Fact Sheets

Question 1

Statins

Answer 1

Exposure - CVD
Toxicodynamics - renal tubular toxicity, block the production of coenzyme (to break down food - kidney injury)
Mostly effects the liver and kidney
Signs, symptoms - reduced urine output, abdominal pain, constipation, dizziness
Standard markers in kidney damage - blood urea nitrogen, increased serum creatinine
Management - heart, bp, breathing

Question 2

Ketamine

Answer 2

Exposure - 75% of users are 12-25, anaesthetic, hallucinogenic
Toxicodynamics - substrates of cytochrome P450 isoforms - cause ulceration of kidney and ureter
Signs and symptoms - decreased bladder compliance, blood in urine, ulcers, reflux of urine back to kidneys
Detection - mass spectrometry, no antidotes
Management - overdose (benzodiazepines)

Question 3

ACE Inhibitors

Answer 3

Exposure - hypertension, heart failure
Toxicodynamics - internal vasodilations, angiotensin generation inhibitor (heart failure,
Signs, symptoms - decreased urine output, fluid retention, thirst, vomiting, diarrhoea
Detection - reduced urinary output
Management - monitor urine output, removal of drug, sodium replenishment

Question 4

Paracetamol

Answer 4

Exposure - OTC drug
Toxicodynamics - inhibits prostaglandins, acute renal failure
Signs, symptoms - vomiting, pallor, decreased urinary output, tachycardia, hepatic necrosis, death - multi-organ failure
Detection - elevated creatinine
Management - activated charcoal,

Question 5

Gentamicin

Answer 5

Exposure - antibiotic
Toxicogynamics - nephrotoxicity, misreading of mRNA interfere with protein synthesis, used to manage gram-negative bacteria, synergy with penicillin
Signs, symptoms- decreased urine output, fluid retention, swelling in the legs, drowsiness, SoB, fatigue
Detection - serum tests
Just stop course to stop effects

Question 6

Heroin

Answer 6

Exposure - recreational drug
Toxicodynamics - Coma, breakdown of muscle tissue and release of proteins, dehydration, kidney damage, low blood pressure
more likely to contract bacterial and fungal infections
signs, symptoms - flushed skin, small pupils, watery eyes, depression, delusions
Detection - testing blood, quickly metabolised so have to look for the metabolites
Antidote - naloxone - opioid blocker
Management - switch to a heroin substitute, detox, withdrawal symptoms

Question 7

Lithium

Answer 7

Exposure - anti-depressants
Toxicodynamics- chronic kidney disease, substitute for sodium in channelsand inhibits action of ADH - severe dehydration
Signs and symptoms - tremors, lethargy, confusion, nausea, vomiting, altered mental status, coma, cardiovascular collapse
Detection - clinical symptoms and kidney tests
Antidotes - isotonic sodium chloride, diuretics
Management- GI decontamination, can’t us activated charcoal bc lithium cant bind to charcoal
Haemodialysis

Question 8

NSAIDs

Answer 8

Exposure - to relieve pain, reduce inflammation, to relieve symptoms
Toxicodynamics - reduced renal plasma flow caused by a decrease in prostaglandins, inhibits COX-1 and COX-2, drug combinations - like renin-angiotensin blockers and diuretics
Signs, symptoms - nausea and vomiting, metabolic acidosis, seizures, elevated bp, bradypnea
Detection - increased serum creatinine
Stop taking NSAIDs
Management - benzodiazepines, sodium bicarbonate