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Spring Pharm Block 4 > FR Review 7 - Tox, Gout, Contraceptives, TB, and Headache > Flashcards

FR Review 7 - Tox, Gout, Contraceptives, TB, and Headache Flashcards

1
Q

Differentiate generally pediatric ingestions from adult ingestions from geriatric ingestions/

A

Peds: ingestions are single, known, and promptly recognized and usually accidental.
Adolescents are most common for suicide attempts.
Adults: ingestions are multiple, intentional, unknown, and with a delayed presentation.
Geriatrics are most likely to be from chronic overmedication.

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2
Q

List 3 substances activated charcoal will not be effective for.

A

Heavy Metals
Hydrocarbons
Alcohols

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3
Q

Why is syrup of ipecac not hot anymore? (2 reasons)

A

It is not effective if substance is post pyloric

Risk of aspiration since most toxins cause decreased level of consciousness or seizures

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4
Q

Describe the mechanism of action of cocaine and the signs and symptoms associated with its administration.

A

It is a sympathomimetic leading to tachycardia, increased alertness, hypertension, etc.

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5
Q

Why are beta blockers avoided in cocaine toxicity?

A

Resultant unopposed alpha-1 stimulation may result in further HTN –> Use CCBs instead.

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6
Q

What is the mechanism of action that causes CO toxicity?

A

CO binds to Hgb with 250x more affinity than O2. The resultant anaerobic metabolism leads to metabolic acidosis which causes the body’s enzymes (which are proteins) to denature

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7
Q

What is the treatment for CO toxicity?

A

High flow O2 for all patients.

Hyperbaric oxygen for severe cases with decreased consciousness.

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8
Q

What three things are a major part of the clinical presentation of a TCA overdose?

A

Tonic-clonic seizures
Cardiac arrhythmias
Anticholinergic affects (C-DUST)

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9
Q

What is the treatment of TCA toxicity and why is it effective?

A

Sodium bicarbonate for 2 reasons.

  • increases plasma protein binding of the drug
  • stabilization of fast Na channels
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10
Q

What two drugs that are not TCAs but when in toxicity are treated the same as TCA toxicity?

A

Carbamazepine (anti-epileptic) and Cyclobenzaprine (muscle relaxant)

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11
Q

What is the greatest risk in the ingestion of a group 1 or 2 hydrocarbon?

A

Aspiration –> generally harmless if they stay in the GI tract

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12
Q

What is the mechanism of action of organophosphates in toxicity?

A

Irreversible inhibitors of acetylcholinesterase resulting in acetylcholine overload

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13
Q

True/False: There are pharmacological uses for reversible acetylcholinesterase inhibitors.

A

True –> most end in “stigmine” and are used to reverse neuromuscular blockers (aka paralytics)

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14
Q

How is organophosphate toxicity managed?

A

Remove all clothing/jewelry and decontaminate the skin with copious amounts of water
Administer atropine
Administer 2-PAM (Pralidoxime)

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15
Q

What is the schedule drug class of barbiturates and benzos?

A

Barbiturates: C-3
Benzos: C-4

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16
Q

When choosing a barbiturate for euthanasia/suicide, should you use a long-acting or short-acting barbiturate and why?

A

Short-acting because even though they are more easily reversible, the produce a more rapid death –> less likely to be discovered after ingestion before death occurs.

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17
Q

What is the antidote to benzodiazepines and what is its contraindication?

A

Flumazenil –> contraindicated in patients that ingested TCAs or any patient that is at risk for seizures

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18
Q

What is the result of formic acid (metabolite of methanol) accumulating in the body?

A

Metabolic acidosis and it is toxic to the optic nerve (causes blindness)

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19
Q

What pathophysiology results from the accumulation of glycolic acid and calcium oxalate crystals (metabolites of ethylene glycol, aka antifreeze) in the body?

A

Glycolic acid = metabolic acidosis

Ca oxalate = crystalizes in kidneys and causes real failure

20
Q

Name two substances that can be used as an antidote to ethylene glycol or methanol and describe the mechanism of each.

A
  • ETOH: alcohol dehydrogenase prefers to bind ETOH resulting in fewer metabolites from ethylene glycol
  • Fomepizole: alcohol dehydrogenase inhibitor that inhibits formation of toxic metabolites without causing inebriation.
21
Q

What is the clinical result of isopropyl alcohol ingestion?

A

It is relatively non-toxic but causes bad gastritis.

