Chapter 81: Emergency Preparedness, Toxicology & Antidotes Flashcards
Which resources have information on toxicology
Micromedex POISONDEX & Lexicomp Lexi-Tox
To reduce accidental poisoning in children, what can be helpful
child-resistant containers
What is required for all rx drugs unless waived by the patient
child-resistant containers
Which drug is excluded from child-resistant containers
Nitroglycerin SL tabs
Common child-resistant packaging includes
- Screw caps
- Unit dose packaging
- Card adherence
- Safety packaging
Topical overdose management
Remove contaminated clothing and wash skin with soap and water for 10 min
Ocular overdose management
remove contact lenses and rinse eye/s with a gentle stream of water for at least 15 min
Which drug is no longer available but used to induce emesis for certain exposures
Ipecac syrup
The first step to the CAB’s (circulation, airway, breathing) is
to evaluate if the pt has a pulse
When is activated charcoal most effective
when used within 1 hour of ingestion
How does activated charcoal work
it absorbs the drug, which prevents GI absorption and systemic toxicity
What is the dose of activated charcoal
1 g/kg
What must be done prior to using activated charcoal
airway should be protected (with intubation, if needed) to prevent aspiration
Activated charcoal CI
- when the airway is unprotected (unconscious, cannot clear throat, cannot hold head upright)
- intestinal obstruction
- when GI tract is not intact or when there is decreased parastalsis
Hepatotoxicity is a dose-dependent adverse effect caused by the increased metabolism of APAP by CYP450 ___ to ____
2E1 to NAPQI
Phase 1 of APAP overdose
1-24 hrs: commonly asymptomatic or non-specific symptoms such as nausea and vomiting
Phase 2 of APAP overdose
24-48 hrs: elevated INR, AST/ALT; symptoms from phase 1 usually subside
Phase 3 of APAP overdose
48-96 hrs: fulminant hepatic failure (e.g., jaundice, coagulopathy, renal failure, &/or death)
Phase 4 of APAP overdose
> 96 hrs: the patient recovers or receives a liver transplant
Antidote for APAP overdose
N-acetylcysteine (NAC)
How does NAC work for APAP overdose
Increases glutathione, which increases GSH.
GSH converts NAPQI to mercapturic acid, which can safely be excreted from the body.
If NAPQI has already bonded to hepatocytes, the damage is irreversible
APAP levels are plotted on
Rumack-Matthew nomogram to determine risk of hepatotoxicity
What formulations does NAC come in
oral and IV
NAC brand name
Acetadote
When is the APAP level drawn
4-24 hrs
How is oral NAC dosed
high-dose bolus x1, then lower dose for 17 dose. Repeat the dose if emesis occurs within 1 hr of administration