of the effects of one drug by another drug
What is synergism?
Action of 2 drugs that total effects is greater than the sum of the independent effects of the 2 substance.
What history taking should take place?
What is the substance?
When was the substance ingested, injected, absorbed, inhaled?
How much was taken, injected, absorbed, inhaled?
What else was taken
Has the pt vomited or aspirated?
Why was the substance taken?
What is alcohol disorder?
Medical condition characterized by physical and psychological addiction to ethanol that can range from mild to severe
What are the warning signs of alcohol disorder?
Consuming large quantities of alcohol or over long period of time
Spending considerable time in activities necessary to obtain alcohol, use alcohol, or recover from effects
Causing or exacerbating social/interpersonal problems due to alcohol use
Reducing social, occupational, or recreational activities due to alcohol use
Continuing to use alcohol even after acknowledging physical and psychological problems that are caused/exacerbated by alcohol use
When does physical dependence on alcohol occur?
Regular consumption of large quantities of alcohol
What nervous system does alcohol have the most effect on?
CNS
What is acute alcohol intoxication?
Acute intoxication from alcohol
What is the most acute risks of alcohol intoxication?
Resp depression and aspiration from vomiting
Assess airway- suction as needed
Provide O2 as needed
Assist ventilation- do not force ventilation, will cause gastric DISTENTION and increase risk of vomiting
Assess BG
Monitor ECG rhythm
Obtain IV access- fluid resuscitate as necessary based on vitals
Administer Thiamine to prevent Wernicke-korsakoff syndrome
What are withdrawl seizures?
person drinking heavily for long time, stops suddenly
Can occur within 12-48hrs after last drink
Treatment same as approach to intoxicated individual
Prolonged seizures usually respond to lorazepam
What are delirium tremors?
Potential lethal complication of alcohol withdrawal
Starts 48-72hrs after last alcohol intake
S/s: confusion, tremors, restlessness, fever, diaphoresis, tachycardia, hypotension
Susceptible to hallucinations
Treatment: protect patient from injury and support cardiovascular system
Physical restraints my be needed
Iv insertion w/ fluid challenge may be needed
How do stimulants work?
Enhance release of catecholamines, stimulating CNS
CNS excitation can create agitation, anxiousness, delirium, dilated pupils
What is Cocaine?
Naturally occurring alkaloid extracted from the leaves of erythromycin coca plant
Grows in South America
What does cocaine do?
Local anesthetic and nervous system stimulant
Enhances release and activity of neurotransmitters, norepinephrine, dopamine and serotonin
Dopamine: causes euphoria feeling
Norepinephrine: stimulation of sympathetic nervous system, increase hr, BP, hyperthermia
Cocaine vs crack cocaine?
Cocaine: water soluble, can be applied topically, snorted, swallowed or injected
Crack cocaine: cocaine cut with baking soda and water, cooked, turns into smokable cocaine
What is cocaine crash?
Cocaine has worn off, pt experiences depression, irritability, exhaustion
What is cocaine washout?
Hypoactive state related to lack of synaptic neurotransmitters
What is amphetamine?
Stimulant, crank, ice, MDA, Adam, MDMA, Eve, ecstasy
What is methamphetamine?
Low cost, long acting, stimulant that is highly addictive
What is the clinical presentation of amphetamine or methamphetamine abuse?
Almost identical to pt w/ cocaine abuse
Amphetamine effects last longer than cocaine
What is synthetic cathiones?
Emerging group of drugs similar to MDMA
Chemical compound derived from khat plant, originates in east africa
Flakka, cloud nine, white lightning are examples
Can be ingested, snorted, smoked, or injected
Associated w/ paranoia, hallucinations, incredible strength, excited delirium, bizarre behaviors, tachycardia, diaphoresis, nausea, hyperthermia
What are s/s of stimulant misuse?
Dysrhythmias, vascular events, hypertension, hyperthermia, seizures, agitation
How do you treat stimulant misuse?
Supportive care
Manage ABCs
Maintain oxygen
Proper monitoring
Initiate IV access and manage hypotension w/ NACL
Assess need for medication admin
Chemical restraint may be needed for excited delirium and bizarre behavior
Aggressive cooling may be indicated due to hyperthermia
Seizures should be treated w/ benzos
Neuromuscular blockade may be needed to control motor activity d/t hyperthermia, acidosis, rhabdo (likely need online med control)
What is marijuana?
Dried leaves and flower buds of cannabis sativa
What is the primary psychoactive ingredient in marijuana?
Delta 9 or THC
What does marijuana cause?
Increased sensory perception and euphoria; can cause anxiety and panic
What are the short term effects of marijuan?
Tachycardia, balance and coordination problems, increased appetite, conjunctival injection, dry mouth, possible memory loss
How long does euphoria from marijuana last?
Around 4-6HRS
How do you assess and manage THC?
Scene size up, ABCs, manage life threats
Rarely life threatening
Can cause panicked/anxiousness d/t euphoria spatial disorientation, altered sense of reality
Pt may have hyperemesis- treat w/ fluids an anti emetics
What is spice? How to treat?
Synthetic cannabinoid
Active substance blend of chemicals that are sprayed on plant like material for smoking
Generally more dangerous than marijuana
Treat w/ supportive care, manage symptoms, fluids/anti emetics as needed
What is hallucinogen?