22
Q

T/F: All alcohols cause toxicity in the form they enter the body.

A

False: all alcohol toxicity is caused by their metabolites.

23
Q

Describe the 4 phases of APAP toxicity.

A

1: (0-24h): severe GI upset
2: (24-72h): Pt feels better –> LFTs rise and peak at around 72 hours
3: (72h +): liver dysfunction continues –> PT/INR increase s/p decreased production of clotting factors, ammonia increases and may lead to hepatic encephalopathy
4: (5-14 days): death or resolution of hepatic impairment

24
Q

What is the antidote for APAP overdose and how is it administered? What is the disadvantage of each route of administration?

A

NAC
PO (mucomyst) –> noxious, difficult to take
IV (acetadote) –> requires large fluid volume

25
Q

What three drugs are contained in the Lilly Cyanide Antidote Kit?

A
  1. Amyl Nitrite Pearls
  2. Sodium Nitrite (Nitroglycerine)
  3. Sodium Thiosulfate
26
Q

What is the antidote for digoxin overdose and how does it work?

A

Digibind –> a protein that binds to digoxin and renders it inactive

27
Q

What is the antidote for iron toxicity?

A

Deferoxamine –> IV

28
Q

How long is deferoxamine administered in iron toxicity?

A

Deferoxamine turns the urine an orange/pink color s/p chelation of the iron. Deferoxamine is administered until the urine returns to normal color.

29
Q

What is the key feature used to identify a brown recluse spider?

A

Fiddle shaped marking on its back

30
Q

What is the treatment for brown recluse spider bite?

A

Wound care, tetanus, dapsone within the first 24 hours –> no anti-venin for brown recluse

31
Q

Describe the mechanism of action of Allopurinol and Febuxostat.

A

Inhibit xanthine oxidase, an enzyme that participates in two steps in the process of making of uric acid. Both prevent the patient from making uric acid.

32
Q

How commonly are Allopurinol and Febuxostat used in the management of gout?

A

One or the other is used as a first line agent.

33
Q

What is the major AE associated with Allopurinol?

A

Rash

34
Q

Describe the advantages and disadvantages of Febuxostat over Allopurinol.

A

Advantages: less prone to cause rash
Disadvantages: higher cost and has a black box warning for coronary artery and cerebrovascular disease.

35
Q

What is the second line medication for gout if one of the first line medications fail?

A

Lesinurad or probenecid (more rarely used than lesinurad)

36
Q

T/F: Oral contraceptives either contain progestin or estrogen but never both.

A

False: Oral contraceptives either contain progestin alone or progestin plus estrogen

37
Q

Give the advantages and disadvantages of transdermal patches as a contraceptive.

A

Advantages: need only be placed once every week
Disadvantages: adherence, less effective in overweight women, black box warning = increased estrogen s/p no first pass metabolism meaning increased risk of thrombosis

38
Q

Give the advantages and disadvantages of injectable progestins as a contraceptive.

A

Advantages: q 3 months
Disadvantages: weight gain, decreased bone mineral density, delayed return of fertility

39
Q

Give the advantages and disadvantages of an IUD as a contraceptive.

A

Advantages: long term contraception, quick return of fertility, decreased risk of thrombosis
Disadvantages: surgical placement, inflammation, doesn’t protect against STI

40
Q

What is the number one AE associated with use of estrogen in an oral contraceptive?

A

Thrombosis –> DVT, PE, etc.

41
Q

What are the advantages and disadvantages of the progestin-only “mini pill”?

A

Advantages: lower risk of thromboembolism.
Disadvantages: adherence - must be taken within same 3-hour time window each day.

42
Q

T/F: Several contraceptive options also protect against STIs.

A

False –> only condoms protect against STIs.

43
Q

List the drugs in the 4-drug regimen for treatment of TB and state a unique quality associated with each.

A

Rifampin: CP450 inducer (inc dose of other drugs)
Isoniazid: always co-administer with B6 (pyridoxine)
Pyrazinamide: causes pain and increases uric acid
Ethambutol: risk of optic neuritis

44
Q

What are the advantages and disadvantages of the triptan medications used to treat headaches?

A

Advantage: come in many dosage forms
Disadvantage: vasoconstriction (caution in angina)

45
Q

What is the primary disadvantage of using ergotamines to treat a headache?

A

Vasoconstriction –> caution in angina

Spring Pharm Block 4 (17 decks)

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