Decontamination, Elimination, Antidotes Flashcards

Question

Yay or nay? SDAC use more than 1 hour after toxicant ingestion?

Answer 1

No evidence to support or exclude the use of AC when more than 1 hour has passed since ingestion

Answer 2

1. Bezoar (clump of ingested pills) 2. Modified release product 3. Toxicant or co-ingestants that reduce GI motility/gastric emptying rate 4. Effect of volume ingested on gastric emptying rate

Answer 3

1. Extended-release formulation 2. Drugs that form bezoars 3. Very large ingestions

Answer 4

1. Toxicant known not to adsorb to AC 2. Unprotected airway (unconscious or trauma) 3. Ingestion of hydrocarbons- risk of aspiration (destroy surfactant, airway epithelium, alveolar septae, and pulmonary capillaries, leading to inflammation, atelectasis, and fever ) 4. Risk of GI perforation (has ulcer, surgery, took caustic agent) 5. Endoscopy will be required (ex. corrosives)

Answer 5

Patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion

Answer 6

1. Toxicant likely to be life-threatening 2. Obvious signs and symptoms of life-threatening toxicity 3. Reason to believe significant amount in stomach 4. AC not an option (not adsorbed, dose required is unreasonable) 5. No spontaenous emesis 6. No highly effective antidote or alternative therapies pose high risk

Answer 7

Introduction of large amounts of fluid into the GIT to expel intraluminary contents

Answer 8

Cleanses bowel with large amounts of PEG (polyethylene glycol electrolyte) solution to minimize drug absorption and expel intraluminal contents out of the GIT; does not cause net change in ions, therefore no electrolyte imbalances.

Answer 9

Expediting the gastrointestinal luminal clearance of sustained-release preparations, toxic heavy metals, or packets of illicit drugs smuggled within the body (“body packers”).

Answer 10

1. Unprotected or compromised airways 2. GI compromise/GI hemorrhage 3. Hemodynamically unstable - Low BP: gut poorly perfused --> defective motility and cannot handle the high volume of PEG-ES in a coordinated manner --> abdominal distention and vomiting 4. Persistent vomiting 5. Suspected leakage from drug packets or Bowel obstruction or perforation 6. Expecting patients to drink adequate amounts of WBI fluid is unrealistic.

Answer 11

1. Nausea/vomiting 2. Abdominal cramping / bloating 3. Aspiration/ARDS (acute respiratory distress syndrome) --> because of misplacement of the NG tube 4. Hypo-/hypernatremia (leading to altered consciousness, seizures, cerebral edema, and death) 5. Interference with AC

Answer 12

It is considered large because it indicates that only a small portion of the total dose (<5-10%) is in the plasma

Answer 13

Multiple dose activated charcoal (MDAC)

Answer 14

1. Hemodialysis 2. Hemofiltration 3. Hemoperfusion

Answer 15

Multiple-dose activated charcoal (MDAC) therapy involves the repeated administration of oral-activated charcoal to enhance elimination of drugs already absorbed into the body by functioning as an adsorbent “sink” at several sites in the gut

Answer 16

1. The amount and dosage form of xenobiotic ingested 2. Severity of the overdose 3. Whether the patient is vomiting 4. Potential lethality of xenobiotic 5. Tolerability

Answer 17

1. Carbamazepine 2. Dapsone 3. Phenobarbital 4. Quinine 5. Theophylline

Answer 18

1. Patients with an unprotected airway (in other words, a depressed level of consciousness) without endotracheal intubation 2. If activated charcoal use is likely to increase the risk and severity of aspiration of a toxin (hydrocarbons with high aspiration potentials) 3. When the threat of GI perforation or hemorrhage is high secondary to medical conditions or recent surgery 4. When endoscopy is likely to be attempted as activated charcoal may obscure endoscopic visualization 5. In the presence of an intestinal obstruction 6. When activated charcoal is known to not meaningfully adsorb the ingested toxin such as metals, acids, alkalis, electrolytes, or alcohols 7. If decreased peristalsis is likely to occur from the substance ingested (opioids or anticholinergics)

