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NAPLEX 2023 > Chapter 81: Emergency Preparedness, Toxicology & Antidotes > Flashcards

Chapter 81: Emergency Preparedness, Toxicology & Antidotes Flashcards

1
Q

Which resources have information on toxicology

A

Micromedex POISONDEX & Lexicomp Lexi-Tox

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2
Q

To reduce accidental poisoning in children, what can be helpful

A

child-resistant containers

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3
Q

Which drug is excluded from child-resistant containers

A

Nitroglycerin SL tabs

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4
Q

Common child-resistant packaging includes

A
  • Screw caps
  • Unit dose packaging
  • Card adherence
  • Safety packaging
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5
Q

Topical overdose management

A

Remove contaminated clothing and wash skin with soap and water for 10 min

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6
Q

Ocular overdose management

A

remove contact lenses and rinse eye/s with a gentle stream of water for at least 15 min

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7
Q

Which drug is no longer available but used to induce emesis for certain exposures

A

Ipecac syrup

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8
Q

The first step to the CAB’s (circulation, airway, breathing) is

A

to evaluate if the pt has a pulse

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9
Q

When is activated charcoal most effective

A

when used within 1 hour of ingestion

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10
Q

How does activated charcoal work

A

it absorbs the drug, which prevents GI absorption and systemic toxicity

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11
Q

What is the dose of activated charcoal

A

1 g/kg

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12
Q

What must be done prior to using activated charcoal

A

airway should be protected (with intubation, if needed) to prevent aspiration

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13
Q

Activated charcoal CI

A
  • 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 paristalsis
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14
Q

Hepatotoxicity is a dose-dependent adverse effect caused by the increased metabolism of APAP by CYP450 ___ to ____

A

2E1 to NAPQI

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15
Q

Phase 1 of APAP overdose

A

1-24 hrs: commonly asymptomatic or non-specific symptoms such as nausea and vomiting

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16
Q

Phase 2 of APAP overdose

A

24-48 hrs: elevated INR, AST/ALT; symptoms from phase 1 usually subside

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17
Q

Phase 3 of APAP overdose

A

48-96 hrs: fulminant hepatic failure (e.g., jaundice, coagulopathy, renal failure, &/or death)

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18
Q

Phase 4 of APAP overdose

A

> 96 hrs: the patient recovers or receives a liver transplant

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19
Q

Antidote for APAP overdose

A

N-acetylcysteine (NAC)

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20
Q

How does NAC work for APAP overdose

A

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

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21
Q

APAP levels are plotted on

A

Rumack-Matthew nomogram to determine risk of hepatotoxicity

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22
Q

What formulations does NAC come in

A

oral and IV

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23
Q

Acetadote generic name

A

NAC

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24
Q

When is the APAP level drawn

A

4-24 hrs after ingestion

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25
Q

How is oral NAC dosed

A

high-dose bolus x1, then lower dose for 17 dose. Repeat the dose if emesis occurs within 1 hr of administration

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26
Q

How is IV NAC dosed

A

3 infusions over a total of 21 hrs

27
Q

Anticholinergic overdose symptoms

A

Flushing, dry skin, mydriasis with double or blurry vision

28
Q

Anticholinergic overdose treatment

A

Primarily supportive care, rarely physostigmine

29
Q

Treatments for warfarin OD

A

Phytonadione (Vitamin K)
Prothrombin complex concentrate (Kcentra)

30
Q

Treatments for factor Xa inhibitor OD

A

Prothrombin complex concentrate (Kcentra)

31
Q

Treatment for heparin & LMWH OD

32
Q

Treatments for dabigatran OD

A

Idarucizumab (Praxbind)

33
Q

Treatments for apixaban & rivaroxaban OD

A

Abdexanet alfa (Andexxa)

