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Pharmacology > Dyshemoglobinemias > Flashcards

Dyshemoglobinemias Flashcards

1
Q

CO absorption/excretion?

A

Direct respiration

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2
Q

Chemical converted to CO in vivo?

A

Methylene chloride

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3
Q

4 effects of CO?

A

(1) Bind hemoglobin with high affinity (shift O2 dissociation curve left, decrease 2,3-BPG) (2) Bind myoglobin (direct myocardial toxicity) (3) Bind mitoch cycochrome oxidase (inhibit cellular respiration) (4) Displace NO from platelets and form peroxynitrites (CNS toxicity)

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4
Q

Risk of delayed neurological effects with CO poisoning?

A

Increased age (>30), Loss of consciousness

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5
Q

O2 Sats with CO poisoning?

A

Pulse ox normal, Co-ox appropriate, Calculation normal

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6
Q

Hyperbaric oxygen mxn?

A

Prevent lipid peroxidation and prevent delayed neurologic sequelae

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7
Q

Indications for HBO?

A

Loss of consciousness, GSC10%, MI/Ventricular dysrhthmias, Neurologic signs 2-4 hours “out”

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8
Q

How to distinguish between CN and CO?

A

Lactate>10 with associated significant CN levels or a pt that does not respond to supporting care with oxygen

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9
Q

Nitrites for CN mxn?

A

attract CN from Fe3+ on cytochromes to Fe3+ in hemoglobin to form methemoglobin

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10
Q

Contraindication for nitrites?

A

Dangerous if concurrent CO poisoning

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11
Q

Enhances normal metobalism of CN? Through what enzyme?

A

Sodium thiosulfate through rhodanase

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12
Q

Best treatment for CN toxicity?

A

Hydroxycobalamin (Cyanokit)

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13
Q

Hydroxycobalamin mxn?

A

Binds with CN to form excretable cyanocobalamin

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14
Q

Indications for hydroxocobalamin?

A

Smoke inhalation pt not improving with supportive care, known CN exposure, nitroprusside at risk pts

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15
Q

Give hydroxocobalamin wtih?

A

Sodium thiosulfate

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16
Q

Methemoglobin O2 sats?

A

Pulse ox falsely lowered to high 80s, Co-ox appropriate, Calculation falsely normal

17
Q

Specific antidote for methemoglobin and mxn?

A

Methylene blue: Cofactor of NADPH reductase. Gains an electron and donates it directly to reduce methemoglobin to hemoglobin

18
Q

Methylene blue indicated for?

A

Methemoglobin level > 20-30%

19
Q

Side effects of methylene blue?

A

Hemolytic anemia (weak oxidizing ability), pain at injection site, dyspnea, restlessness, tremor, apprehension, precordial pain

20
Q

Non-responders to methylene blue?

A

Wrong diagnosis, G6PD deficiency, CL salts inactivating G6PD, Sulfhemoglobinemia, Hemoglobin M disease

21
Q

Acquired methemoglobinemia?

A

Nitrites

Pharmacology (46 decks)

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