Answer 19

1. Constipation 2. Bowel obstruction- could require intervention 3. Emesis/aspiration 4. Rectal ulcer/hemorrhage 5. Reduction of therapeutically used xenobiotics as the therapeutic xenobiotic may bind to the AC

Answer 20

1. Long t1/2 2. Small Vd (<1 L/kg) 3. Undergo enterohepatic recirculation (Assuming they are adsorbed)

Answer 21

Uses diffusion through a conc gradient

Answer 22

Uses convection through a pressure gradient - Removes larger molecules

Answer 23

Blood passes through adsorbent substance - Even larger molecules - Plasma removed, treated, and returned to body

Answer 24

Combines hemodialysis and hemofiltration

Answer 25

Ion trapping - Ionized drugs cannot cross lipid bilayer. They are polar and water soluble and lipid insoluble - gets eliminated by the kidneys

Answer 26

Major route of elimination must be kidneys

Answer 27

acidic alkaline

Answer 28

1. Salicylates 2. Phenobarbital 3. Chlorpropamide 4. Formate 5. Diflunisal 6. Fluoride 7. Methotrexate 8. 2,4-dichlorophenoxyacetic acid

Answer 29

sodium bicarbonate ascorbic acid

Answer 30

1. Established/incipient renal failure 2. Pre-existing heart failure: Heart failure; can’t withstand the fluid and sodium, therefore would likely be better suited for hemodialysis

Answer 31

moderately severe salicylate poisoning who do not meet the criteria for hemodialysis (first line)

Answer 32

1. Neutralize or counteract the toxin. 2. Prevents the development of, or reverses the signs and symptoms of toxicity 3. Specifically counteracts the poison beyond a more general decontamination/ elimination strategy

Answer 33

1. Receptor antagonists - e.g., Atropine, vitamin K 2. Chemical/chelator - Forms compounds of lesser toxicity that is removed - e.g., Deferoxamine, digoxin-specific antibody fragments, idarucizumab 3. Dispositional - Alters toxicant's ADME - e.g., Ethanol, fomepizole 4. Unclassified - e.g., Intralipid

Answer 34

1. Acetyl-cholinesterase inhibitors 2. Pesticides 3. Clitocybe or inocybe mushrooms 4. Sometimes for digitalis although indirect MOA

Answer 35

1. Competitive antagonist of acetylcholine 2. Common binding site on muscarinic receptors but not nicotinic receptors

Answer 36

To reduce saliva and fluid in the respiratory tract

Answer 37

Physostigmine

Answer 38

Acts as a chelator and binds free Fe3+ to form ferrioxamine, which is renally excreted (brown urine results)

Answer 39

1. GI decontamination (gastric lavage if warranted) AND 2. Supportive measures (ABC)

Answer 40

1. Rapid IV administration can cause: - Flushing, urticaria, hypotension, shock 2. Fe3+ - Ferrioxamine complex: - Hypotension - Accumulation if there is renal disease - Reddish urine 3. May need hemodialysis to remove ferrioxamine complex because it may accumulate in renal impairment

Answer 41

Binds to digoxin and complex is excreted renally

Answer 42

Praxbind (Idarucizumab)

Answer 43

1. Thrombosis 2. Hypersensitivity 3. Hereditary fructose intolerane

Answer 44

Blocks the formation of toxic metabolites by having a higher affinity for the enzyme Alcohol Dehydrogenase (ADH)

Answer 45

1st line = fomepizole 2nd line = ethanol

Answer 46

80,000 8,000

Answer 47

Intravenous lipid emulsion (ILE) (Intralipid)

Answer 48

1. Modulation of intracellular metabolism 2. Lipid sink 3. Activation of ion channels

Answer 49

1. Pancreatitis 2. Fat emboli syndrome 3. Lipemic serum (high lipid content in the serum)