finals pt2 Flashcards
In the United States, ——- has replaced viral hepatitis as the most common cause of acute liver failure
acetaminophen toxicity
acetaminophen tox occurs due to
-CYP enzyme induction
-Glutathione depletion (Paracetamol overdose, glutathione deficiency)
-Inhibition of glucuronidation
paracetamol dose adjustment is recommended in certain patient groups due to low —- stores.
-glutathione stores
-the patient groups are:
Elderly
Infants
Starvation
Malabsorption
——- has been shown to be well tolerated in hepatocellular insufficiency and even cirrhosis within the normal recommended dose range
Paracetamol
overdose of which agent leads to fetal death and spontaneous abortion
paracetamol
Patients taking which drugs are at a higher risk of acetaminophen toxicity
anticonvulsants or isoniazid
RUQ (right upper quadrant) abdominal pain, jaundice, inc AST ALT, hypOglycemia, metabolic acidosis and edema.
the following are clinical symptoms of which stage of acetaminophen toxicity
Stage II/ 24-48 hr
peak AST ALT >1000 IM/L, transaminase value rapid progression >3000 IU/L
and Pancreatitis and Nephrotoxicity
these occur in which stage of acetaminophen toxicity
Stage III/ 72-96 Hrs
-A proposed strategy for predicting hepatotoxicity:
Acetaminophen concentration X ALT concentration
= <1500 - Low risk
= 1500-10,000 - Low to moderate risk
= >10,000 - High risk
Acetaminophen crosses the placenta, and the fetal liver is able to elaborate the hepatotoxic metabolite (NAPQI) by —- weeks’ gestation.
14 weeks’ gestation
what lab values indicate acetaminophen toxicity
-low creatinine clearance
-elevated INR,
-and serum creatinine higher than 3.4 mg/dL
——– correlate 4-hour serum acetaminophen concentrations to
TIME since ingestion to assess potential hepatotoxicity
Rumack-Matthew nomogram
-predicts potential toxicity beginning at 4-24hr after ingestion
measurement before 4h may not be reliable
N-Acetylcysteine is of maximal benefit if started within ——- hours
8–10 hours
If vomiting interferes with oral acetylcysteine administration, administer the following drug: —-
high-dose IV metoclopramide (1–2 mg/kg)
Ondansetron
IV NAC if necessary.
administer activated charcoal if patient presents to ED within – hour(s) of acetaminophen ingestion.
1 hour
Do not administer charcoal if more than —- hours have passed since ingestion of acetaminophen, unless delayed absorption is suspected (eg, as with Tylenol Arthritis Pain™ or co- ingestants containing opioids or anticholinergic agents)
3–4 hours
when is continuous delayed absorption of acetaminophen expected
-Tylenol Arthritis Pain
-co- ingestants containing opioids or anticholinergic agents
Lethargy Slurred speech
Nystagmus and ataxia
and at higher doses, hypotension, hypothermia and bradycardia
are associated with ——— toxicity
BARB and BZD toxicity
skin bullae is seen with —- toxicity
BARB
Withheld barbiturates from a ——- patient until symptoms clear
comatose or grossly intoxicated
what drugs are used for complete detoxification from barbiturates
osmotic diuretic and urine alkalinizer NaHCo3
-other drugs are used such as diphenhydramine (antihistaminic) for withdrawal effects, in addition to BZPs for withdrawal seizures like diazepam)
what lab test is conducted to confirm BZD toxicity
QuaLitative testing to confirm presence of BDZ
what is the ideal indication for flumazenil
isolated iatrogenic BZD overdose in BZD-naive patients
