CPC I

Question 1

How is a modified Rumack-Matthew normogram used?

Answer 1

For a single ingestion of standard (NOT sustainted) release formulas

Time of ingestion versus blood levels
–Minimum of 4 hours to get into the blood

Tells you if there is a potential for acetominophen toxicity

Question 2

Explain how acetaminophen is rendered toxic to hepatocytes.

Answer 2

5% of acetominaphin is oxidized -> n-acetyl-p-benzoquinoneimine (NAPQI)

NAPQI = highly reactive electrophile

• -Reacts with -SH groups on glutathione and other thiols
• -IF glutathione, then eliminated
• -IF other proteins, then cell death

Question 3

State 4 mechanisms by which n-acetylcystine (NAC) prevents acetaminophen toxicity.

Answer 3

Helps clear toxic metabolite of acetaminophen by regenerating glutathione

• -NAC is a precursor/substitute
• —-Can’t give glutathione - doesn’t enter liver
• -Must be given within 16 hours

Question 4

Explain the mechanism for disseminated intravascular coagulation.

Answer 4

DIC = consumptive coagulation

–Clotting in microvasculature throughout body uses up all clotting factors -> BLEEDING

Question 5

What does an elevated AST/ALT show you?

Answer 5

Liver damage (or occasionally other organ damage, iatrogenic hemolysis)

Question 6

What causes hepatic encephalopathy? How can it be treated?

Answer 6

Buildup of NH4+ in blood due to liver damage

Treated with lactulose: acidifies gut lumen -> traps NH4+ -> excreted

Question 7

What does a left shift mean? What does it indicate?

Answer 7

Increase in immature leukocytes

Indicates bad infection