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STAGE 2 - Pharmacology and Drug Action > Drug Overdose > Flashcards

Drug Overdose Flashcards

1
Q

Define drug ovedose

A

The ingestion/application of a drug/substance in quantities greater than that recommended

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2
Q

Give examples of drugs that are most frequently used for intentional self-poisoning

A
  • Benzodiazepines
  • Analgesics
  • Antidepressants
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3
Q

Drugs that are likely to cause overdose include Enzyme inhibitors such as ketoconazole & erythromycin. TRUE or FALSE

A

TRUE

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4
Q

Drugs that are likely to cause overdose include Enzyme inducers such as Rifampicin and Carbamazepine. TRUE or FALSE

A

TRUE

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5
Q

State 3 characteristics of drugs with risk of overdose

A

1) Narrow therapeutic window (Digoxin, Theophylline)
2) High toxic potential (Aminoglycosides)
3) Steep dose-response curve (Warfarin and Sulhonylurea derivatives)

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6
Q

Identify the 6 principles of drug overdose

A

1) Immediate measures -Evaluation
2) Supportive measures
3) Absorption prevention
4) Elimination
5) Antidotes
6) Psychiatric assessment

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7
Q

Describe the steps of evaluation of a drug overdose

A
  • Recognise the poison
  • Identify agents involved
  • Assess severity
  • Predict toxicity
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8
Q

State 3 absorption prevention methods of drug overdose

A
  • Activated Charcoal
  • Gastric lavage
  • Induced vomitting
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9
Q

Describe ‘Activated charcoal’ method

A
  • Toxic substances are adsorbed and GI tract absorption inhibited
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10
Q

Name 6 substances that charcoal does not absorb

A
  • Petroleum distillates
  • Inorganic acid and alkali
  • Alcohol
  • Metal ions
  • Cyanide
  • Lithium
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11
Q

State 3 methods for the elimination of poisons

A

1) Renal elimination
2) Forced alkaline diuresis
3) Hemodialysis/Haemoperfusion

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12
Q

Fluid and electrolyte disturbances may occur as a result of forced alkaline diuresis. TRUE or FALSE

A

TRUE

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13
Q

Hemodialysis/Haemoperfusion is used in cases of severe poisoning. TRUE or FALSE

A

TRUE

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14
Q

Define Antidote

A

Agents with a specific action against the activity/effect of drugs involved in poisoning cases

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15
Q

How many stages of Paracetamol overdose are there ?

A

4 stages

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16
Q

Describe symptoms of stage 1 Paracetamol overdose

A
  • 0.5 to 24hrs

- Varies from no symptoms to Malaise

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17
Q

Describe symptoms of stage 2 Paracetamol overdose

A
  • 24 to 72hrs
  • Elevations of hepatic aminotransferase
  • Elevations of prothrombin time (PT) and total bilirubin
  • Right upper quadrant pain. liver enlargement and tenderness
  • Oliguria and renal function abnormalities
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18
Q

Describe some symptoms of stage 3 Paracetamol overdose

A
  • 72 to 96hrs
  • Jaundice, confusion
  • Elevation in hepatic enzymes
  • Lactic acidosis
  • 25% renal failure
  • Maybe death
19
Q

Describe stage 4 Paracetamol overdose

A
  • 4 days to 2 weeks

- Usually recovery phase that begins by day 4

20
Q

What is required for paracetamol overdose management for <4 hrs

A

Activated Charcoal

  • May reduce absorption by 50-90%
  • Single oral dose of 1g/kg
21
Q

What is required for paracetamol overdose management for <8 hrs

A
  • Acetylcysteine

- Limits the formation and accumulation of NAPQI

22
Q

What is required for paracetamol overdose management for <24 hrs

A
  • Oral Methionine

- Protects liver from damage

23
Q

What is required for paracetamol overdose management for >24 hrs

A
  • Liver transplantation specialist advice
24
Q

Name a condition where Liver transplantation is life-saving

A

Fulminant hepatic necrosis

25
Name 4 indications for liver transplant
1) Acidosis (pH <7.3) 2) Prothrombin time (>100 secs) 3) Creatinine levels>300mcg/L 4) Grade 3 encephalopathy (or worse)
26
State examples of ADR's caused by Aspirin
- Interference of metabolism - GI bleeding and prolonged bleeding - Activation of respiratory centre
27
Describe the effects of interference of metabolism
- Prevents formation of ATP/promotes formation lactate and pyruvate - Inhibits amino acid metabolism - Inhibits Kreb cycle enzymes/ encourages lipid metabolism and ketogenesis
28
State 3 effects of Aspirin overdose
- Metabolic acidosis - Respiratory alkalosis - Electrolyte imbalance
29
How is metabolic acidosis brought about ?
Acidic pH promotes movement of salicylate into the tissues
30
How is Electrolyte imbalance brought about ?
- Increased renal excretion of bicarbonates - Increased pulmonary insensible losses - Vomiting
31
Identify the most important management of Aspirin Overdose
- Urine alkalinization (w/sodium bicarbonate)
32
What is the result of Urine alkalinization?
Enhanced excretion of ionized, acid form salicylate
33
Opioids bind to specific opioid receptors in the CNS. TRUE or FALSE
TRUE
34
State 4 key characteristics of opioid overdose
- Pinpoint pupils - Respiratory depression - Decreased level of consciousness - Hypotension and Bradycardia
35
Why is 'pinpoint pupils' of significance in opioid overdose ?
It acts as an important diagnostic feature in opioid poisoning
36
Identify the antidote used for opioid overdose management ?
Naloxone
37
State 4 side effects of Naloxone
- BP changes - Arrhythmias - Seizures - Withdrawal
38
Pesticides are organophosphate irreversible anticholinesterases (AChE). TRUE or FALSE
TRUE
39
AChE increases Acetylcholine (Ach) levels. TRUE or FALSE
TRUE
40
State 3 effects of increased Ach
1) CNS effects 2) Nicotinic signs 3) Muscarinic signs
41
Identify the antidote used for pesticide overdose management ?
Pralidoxime
42
Identify 3 types of pesticide overdose management
1) Use of Pralidoxime 2) Clearing airways 3) AChE regenerator (oxime agents)
43
What is the use of Oxime agents
The acts as AChE regenerators and hydrolyze phosphorylated AChE
44
Name a drug required simultaneously alongside Pralidoxime to treat muscarinic pesticide excess
Atropine

STAGE 2 - Pharmacology and Drug Action (8 decks)

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