Emergency Preparedness, Toxicology, and Antidotes Flashcards

1
Q

When are child-resistant containers not required for prescription drugs?

A

When waived by a patient

Specific substances that are excluded such as nitroglycerine SL tablets

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2
Q

If topical exposure to toxin, what should be done during initial management?

A

Remove contaminated clothing

Wash skin with soap and water for 10 minutes

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3
Q

If ocular exposure to toxin, what should be done during initial management?

A

Remove contact lenses

rinse eye/s with water for at least 15 minutes

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4
Q

If oral ingestion, what should be done during initial management?

A

Remove substances from mouth

If burning/irritation - drink small amount of water or milk

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5
Q

For inhaled exposure, what should be done during initial management?

A

Move to fresh air

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6
Q

For ingestion of button batteries, what should be done during initial management?

A

Give 2 teaspoons of honey every 10 minutes and go to ER immediately

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7
Q

What is ipecac syrup and when to use it

A

Makes you barf

Not recommended any more

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8
Q

When can acitvated charcoal be given? How does it work?

A

Only given in ER
MUST be given WITHIN 1 HOUR or it’s not effective
Charcoal adsorbs drug, preventing GI absorption

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9
Q

Activated charcoal dose and important administration notes

A

1 g/kg

Airway MUST be protected (intubation) before administration to prevent aspiration

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10
Q

Activated charcoal contraindications

A

Unprotected airway
Intestinal obstruction
When GI tract is not intact

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11
Q

How does APAP cause toxicity?

A

APAP is metabolized by CYP 2E1 to NAPQI which can cause liver injury and failure

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12
Q

Stages of APAP toxicity

A
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
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13
Q

APAP antidote and MOA

A

NAC

Increases glutathione which increases GSH which converts NAPQI to mercapturic acid which can be excreted

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14
Q

Opioid antidote

A

Naloxone

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15
Q

Anticholinergic overdose s/sx and treatment

A

S/sx: flushing, dry skin and mucous membranes, mydriasis (pupil dilation), blurry vision
Antidote: Physostigmine

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16
Q

Warfarin antidote

A
Vitamin K
Prothrombin complex (Kcentra)
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17
Q

Heparin and LMWH antidote

A

Protamine

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18
Q

Dabigatran antidote

A

Idarucizumab (Praxbind)

19
Q

Apixiban, rivaroxaban antidote

A

Andexanet alfa (Andexxa)

20
Q

Benzo antidote

A

Flumazenil

Can cause seizures who have been on benzos chronically

21
Q

Beta blocker overdose treatment

A

Glucagon (if unresponsive to symptomatic treatment)
High dose insulin + glucose
Lipid emulsion

22
Q

CCB overdose treatment

A

Calcium (duh)
Glucagon (if unresponsive to symptomatic treatment)
High dose insulin + glucose
Lipid emulsion

23
Q

Cyanide poisoning treatment

A

Caused by smoke inhalation, nitroprusside

Treatment: Hydroxocobalamin (Cyanokit) or sodium thiosulfate + sodium nitrate

24
Q

Digoxin antidote

A

Digoxin Immune Fab (DigiFab)

25
Q

How to treat arsenic, gold, mercury toxicity

A

Dimercaprol

26
Q

How to treat copper toxicity

A

Penicillamine

27
Q

How to treat lead toxicity

A

Succimer, DMSA

28
Q

How to treat thalliu toxicity?

A

Ferric hexacyanoferrate

29
Q

How to treat hydrocarbon/petroleum product toxicity

A

Do NOT induce vomiting
Keep pt NPO d/t aspiration risk
No real treatment, just support and wait it out

30
Q

How to treat isoniazid toxicity

A

Pyridoxine (B6), benzos, and/or barbiturates

31
Q

How to treat iron toxicity?

A

Deferoxamine

32
Q

Organophosphate overdose s/sx and treatment

A

S/sx: SLUDD (salivation, lacrimation, urination, diarrhea, defecation)
Treat: atropine and pralidoxime

33
Q

Methotrexate overdose treatment

A

Leucovorin (folinic acid)

34
Q

How to treat methemoglobinemia?

A

Methylene blue

35
Q

How to treat neostigmine, pyridostigmine overdose?

A

Pralidoxime

36
Q

How to treat nicotine overdose

A

Supportive care (atropine for bradycardia, benzos for seizures)

37
Q

How to treat salicylate overdose

A

Sodium bicarb - alkalinizes urine which decreases drug reabsorption and increases excretion

38
Q

How to treat stimulant overdose

A

Benzos

Supportive care

39
Q

How to treat TCA overdose?

A

Sodium bicarb to decrease widened QRS complex

40
Q

How to treat valporic acid or topiramate-induced hyperammonemia

A

Levocarnitine

41
Q

How to treat animal bites?

A

Rabies vaccine + rabies imunoglobulin

42
Q

How to treat black widow spider bites

A

Antivenin

43
Q

How to treat scorpion sting

A

Antivenin

44
Q

How to treat snake bites?

A

Crotalidae polyvalent immune FAB (CroFab) for copperhead and rattlesnakes
Crotalidae Immune F(ab’)2 (Anavip) for rattlesnake bites