clinical toxicity I and II Flashcards
what is the toxicidrome for opioids?
altered mental, decreased RR, decreased HR, BP, temperature, pinpoint pupils and decreased bowel sounds.
what are some common opioids
heroin, fentanyl, codeine, hydrocodone, meperidine, oxycodone, methadone
what to give in a opioid scenario
ABC/substrates. remove all obstructive process, assess and protect if necessary, IV fluids, O2 100%, dextrose/thiamine.
what drug can reverse an opioid OD
naloxone. competitive mu/delta/kappa antagonist. can precipitate withdrawal.
are higher or lower doses of naloxone needed for synthetic opioids
higher,
what are some natural opioids
morphine, codeine
what are some semi-synthetic opioids
heroin, oxycodone, hydromorphone
what are some fully synthetic opioids
meperidine, methadone, fentanyl.
what is characteristic of opioid withdrawal
flu-like symptoms nausea, vomit, piloerection, yawning. normal mental status
what are two other opioid reversal drugs
nalmefene and naltrexone
benzodiazepam toxidrome
depressed mental status, normal vitals
treatment for the benzodiazepam OD
supportive, ABCs, consider flunazenil
what is flunazenil
competitive non-selective benzodiazepam antagonist. only works for benzodiazepam, not the other sedative-hypnotics
do patients have to have a history of acetominophen ingestion to have a treatable level?
no. 1/500 w/o a history have a treatable level.
stage 1 acetominophen toxidrome
0-24hrs GI irritation, generally asymptom.
stage II acetominophen toxidrome
24-72 hours. LFT and renal function abnormalities, can have RUQ pain.
stage III acetominophen toxidrome
72-96 hrs. hepatic necrosis, can also show renal failure
stage IV acetominophen toxidrome
4days-2weeks. resolution of organ function
what is antidote for acetominophen poisoning
N-acetylcysteine. best if given within 8 hours of overdosr.. it is effective for all stages of toxicity.
when is NAC indicated for patients with acetominophen poisoning
a level unknown at the time of ingestion over the rumack-mathew nomogram. if the patient is showing signs og hepatotoxicity. when the APAP level will not be available within 8 hours of ingestion.
what are the signs of late APAP toxicity
prothrombin time > 200, serum Cr > 3.3. hepatic encephalopathy, blood pH < 7.3, factor VIII/V ratio > 30
what are two measures for the APAP toxicity that predict a poor prognosis
serum lactate elevation taken at various times throughout presentation. serum phosphate levels even more accurate. if the phosphate levels are elevated 2-3 days post OD >1.2 then that confers a poor prognosis
what are the mechanisms of NAC
supplies sulfhydryl groups, antioxidant. improves microcirculation, supplies glutathione and has antiinflammatory properties.
tricyclic antidepressants
anticholinergic, catechol reuptake inhibitors, alpha-adrenergic blocker, GABA antagonists, sodium channel blocker.