Clinical Toxicology Flashcards
Metabolism of Acetaminophen (APAP)
Sulfation
Glucuronidation
Oxidation CYP450 2E1
Toxic Metabolite of Paracetamol
N-Acetyl-p-benzoquinone imine (NAPQI)
Stages of Paracetamol Toxicity
I - N/V, anorexia, diaphoresis
II - Asymptomatic, Clinical Improvement
III - Abdominal pain, hepatic failure, coma, death
IV - Recovery
Antidote for Paracetamol Toxicity
N-Acetylcysteine (NAC)
Salicylates Toxicity
Salicylism
Salicylates Poisoning S/S
Mild: Tinnitus
Severe: Lethargy, Convulsions, coma, Metabolic Acidosis
Treatment of Salicylates Poisoning
Urine Alkalinization with NaHCO3
Vitamin K1/ fresh frozen plasma (for bleeding)
Hemodialysis or Hemoperfusion (100mg/dL)
Digoxin toxicity treatment
Lidocaine or Phenytoin
Digoxin-specific Fab antibodies (Digibind)
Potassium Chloride
Cholestyramine
Treatment for Organophosphates Poisoning
Atropine
Pralidoxime
Treatment for Strychnine poisoning
Diazepam
Phenobarbital
Neuromuscular blockers
Skeletal muscle relaxant
S/S of Strychnine Toxicity
Rigor Mortis
Spinal Convulsion
Sardonic smile
Resp. Arresrt
Skeletal Muscle relaxants
Succinylcholine - Malignant Hyperthermia (DOC: Dantrolene)
Tubocurarine - Release Histamine (DOC: Epi)
Methylxanthine
Theophylline (1,3-dimethylxanthine)
Signs and symptoms of Theophylline poisoning
Seizures, Cardiac Dysrhythmias
S/S of Tricyclic Anti-Depressant Toxicity
Convulsions, Cardiotoxicity, Coma
Anticholinergic Effects
Pulmonary depression
Management of Methylxanthine Toxicity
Ipecac Syrup
Activated Charcoal
Whole Bowel Irrigation
Hemoperfusion & Hemodialysis
B-blockers - Arrhythmia
Diazepam - Seizure
TCA Poisoning Management
Physostigmine: DOC for Anticholinergic signs & symptoms NaHCO3: DOC for Cardiopulmonary toxicity
Phenytoin &/or Benzodiazepine: DOC for CNS manifestations
Beta-blockers poisoning S/S
Bradycardia
Hypotension
Bronchospasm
Treatment of B-blocker Poisoning
Glucagon
Atropine
Epi
CCBs Poisoning Management
Calcium Chloride IVP
Glucagon
Warfarin Toxicity
Bleeding
Treatment for Warfarin Toxicity
Vit. K (Phylloquinone)
Heparin Toxicity
Bleeding
Treatment foHeparin Toxicity
Protamine Sulfate (acts as the base to neutralize heparin activity)
1mg Protamine = 100IU Heparin
Chloramphenicol Toxicity
Gray Baby Syndrome
Aplastic Anemia
Bone Marrow Depression
Treatment for Chloramphenicol Toxicity
Charcoal Hemoperfusion
Vancomycin Toxicity
Red Man/Red Neck - Inc. Histamine
Treatment for Vancomycin Toxicity
Antihistamine Slow Infusion
Isoniazid (INH) Toxicity S/S
Peripheral Neuropathy
Hepatitis
Isoniazid Toxicity Management
Pyridoxine (Vit. B6)
Activated Charcoal can limit further absorption of the drug form in the GIT
Benzodiazepine
Lithium Toxicity
Mild: polyuria, blurred vision, weakness, slurred speech, Ataxia, tremor & myoclonic jerks
Severe: delirium, coma, seizures & hyperthermia
Treatment for Lithium Toxicity
Ipecac Syrup, NA polysterene sulfonate, WBI (SR products), hemodialysis (rebound effects)
S/S of K Toxicity
Cardiac Irritability
Dysrhythmia
Peripheral Weakness
