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Ronnie's lectures > Drug overdose > Flashcards

Drug overdose Flashcards

1
Q

What is drug overdose?

A

The ingestion or application of a drug or other substances in quantities greater than are recommended or generally practiced.

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2
Q

Drug overdose can occur accidently or deliberately. TRUE OR FALSE?

A

TRUE

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3
Q

List the drugs that are mostly used intentionally for self poisoning?

A
  • Benzodiazepines
  • analgesics
  • antidepressants
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4
Q

What are the drugs that are mostly at risk and provide examples for each?

A
  • Drugs with a narrow therapeutic window e.g digoxin and theophylline
  • Drugs with steep dose response curves e.g warfarin, sulhonylurea der
  • Drugs that are enzyme inhibitors e.g Ketoconazole, erythromycin
  • drugs that are enzymes inducers e.g rifampicin, carbamazepine
  • Drugs with high toxic potential e.g aminoglycosides
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5
Q

Give examples of patients that are most at risk?

A
  • Polymorbidity
  • Polypharmacy
  • Chronic disease
  • Non compliance
  • Self treatment
  • Abuse
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6
Q

What equation can be used to calculate the therapeutic window/index?

A

Therapeutic window = Dose causing toxicity/Dose providing efficacy

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7
Q

Provide some examples of drugs that have a very narrow therapeutic window/index?

A
  • Aminoglycoside antibiotics
  • Anticoagulants
  • Aspirin
  • Digoxin
  • Lithium
  • Tricyclic antidepressants
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8
Q

What are the 6 steps required for the treatment of drug overdose?

A
  1. Immediate measures evaluation
  2. Supportive measures
  3. Prevent absorption
  4. Elimination
  5. Antidotes
  6. Pschiatric assessment
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9
Q

What ocurs in Evaluation for drug poisoning treatment?

A
  • Recognition of poisoning (pill bottles/examination)
  • Identification of agents involved
  • Assessment of severity
  • -prediction of toxicity
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10
Q

What does the ABC stand for in supportive care after drug poisoning?

A

A- airway
B- Breathing
C- Circulation

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11
Q

What ocurs in supportive measures for drug poisoning treatment?

A
  • ABC
  • Protect airway
  • Vital signs, mental status, pupil size
  • Pulse oximetry, cardiac monitoring, ECG
  • Cervical immobilization if suspect trauma
  • Rule out hypoglycaemia
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12
Q

What occurs in gastric lavage?

A
  • Flexible tube is inserted through the nose into the stomach
  • Stomach contents are then suctioned via tube
  • A solution of saline is injected into the tube
  • Not be used in unconscious patients unless intubated
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13
Q

What steps are taken in the preventing absorption phase after drug poisoning?

A
  • Gastric lavage
  • Induced vomiting - not recommended routinely due to risk of aspiration
  • Activated charcoal
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14
Q

What does activated charcoal do?

A
  • Absorbs toxic substances or irritants, inhibiting GI absorption
  • Given as a single oral dose of 25-100g
  • Repititve doses useful to enhance the elimination of certain drugs e.g theophylline
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15
Q

What substances does charcoal not absorb?

A
  • Petroleum distillates
  • Inorganic acid and alkali
  • Alcohol
  • Metal ions
  • Cyanide
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16
Q

What types of medication are given in renal

elimination?

A

-Medications thta stimulate urination or defecation to increase the release/elimination of the drug out of the body

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17
Q

What is infused in forced alkaline diuresis?

A

-Infusion of large amounts of NS+NAHCO3

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18
Q

What types of drug does forced alkaline diuresis help to eliminate?

A

-acidic drugs that are mainly excreted by the kidney e.g salicylates

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19
Q

What issues can be caused by forced alkaline diuresis?

A

Can cause serious electrolyte disturbance

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20
Q

What types of dialysis are reserved for severe poisoning?

A

Hemodialysis and haemoperfusion

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21
Q

Hemodialysis and haemoperfusion can be used temporarily or as long term if kidneys are damaged due to overdose. TRUE OR FALSE?

A

TRUE

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22
Q

What are antidotes?

A

They are agents witha specific action against the activity or effect of drugs involved in poisoning cases

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23
Q

List and give examples of each antidote mechanisms

A
  • Pharmacological antagonists
    e. g naloxone (opiate poisoning) and ethanol (methanol poisoning)
  • Enhance physiological function to compensate
    e. g Physostigmine (belladona alkaoid poisoning)
  • Restore active site of drug target
    e. g Pralidoxime (pesticide poisoning)
  • Bypass block
    e. g Glucagon (beta blocker poisoning)
  • Sequester poison
    e. g Digibind (digoxin poisoning)
  • speed up excretion
    e. g chloride is used as an antidote for bromide and iodide overdose
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24
Q

Paracetamol overdose causes toxic reactions with protein and nucleic acids, which leads to hepatoxicity. TRUE OR FALSE?

A

TRUE

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25
Q

Explain the 4 stages clinical features of paracetamol drug overdose?