34
Q

Treatment for BZD OD

A

Flumazenil - can cause seizures when used in pts on BZDs chronially

not routinely recommended

35
Q

Treatment for BB OD

A

Glucagon (if unresponsive to symptomatic tx)

high dose insulin

36
Q

Treatment for CCB OD

A

Glucagon
Calcium chloride or gluconate (administer Ca IV only)

37
Q

Cyanide: smoke inhalation, nitroprusside in high doses/long durations/renal impairment treatment for OD

A

Hydroxocobalamin (Cyanokit)

38
Q

Treatment for digoxin OD

A

Digoxin Immune Fab (DigiFab)

39
Q

What should be administered for ethanol OD if suspected to be a chronic alcohol user

A

thiamine (B1) to prevent Wernicke’s encephalopathy
Can cause increased anion gap

40
Q

Treatment for arsenic, gold, mercury OD

A

Dimercaprol

41
Q

Treatment for copper OD

A

Penicillamine

42
Q

Treatment for lead OD

A

Succimer (Chemet)

43
Q

In patient’s with Hydrocarbon OD (petroleum products, gaosline, kerosene, mineral oil, paint thinners), what should be avoided

A

Do not induce vomiting; keep pt NPO d/t aspiration risk

44
Q

Treatment for insulin or other hypoglycemic OD

A
  • Dextrose injection or infusion (drip), oral glucose (do not administer if pt is unconscious)
  • Glucagon (when IV or oral dextrose cannot be administered)
45
Q

Treatment for isoniazid OD

A

Pyridoxine (B6)

46
Q

Iron & aluminum OD treatment

A

Deferoxamine (Desferal)

47
Q

Symptoms of organophosphate OD

A

OPs block acetylcholinesterase, which increases ACh levels and causes cholinergic “SLUDD” sx: salivation, lacrimation, urination, diarrhea/defecation

48
Q

Treatment for organophosphate, including industrial insecticide, OD

A
  1. Atropine (anticholinergic effects)
  2. pralidoxime (treats muscle weakness and relieves paralysis of respiratory muscles by reactivating cholinesterase)
  3. combo of both
49
Q

Treatment for MTX OD

A

Leucovorin (folinic acid), levoleucovorin (Fusilev)

50
Q

Methylene blue is CI in pts with

A

G6PD deficiency

51
Q

Treatment for neostigmine, pyridostigmine OD

A

Pralidoxime (counteracts muscle weakness)

52
Q

Early sx of nicotine OD

A

abdominal pain, nausea

53
Q

Treatment for nicotine OD

A

Supportive care (e.g., atropine for symptomatic bradycardia, BZDs for seizures)

54
Q

Treatment for salicylate OD

A

Sodium bicarbonate (alkylating agent to alkalinize the urine to decrease drug absorption and increase excretion of salicylates)

55
Q

Stimulant OD treatment (including ADHD and weight loss drugs)

A

supportive care for agitation or seizures (BZDs)

56
Q

Toxic alcohols, ethylene glycol (antifreeze), methanol treatment for OD

A

Can cause increased anion gap
Fomepizole is preferred, ethanol 2nd line

57
Q

OD of TCAs can quickly cause

A

fatal arrhythmias

58
Q

TCA OD treatment

A

Sodium bicarbonate to decrease a widened QRS complex

59
Q

Valproic acid or topiramate-induced hyperammonemia treatment

A

Levocarnitine

60
Q

What are the SLUDD symptoms for organophosphate OD

A 
Salivation
Lacrimation
Urination
Diarrhea
Defecation
61
Q

What is the combination of atropine and pralidoxime called for organophosphate OD

62
Q

Antidote for animal bites

A

Rabies vaccine + Human rabies immune globulin

63
Q

Black Widow spider bites and scorpion sting antidote

A

Antivenim (specific to bite)

64
Q

Snake bite antidote

A

Crotalidae polyvalent immune FAB (Crofab) for copperhead and rattlesnake bites

NAPLEX 2023 (88 decks)

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