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P&T Block 1 > L5 > Flashcards

L5 Flashcards

1
Q

What is Vd? Include equation.

A

= Apparent volume into which a drug distributes
Vd = dose (mg)/ [ ]
Units = L/kg

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2
Q

What does low Vd mean?

A

Drug resides mostly in plasma

Caffeine

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3
Q

What does high Vd mean?

A

Drug resides mostly in tissue
Soluble or actively transported
Choroquine

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4
Q

Where can drugs be metabolized?

A

Liver
Kidneys
Lungs

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5
Q

Where can drugs be eliminated?

A

Kidneys

Feces

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6
Q

What is the toxic metabolite of Tylenol?

A

NAPQI
Acteaminophen –> NAPQI
- cP450

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7
Q

What molecule usually detoxes NAPQI?

A

Glutathione

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8
Q

What is zero order elim?

A

Fixed amt drug elim per time

Alcohol

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9
Q

What is first order elim?

A

Eliminated by 1/2 life = half [drug] per unit time

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10
Q

What is saturable elim? Name example.

A

Elim via 1st order until saturation pt reached –> zero order elim
Phenytoin

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11
Q

What is the difference between half life of elim vs duration of action?

A

Need to consider BOTH when dosing
1/2 life of elim = how long the drug stays in your system
Duration of action = how long the drug effects can be seen

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12
Q

Describe pediatric poisonings

A

Single exposure
Acute - short discovery time
Most household products

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13
Q

Which 2 pills are 1 pill killers of kids?

A

Clonidine - BP & ADHD

Culfonylureas - T2D

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14
Q

Describe adult overdose

A

Mixed, multiple exposures
Acute or chronic med exp
Delayed presentation
Prescription meds

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15
Q

Describe sympathomimetic toxidrome

A 
= amphetamines, cocaine
↑HR, BP, RR
↑ Temp
Mydriasis 
Agitation 
Diaphoresis - sweating
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16
Q

Anti-cholinergic toxidrome

A 
= atropine, scopolamine, anti-histamines, synthetic marijuana, K2, spice
(sympa overdrive) 
↑HR, BP
Normal or ↑RR
↑T
Mydriasis 
Agitated 
DRY, bowel sounds decreased, urine retention
17
Q

Opioid toxidrome

A 
= heroine, morphine, oxycodone
↓HR, BP
↓↓↓ RR - worried about this! CNS depression, need to maintain respiration!! 
Miosis
Lethargy, coma
↓ bowel sounds, urine retention
18
Q

Cholinergic toxidrome

A 
= Organophosphates, pesticides (para overdrive = SLUDGE, DUMB BELLS)
↓HR, BP
↑RR
↓Temp - not remarkable
Miosis
Lethargy, seizure
Sweating
↑bowel sounds, peeing the bed
19
Q

What labs do you get for poisoned pts?

A

Serum labs based on what you think they’re ODing on

  • Acetaminophens & salicylates (aspirin)
  • Anti-epileptics: phenytoin, phenobarbital, carbamazepine, valproic acid
  • Methemoglobin, carboxyhemoglobin
  • Alcohols: ethanol, methanol, ethylene glycol
20
Q

How do you determine whether to treat an OD?

A

Nanogram

Above SOLID line = treat with antidote

21
Q

What is the antidote for tylenol OD?

A

Acetlycysteine = glutathione precursor

22
Q

Calculate anion gap

A

Na - (Cl + HCO3)

23
Q

What is the mneumonic if AG > 15

A 
MUDPILES
Methanol
Uremia
DKA
Phenformin, paraldehyde
Iron, isoniazid
Lactic acid
Ethylene glycol
Salicylates
24
Q

3 options for GI intervetion with overdose

A

Gastric lavage
Activated charcoal
Whole bowel irrigation

25
Q

Reqs for gastric lavage

A

1 hr

Life threatening

26
Q

Reqs for activated charcoal

A

Absorbs toxins -> fecal excretion

Most drugs and toxins

27
Q

What doesn’t charcoal bind

A

Hydrocarbons
Alcohols
Metals

28
Q

Reqs for whole bowel irrigation

A

Slow release pills
Metals
Foreign bodies - body packers

29
Q

3 mechanism to enhance drug elim

A

Multiple dose activated charcoal - bile trap, drugs that might get released later
Urine alkalinization = low pKa drugs so preferentially move them into urine
Extracorporeal drug removal = dialysis

30
Q

5 drugs that are eligible for multiple dose of activated charcoal

A 
Theophylline
Phenobarbital
Dapsone
Cyclopeptide mushrooms 
Carbamazepine
31
Q

Which drugs are good candidates for urine alkalinization?

A

Aspirin

Methotrexate

32
Q

Req for extracorporeal drug removal

A

Small molecules
Low protein binding
Small Vd (in plasma)
Water soluble

33
Q

Antidote for opioids

A

Naloxone

34
Q

Antidote for digoxin and crotalidae snake bite

A

Fab = Abs vs each

35
Q

Sulfonylurea antidote

A

Octreotide

36
Q

Ethylene glycol, methanol antidotes

A

Fomepizole

37
Q

Anticholinergics antidotes

A

Physostigmine

38
Q

Organophosphorus/carbamate antidote

A

Atropine

Pralidoxime

P&T Block 1 (43 decks)

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