A

Stage 1:
(0-5 to 24hrs) - No symptoms, vomiting and nausea
Stage 2:
(24hrs to 72hrs) - Subclinical elevations of hepatic aminotransferases, elevation of prothrombin, liver enlargement and tenderness, renal function abnormalities
Stage 3:
(72-96 hrs) - confusion (hepatic encephalopathy), lactic acidosis, hyperammonemia, hypoglycemia
Stage 4:
(4 days to 2 weeks) - Recovery phase that usually begins by day 4

26
Q

How is paracetamol overdose managed, explain what ecah component does?

A
  • Activated charcoal - may reduce absorption by 50 to 90%
  • Acetylcysteine (antidote) a glutathione precursor (limits the formation and accumulation of NAPQI
  • Methionine p.o - protects liver from damage
  • Specialist advice for liver transplantation
27
Q

What are the indications for liver transplantation?

A
  • Acidosis (pH greater than 7.3)
  • Prothrombin time less than 100 sec
  • Creatinine greater than 300mcg
  • Grade 3 encephalopathy
28
Q

What are the functions of Aspirin?

A
  • Analgesic
  • Antipyretic
  • Anti-inflammatory
  • Anti platelet
29
Q

Aspirin is not a type of NSAID. TRUE OR FALSE?

A

FALSE

30
Q

What concentration in plasma does aspirin have to be considered as intoxication?

A

40 to 50 mg/dl

31
Q

Why does metabolic acidosis occur during aspirin overdose?

A

Because ketogenisis is inhibited

32
Q

An acidic pH promotes the movement of salicylate into the tissues. TRUE OR FALSE?

A

TRUE

33
Q

Why does respiratory alkalosis occur?

A

Due to hyperventilation (CO2 exhalation increases)

34
Q

Why does electrolyte imbalance occur during aspirin overdose?

A
  • Increased renal excretion of bicarbonates, NA+, K+ follow
  • Increased pulmonary insensible losses
  • Vomiting
35
Q

Actiavted charcoal is known to reduce the amount of activated salycilate by 50-80%. TRUE OR FALSE?

A

TRUE

36
Q

Fluid replacement is not important in the management of salicylate toxicity. TRUE OR FALSE?

A

FALSE

37
Q

What are the major ways in which fluid is lost in aspirin overdose?

A
  • Tachypnea
  • Vomiting
  • Hypermetabolic state
  • Insensible perspiration
38
Q

What is the most important management for aspirin overdose?

A

Through urine alkalinization with sodium bicarbonates

39
Q

What does urine alkalinization with sodium bicarbonates result in?

A

Enhanced excretion of ionized acid form of salicylate

40
Q

How can alkalinization be achieved?

A

By giving a bolus 1-2 mEq/kg followed by IV infusion of 3 ampules of sodium bicarbonate in 1 L of D5W

41
Q

What are the indications for hemodialysis?

A
  • Renal failure
  • Congestive heart failure
  • Acute lung injury
  • Persistant CNS disturbance
  • Progressive deteriorative vital signs
  • Salicylate concentration acute
42
Q

Opioids bind to what specific receptors?

A

Specific opioid receptors in the CNS

43
Q

What are the characteristics of opiates overdose?

A
  • Respiratory depression (breathing slows, sometimes to a stop)
  • Pinpoint pupils
  • Decreased level of consciousness
  • Hypotension and bradycardia (HR slows, blue lips, nails due to insufficient O2 in blood)
44
Q

What is an important feature in opioid poisoning?

A

Pinpoint pupils

45
Q

What two types of drugs are most common in drug overdose?

A

Heroin and morphine

46
Q

What is the antidote for opiate overdose?

A

Naloxone

47
Q

How does Naloxone act as an antidote?

A

It is a competitive antagonist at opioid receptors

48
Q

What is the elimination half life of naloxone?

A

60 TO 90 minutes

49
Q

Repeated administration/infusion of naloxone may be necessary. TRUE OR FALSE?

A

TRUE

50
Q

Pesticides are not organophosphate. TRUE OR FALSE?

A

FALSE

51
Q

What are organophosphate?

A

They are irreversible anticholinesterases

52
Q

What are the nicotinic signs in pesticide poisoning?

A
  • Twitching
  • Fasciculations
  • Muscle weakness
  • Elevated Bp
53
Q

What are the muscarinic signs in pesticide poisoning?

A
  • Bronchoconstriction
  • Increase secretion
  • Sweating
  • GI
  • Miosis
54
Q

What are the CNS signs in pesticide poisoning?

A
  • Anxiety
  • Restlessness
  • Confusion
  • Headache
55
Q

What is the antidote for pesticide poisoning?

A

Pralidoxime, i.v for several days

56
Q

What is the AchE regenerator called?

A

Oxime

57
Q

What does oxime do?

A

It hydrolyzes the phosphorylated AChE

58
Q

Pralidoxime is positively charged so does not enter the CNS. TRUE OR FALSE?

A

TRUE

59
Q

The effects of organophosphate poisoning on the CNS is irreversible. TRUE OR FALSE?

A

TRUE

60
Q

Silmutaneous use of atropine is required to control muscarinic excess. TRUE OR FALSE?

A

TRUE

61
Q

Why is pretreatment with reversible inhibitors required?

A

To protect against excessive AchE inhibition when possibly lethal poisoning is anticipated

Ronnie's lectures (12 decks)

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