Substance that impairs judgement, alter user’s perception of reality, creates unrealistic sensation of images or sounds that are not actually present
How are hallucinogens classified?
naturally occurring-
Synthetic- LSD, PCP, Ketamine
What is LSD? How do you assess and treat?
Fungus that contaminates rye flour and wheat
Usually ingested orally in tablet, capsule, or liquid
May result in synesthesias (crossing of senses, tasting colors)
Effects are mostly sympathomimetic: mild tachycardic, palpitation, dilated pupils, and sweating
Management is generally supportive
Limit sensory stimulation
Don’t use lights and sirens
What is phencyclidine? How to assess? How to treat?
PCP; aka angel dust, rocket fuel; dissociative anesthetic that has hallucinogen properties
No medical purpose
Works at NMDA receptor
Typically smoked or snorted
S/s include: slurred speech, staggering gait, tachycardia, hypertension, staring blankly, horizontal nystagmus
Display extraordinary strength, sense of invincibility, lack of awareness to pain
Care focuses on: calming pt, addressing wounds, IM sedatives may be necessary,
What is ketamine? What does it do? How to assess? How to treat?
Dissociative anesthetic
Short acting
Used for procedural sedations, management of agitate and violent behavior
Works at NMDA receptor; bind to my-opioid receptor
Low doses: mild inebriation, euphoria, increase sociability
Higher doses: nausea, difficulty moving, significant hallucinations
Manage ABCs manage life threats
Provide O2 as needed
IV access
Provide safe transport
Benzos can help calm agitated pt who is experiencing delirium
What is peyote and mescaline? What’s it do? How to assess and treat?
Hallucinogen found in southwest us
Mescaline found in small peyote cactus
Causes psychedelic feeling : flashes of color, commonly in geometric patterns
Dry plant can cause gastric irritation w/ severe vomiting
May experience out of body feeling
Prehospital care: supportive, provide o2 as needed, safe transport. Consider fluids and anti emetics if pt is vomiting
What is psilocybin mushrooms? What’s do they do? How to assess and treat?
Hallucinogenic mushrooms
Have bitter taste and are usually combined with other liquids/food to disguise flavor
Effects similar to LSD, occurring within 30mins, lasting 4-6HRS
S/s: weakness, drowsiness, nausea, vomiting, dilated pupils, mild tachycardia, mild hypertension
Seizure and hyperthermia have occurred in some pt’s
Management: supportive care, manag ABCs, monitor vitals, ECG, consider IV for facilitate SZ control w/ benzos Diazepam (Valium), Lorazepam (Ativan), or Midazolam (Versed)
What do sedative-hypnotic drugs do?
CNS depressant
Produce range of effects from light sedation to total anesthesia
High potential for misuse
High risk of drug diversion
What are barbiturates? What does they do? How to assess and treat?
Act as CNS depressant
Anxiolytics, anti convulsants, hypnotics
Analgesic effects have also been associated with/ barbiturates
Similar to alcohol in terms of dependence and withdrawl
Potentiate GABA receptor to inhibit cellular excitation
Increased dosage cause widespread CNS depression
Ultra short active barbs Preferred for airway management and stopping SZ
Long acting barbs preferred for sustained therapeutic level of med over long period of time
Assessment findings reflect dosage; similar to alcohol intoxication
S/s: decreased alertness, nystagmus, ataxia, mental confusion, slurred speech, increased lethargy leading to unresponsive
At risk for vomiting and aspiration
Treatments: manage ABCs, support ventilation, suction when needed, prevent aspiration, pulse ox and capno, IV access, 250ml crystalloid bolus, persistent hypotension use vasopressor,
What are benzodiazepines? What does they do? How to you manage them?
Sedative-hypnotic family
Used to treat anxiety, sz, withdrawal symptoms
Effects GABA pathways similar to barbiturates, results in sedation and reduced anxiety
Common Opoids
Morphine
Codeine
Tramadol
Heroine
Fentanyl
Methodone
Oxycodone
Hydrocodone
Common Anticholinergics
Atropine
Scopolamine
Antihistamines
Common Cholergic
Organic Phosphates Compounds:
Carbamates
Arecholine
Pilocarpine
Urecholine
Choline
Common Sympathomimetics
Caffeine
Cocaine
Methamphetamines
Amphetamines
Ritalin
LSD
Theophylline
MDMA
Common Sedative-Hypnotics
Anti-anxiety meds
Muscle relaxers
Anitepileptics
Preanesthetic meds
Barbituates
Benzodiazepines
S/S of Anticholenergic meds
Increased HR/BP
Warm/Dry Skin
Dilated Pupils
S/S of Cholinergic Agents
Pinpoint Pupils
Diaphoresis
Increased Bowel sounds/issues
S/S of Opioid Use
Decreased HR/BP
Decreased RR
Cool/Dry Skin
Pinpoint Pupils
S/S Sympathomimetic/Stimulant Use
Elevated BP/HR
Elevated RR
Warm/Wet Skin
Dilated Pupils
Increased Bowel Sounds/Issues
Anxious/Agitated
Delirium
Thin Appearance
Track Marks
S/S of Sedative-Hypnotic drug use
Decreased HR/BP
Decreased RR
Cool/Dry skin
If it ends in -LAM or -PAM, it is most likely a…..
Benzodiazepine
Which class of drug is a CNS depressant?
Barbituates
