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Toxicology > General Methods of Tx > Flashcards

General Methods of Tx Flashcards

1
Q

What methods are used for prevention of absorption?

A
  • gastric emptying
    • emesis
  • -gastric lavage
  • adsorption
    • activated charcoal
  • catharsis
    • affects the GI transit time
  • dilution
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2
Q

What is used to stimulate emesis?

A
  • syrup of ipecac
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3
Q

What are some of the contraindications of using syrup of ipecac?

A
  • corrosive/caustic agents

- petroleum distillate

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4
Q

What are some of the complications associated with gastric lavage?

A
  • cardiac arrythmias
  • low pO2
  • laryngospasm
  • pharingeal injury
  • esophageal or gastric perforation
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5
Q

In what location is activated charcoal most useful in binding poisons?

A
  • small intestine (one they have left the stomach)
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6
Q

What agents are activated charcoal NOT useful for?

A
  • corrosive ingestions (ACIDS)
  • methanol/ethanol
  • CN, As
  • Fe
  • F
  • heavy metals
  • lithium
  • potassium
  • petroleum distillates
  • tobramycin
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7
Q

What are the contraindications behind using activated charcoal?

A
  • ingestion of caustic substances

- presence of ileum or bowel obstruction

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8
Q

What are the complications associated with using activated charcoal?

A
  • vomiting
  • aspiration pneumonitis
  • constipation
  • GI obstruction
  • charcoal empyema
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9
Q

What is the dose of activated charcoal?

A
  • 30-100 g as a slurry in water (there are also sorbitol containing compounds)
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10
Q

What is the effect of MDAC?

A
  • may help prevent reabsorption of the drug in the GIT
  • increases the clearance of drugs excreted in the feces
  • known as GI dialysis
  • ensures that there is a marked serum to GI lumen concentration gradient
  • route of admin other than oral
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11
Q

What does MDAC have efficacy in?

A
  • analgesics
  • antiarrythmics
  • anticonvulsants
  • benzos
  • beta blockers
  • cardiac glycs.
  • TCAs
  • NSAIDs
  • salicylates
  • sedatives
  • – A LOT
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12
Q

What is an indication for a whole bowel irrigation?

A
  • ingestion of iron or zinc salts
  • ingestion of SR medications
  • ingestion of drug packets
  • ingestion of crack vials
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13
Q

What are some of the CIs to whole bowel irrigations?

A
  • presence of ileum or GI obstruction

- GI bleeding or perforation

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14
Q

What are some of the complications of whole bowel irrigations?

A
  • abdominal cramping
  • vomiting
  • profuse diarrhea
  • hyperchloremia (essential to monitor electrolytes)
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15
Q

What is the technique of whole bowel irrigations?

A
  • administer large volumes of isotonic, non absorbable polyethylene glycol/electrolyte solution over 40 minutes to several hours
    (example of this is colyte)
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16
Q

What is the pro of using a cathartic in bowel irrigation?

A
  • less violent
  • used to move the poison or the poison/charcoal complex through the GIT
  • can help to remove the poison
  • can help decrease absorption
  • can help prevent the formation of concentrations of drug or drug/charcoal complex
  • same CI and complications as with whole-bowel irrigation
17
Q

What are some of the examples of a cathartic?

A
  • sorbitol
  • magnesium citrate
  • magnesium or sodium sulfate
18
Q

In what situation might dilution have some value?

A
  • after the ingestion of a corrosive agent
  • CI in coma and convulsions

(NEVER USE WITH ACID)

19
Q

What are the indications that would lead you to think that enhancement of elimination would be a good way to go to remove the toxin?

A
  • failure to respond to supportive care (hypotension, heart failure, seizures, metabolic acidosis, or dysrhythmia)
  • normal route of elimination is impaired
  • plasma concentration indicates high risk of mortality
  • concomitant disease and are in a high or low age group
20
Q

What method does diuresis work on?

A
  • increasing the renal clearance by manipulation of the pH
21
Q

What is alkaline diuresis?

A
  • give NaHCO3 to increase urinary pH to 7-8 (increases renal excretion of salicylate, isoniazid and phenobarb)
22
Q

What is acid diuresis?

A
  • give NH4Cl to reduce the urinary pH to 4.5-5.5 (works for weak bases such as amphetamines and phencyclidine)
23
Q

What drugs does peritoneal dialysis remove?

A

water soluble, LMW (< 500 Da), poorly protein bound compounds that have a low Vd
(alcohol, lithium, salicylates and theophylline)

24
Q

What are examples of drugs that GI dialysis can remove?

A
  • phenobarbital
  • theophylline
  • VPA
25
Q

What are the indications for hemodialysis?

A
  • poison is dialysable
  • patient is deteriorating despite care
  • severe electrolyte problems
  • lethal blood levels
  • risk of prolonged coma
  • risk of renal failure
26
Q

What specific poisonings is hemodialysis useful for?

A
  • methanol
  • ethylene glycol
  • salicylate
  • theophylline
  • ethanol
27
Q

What are some of the complications of hemodialysis?

A
  • clotting and leaking of blood from around connections
  • embolus
  • hypotension
  • convulsions
  • arrhythmias
  • infections
28
Q

What is charcoal hemoperfusion?

A
  • compounds have to be able to be absorbed by AC
  • cartridge containing a sorbent with large SA
  • cartridge changes as often as q2-4h
  • anticoagulation
  • usually performed for 4-6 hours
  • hemoperfusion is not limited by plasma protein binding
29
Q

What are some examples of drugs that can be removed by hemoperfusion?

A
  • carbamazepine, phenobarbital, phenytoin and theophylline
30
Q

What is hemo filtration?

A
  • movement of plasma across a semi-permeable membrane in response to hydrostatic pressure gradient
  • no dialysate solution on the other side of the membrane
  • smaller solutes are transported across the membrane following the water (bulk flow) while larger solutes are excluded
31
Q

What is plasmapheresis and exchange transfusion?

A
  • used to eliminate molecules with large MW ( > 15,000 Da)
  • both remove plasma proteins (benefit of removing protein bound molecules, dig-dig antibodies and thyroxine)
  • risk of infections and allergic reactions
  • expensive
  • exchange transfusion appropriate in small infants
32
Q

What is a lipids rescue?

A
  • IV lipid emulsions

- lipid sink of pharmacokinetic sequestrations of (local anesthetics, TCA or CCBs)

Toxicology (4 decks)

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