duric Flashcards
1
Q
What is poison
A
- poisoning is situational and quantitative in nature
- Drug or substance “dose” is the primary determinant of toxicity
- Toxic effects of chemicals in phsyiological systems are also dependent on DURATION OF TIME that these chemicals are present
what was the dose? how long ago?
2
Q
LD50
A
- dose at which 50% of animals tested DIE
- legally, a poison has an LD50 < 50mg/kg bwt
*
- legally, a poison has an LD50 < 50mg/kg bwt
3
Q
Therapeutic index
A
- LD50/ED50
- the larger the number, the safer the drug
- measure of relative safety
4
Q
describe the clinical management of poisoning
A
- Rapid measures are called for in every case of poisoning
- Support vitals (AIRWAY, BREATHING, CIRCULATION)
-
Reduce/remove the drug in/from the body
- decrease dose/decrease time of exposure
- Treating the UNCONSCIOUS PATIENT
- several general antidotes available to tx pts upon presentation at the hospital:
- GLUCOSE/INSULIN (diabetic shock/hypoglycemia)
- NALOXONE (narcotic overdose)
- several general antidotes available to tx pts upon presentation at the hospital:
5
Q
describe the drug removal via EMESIS
A
- emesis inducers utilized to remove UNABSORBED TOXICANTS from the GI tract
- APOMORPHINE
- SYRUP of IPECAC
- CONTRAINDICATIONS
- petroleum hydrocarbon solvent –> chemical pneumonitis
- Caustic acid or alkali agent (rupture)
6
Q
describe the use of activated charcoal
A
- Administered orally in water
- VERY LARGE SURFACE AREA allows binding of ORGANIC TOXICANTS which PREVENTS ABSORPTION
- often induces EMESIS
- DOSING
- maximum effect, administer within 30mins of ingesting poison
- DECREASES EFFECTIVENESS OF OTHER MEDICATIONS
7
Q
Organophosphates Antidotes
A
PRALIDOXIME
- Administered with ATROPINE to block MUSCARINIC EFFECTs OF PARASYMPATHETiC NERVOUS SYSTEM
- used to treat poisoning by:
- insecticides etc
8
Q
Cyanide antidoes
A
- CYANIDE particularly effects CNS and cardiac tissue
- produces death in 1-15 minutes
- Administer
- CYANIDE ANTIDOTE KIT (three agents in order)
- inhalation of AMYL NITRITE
-
IV SODIUM NITRITE
- convert hemoglobin into methemoglobin
-
SODIUM THIOSULFATE
- reacts with cyanmethemoglobin to gie thiocyanate and hemoglobin
- CYANIDE ANTIDOTE KIT (three agents in order)
9
Q
Antidotes to Botulinum toxin
A
- BOTULINUM TOXIN = most potent poison known, rapidly absorbed and prevents ACh release from nerve terminals
- most commoly causes RESPIRATORY DEPRESSION
- TX = ABCs
-
TRIVALENT ANTITOXIN (neutralizing antibodies against botulinum toxin types A, B, E
- Single dose per patient
-
TRIVALENT ANTITOXIN (neutralizing antibodies against botulinum toxin types A, B, E
10
Q
Antidotes to heavy metals
A
- TX with CHELATORS (BAL, EDTA, DMSA, DMPS, Calcium EDTA, deferoxamine) complex with Hg, Pb, As, Fe and/or Ag making them inert and increasing renal excretion
- BAL (british Anti-Lewisite)
11
Q
Acetaminophen
A
- Frequently encoutnered toxicant
- Signs occur after depletion of glutathione
- nausea, vomiting, HEPATIC NECROSIS, DEATH DUE TO HEPATIC FAILURE
- Treatment: ABC, emetics, gastric lavage, Charcoal, LFG
- N-ACETYLCYSTEINE –> restores glutathione levels
12
Q
cocaine –> toxicants
A
- Frequently encountered toxicants
- Signs
- CNS stimualtion, euphoria, halo lights, CARDIAC DYSRHYtHMIA leading to CARDIAC ARREST
- TX: ABC’s, charcoal, diazepam
- LIDOCAINE (dysrhythmia)
13
Q
Benzodiazepine toxicant
A
- frequently encountered toxicant
- SIGN
- rarely fatal unless taken with ETOH or other CNS depressant due to SYNERGISTIC CNS DEPRESSION
- TX: ABC’s Emesis, gastric lavage
- RECEPTOR ATANGONIST = FLUMAZENIL
14
Q
Meperidine toxicant
A
- Frequnetly encoutnered toxicant
- SIGNS
- DILATED pupils due to antimuscarinic effects, INCREASE IN HR
- TX = ABC’s, gastric lavage, diazepam for seizures etc
15
Q
OPIATE toxicants
A
- Frequently encountered toxicant
- SIGNS
- Bilateral miosis (PPP), HEART RATE and RESPIRATORY DEPRESSION/ARREsT
- cns depression, apnea, decrease body temp
- tx: ABC’s, naloxone, gastric lavage
