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Pharm Quiz #2 > Drug Poisoning > Flashcards

Drug Poisoning Flashcards

1
Q

Bath salts Active ingredient and basic info

A
  • 4-methylene-dioxypyrovalerone (MDPV)
  • Central nervous system stimulant
  • Potentially severe and lethal
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2
Q

Treatment for Bath salts

A
  • Mimics that for amphetamines
  • Manage airway and control agitation
  • Beside serum glucose to rule out hypoglycemia
  • Chemical restraint (best) versus physical restraint
  • Gastric decontamination
  • Core temperature monitoring (can get hyperpyrexic)
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3
Q

Drug treatment of overdose for bath salts

A
  • Agitation control with benzodiazepines
  • Treat hypertension with intravenous agents
  • Seizure control with benzodiazepines
  • No antidote: Symptomatic treatment only at this time
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4
Q

Anticholinergic effect agents

A

o Antihistamines
o Antiparkinson drugs
o Antipsychotics
o Muscle relaxants

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5
Q

Symptoms of Anticholinergic effect agents

A

o Delirium, tachycardia, dilated pupils, dry/flushed skin

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6
Q

Treatment for Anticholinergic effect agents

A

o Muscle relaxants:
 Activated charcoal
 Benzodiazepines (seizures, anticholinergic agitation/delirium)
 Sodium bicarbonate for QRS prolongation
 Fluids; dopamine or norepinephrine if vasopressors needed

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7
Q

Sympathomimetic agents

A 
(block reuptake of norepinephrine)
o	Cocaine
o	Amphetamines
o	Decongestants
o	“Diet aids”
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8
Q

Symptoms of Sympathomimetic agents

A

o Delusions, paranoia, tachycardia, hypertension, hyperpyrexia, diaphoresis, mydriasis, hyper reflexia

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9
Q

Treatment of Sympathomimetic agents

A

o Benzodiazepines
o Nitroglycerin
o Lidocaine
o Sodium bicarbonate (for cocaine-related ventricular arrhythmias)

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10
Q

Depressant Drugs

A

o Opiates/Opioids (codeine, morphine, heroin)
o Barbiturates
o Benzodiazepines
o Ethanol

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11
Q

Symptoms of Depressant Drugs

A

o Coma, respiratory depression, miosis, hypotension, bradycardia, diminished bowel sounds, hyporeflexia

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12
Q

Treatment of Depressant Drugs

A

o Opioids
 naloxone
o Benzodiazepines
 flumazenil (cautiously

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13
Q

What do Opioids do?

A

• Stimulation of opiate receptors resulting in sedation and respiratory depression

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14
Q

• Kinetics of Opioids

A

o Peak effect in 2 to 3 hours but
 Watch for use of long-acting dosage forms
 Opioids slow gastrointestinal transit so possible delayed peak effects
 Fentanyl patch effect can persist after patch removal
•

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15
Q

Toxic doses of Opioids

A

Vary on agent, route, rate of administration

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16
Q

Clinical presentation of

Mild to moderate overdose of Opioids

A 
Lethargy
“pinpoint” pupils
Blood pressure/pulse rate depressed
Bowel sounds diminished
Flaccid muscles
17
Q

Clinical presentation of

Severe overdose of Opioids

A

Coma

Respiratory depression

18
Q

Basics of Opiate overdose treatment

A
  • Airway, ventilation assist, oxygen

- Treat: Coma, Hypotension, Seizures

19
Q

What drug to treat opioid OD

A

Naloxone

20
Q

Naloxone

A

 200 to 400 mcg IV (or IM) repeated every 2 to 3 minutes if no response
 If opioid overdose, doses of up to 10 to 20 mg have been used
• If no response, no it wasn’t opioid OD  try benzodiazepine OD treatment
 Naloxone dose could wear off before opioid dose does

21
Q

Cholinergic like agents

A 
o	Organophosphates (Sarin gas)
o	Exposure to acetylcholinesterase inhibitor
22
Q

Cholinergic like agents symptoms

A

o Confusion, CNS depression, weakness, salivation, lacrimation, urinary/fecal incontinence, pulmonary edema, seizures

23
Q

Cholinergic like agents treatment

A 
o	Atropine
o	Pralidoxime (Protopam)
24
Q

Pralidoxime (Protopam) MOA

A
  • Reactivates cholinesterase (mainly outside of the CNS) which has been inactivated by phosphorylation due to an organophosphate
  • atropine is always required concomitantly to block the effect of accumulated acetylcholine at this site
25
Q

Gastric Emptying is done by?

A

Syrup of ipecac

26
Q

Syrup of ipecac MOA

A

local irritation of gastric mucosa and stimulation of chemoreceptor trigger zone

27
Q

Syrup of ipecac ADR

A

Arrhythmias

Rare cases of fatal myocarditis after excessive doses

28
Q

Syrup of ipecac effects with other drug

A

Activated charcoal neutralizes ipecac effect

29
Q

Adsorbent

A

Activated charcoal

30
Q

Activated charcoal MOA

A

o Adsorbs various toxins in gastrointestinal tract; greatest benefit only up to 60 minutes post ingestion.

–> has lots of surface area, so drugs can get stuck to it

31
Q

Activated charcoal ADR

A

o Vomiting from rapid ingestion, constipation, diarrhea

32
Q

What do you add before 1st dose of Activated charcoal

A

• Add sorbitol to first dose to reduce chance of vomiting

•

33
Q

Antidote for antifreeze

A

Fomepizole (Antizol™)

34
Q

Antidote for benzodiazepines

A

Flumazenil (Romazicon™)

35
Q

Antidote for iron toxicity

A

Deferoxamine mesylate (Desferal™)

36
Q

Antidote for digoxin

A

Digoxin Immune fab (Digibind™)

37
Q

Antidote for insulin‑induced hypoglycemia

A

Glucagon

38
Q

Antidote for acetaminophen toxicity

A

Acetylcysteine (Acetadote™)

- Mucolytic

39
Q

Pediatric Poisoning:

A
  • often small amounts of substance are absorbed
  • proverbial glass of milk for the child and a pitcher of reassurance for the parent
  • Keep the phone number of the poison control center close at hand

Pharm Quiz #2 (6 decks)

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