Emergency Preparedness, Toxicology, and Antidotes Flashcards
When are child-resistant containers not required for prescription drugs?
When waived by a patient
Specific substances that are excluded such as nitroglycerine SL tablets
If topical exposure to toxin, what should be done during initial management?
Remove contaminated clothing
Wash skin with soap and water for 10 minutes
If ocular exposure to toxin, what should be done during initial management?
Remove contact lenses
rinse eye/s with water for at least 15 minutes
If oral ingestion, what should be done during initial management?
Remove substances from mouth
If burning/irritation - drink small amount of water or milk
For inhaled exposure, what should be done during initial management?
Move to fresh air
For ingestion of button batteries, what should be done during initial management?
Give 2 teaspoons of honey every 10 minutes and go to ER immediately
What is ipecac syrup and when to use it
Makes you barf
Not recommended any more
When can acitvated charcoal be given? How does it work?
Only given in ER
MUST be given WITHIN 1 HOUR or it’s not effective
Charcoal adsorbs drug, preventing GI absorption
Activated charcoal dose and important administration notes
1 g/kg
Airway MUST be protected (intubation) before administration to prevent aspiration
Activated charcoal contraindications
Unprotected airway
Intestinal obstruction
When GI tract is not intact
How does APAP cause toxicity?
APAP is metabolized by CYP 2E1 to NAPQI which can cause liver injury and failure
Stages of APAP toxicity
Phase 1 (1-24 hours): asymptomatic, N/V Phase 2 (24-48 hours): hepatotoxicity present (elevated INR, AST/ALT) Phase 3 (48-96 hours): fulminant hepatic failure (jaundice, coagulopathy, renal failure and/or death) Phase 4: (>96 hours): pt recovers or receives a liver transplant
APAP antidote and MOA
NAC
Increases glutathione which increases GSH which converts NAPQI to mercapturic acid which can be excreted
Opioid antidote
Naloxone
Anticholinergic overdose s/sx and treatment
S/sx: flushing, dry skin and mucous membranes, mydriasis (pupil dilation), blurry vision
Antidote: Physostigmine
Warfarin antidote
Vitamin K Prothrombin complex (Kcentra)
Heparin and LMWH antidote
Protamine
Dabigatran antidote
Idarucizumab (Praxbind)
Apixiban, rivaroxaban antidote
Andexanet alfa (Andexxa)
Benzo antidote
Flumazenil
Can cause seizures who have been on benzos chronically
Beta blocker overdose treatment
Glucagon (if unresponsive to symptomatic treatment)
High dose insulin + glucose
Lipid emulsion
CCB overdose treatment
Calcium (duh)
Glucagon (if unresponsive to symptomatic treatment)
High dose insulin + glucose
Lipid emulsion
Cyanide poisoning treatment
Caused by smoke inhalation, nitroprusside
Treatment: Hydroxocobalamin (Cyanokit) or sodium thiosulfate + sodium nitrate
Digoxin antidote
Digoxin Immune Fab (DigiFab)
