Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 401 Midterm #2 > Lec 14 - PADIS > Flashcards

Lec 14 - PADIS Flashcards

1
Q

What does PADIS stand for?

A

poison and drug info service

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

are the 2 branches of PADIS and what service do they provide?

A

Poison centre - for public and HCPs to ask for advice regarding poisonings.

  • ppl can ask about exposure to drugs, chemicals or toxins if htey’re conerned they took too much med or that they’ve been exposed to too much.
  • Can also call for tips on prevention. Eg// planting garden and wondering about a plant that might be poisonious to grandchild.

Medication Advice centre: Handle calls about general info abotu meds, how does it work, can i use in pregnancy, any ddis? How do i dose? side effects etc?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who staffs PADIS?

A
  • specially trained and certified healthcare porfessionals.
  • medical toxicologists (emerge docs with additional toxicology training)
  • info specilaist (pharmacists and registered nurses with background in emerge or icu.).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the top 10 categories PADIS gets called about?

A

1) Analgesics (6153)

  • 2) Household Cleaning
    Substances (3790)
  • 3) Antidepressants (2870)
  • 4) Sedative
    Hypnotics/Antipsychotics (2666)
  • 5) Cosmetics/Personal Care

Products (2349)
* 6) Cardiovascular Drugs (1652)

  • 7) Hormones and Hormone

Antagonists (1377)
* 8) Stimulants and Street Drugs
(1291)

  • 9) Foreign Bodies/Toys (1148)
  • 10) Vitamins (1139)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the top 10 SUBSTANCES padis gets called about?

A
  • 1) Acetaminophen (5226)
  • 2) Ibuprofen (4082)
  • 3) Atypical Antipsychotics (2865)
  • 4) Benzodiazepines (2292)
  • 5) Alcohol (1825)
  • 6) Antibiotics (1385)
  • 7) Diphenhydramine (1244)
  • 8) Other Sedative Hypnotics
    (1239)
  • 9) Sertraline (1058)
  • 10) Citalopram (940
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the purpose of the National Poison Data System? (NPDS)

A

it’s a data warehouse for Americ’as 55 poison control centres, where each centre submits data in real time, thus allowing real-time AE monitoring, surveillance, response and situational awareness.

Eg/ durign pandemic, there was false promotion of use of bleach and HCCLQ for covid –> poison centers could see these trends in real time. Allows for real time tracking from public health standpoint.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the steps when approaching a toxicology patient? What do A-G acronym stand for?

A
  • Airway
  • Breathing
  • Circulation
  • Decontamination
  • Elimination
  • Find an antidote
  • General management
  • must address these in order of priority!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When calling PADIS, What are the 6 categories of Physical Assessment info is most crucial?

A

CNS
* Level of consciousness/Behavior (staring off into space, lashing out)

Pupils
* Dilated/pinpoint

Vital signs
* HR, BP, RR, Temperature (hyper or hypothermic)
* ECG (QRS and QTc prolongation?)

Skin and Mucous membranes
* Diaphoretic/Dry

Muscle tone/reflexes/clonus
*Tremors/stiffness/flaccid

Odors
* Chloral hydrate – pear like odour (certain cmpds associated with odors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Review:
- what are the 7 most common toxidromes?

A

Sympathomimetics
anticholinergics
cholinergics
opioids
sedative-hypnotic
Serotonin syndrome
withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 cardinal sx of opioid overdose?

A

Decreased LOC, Decreased respiratory rate, Pinpoint pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the ABCDEFG’s of opioid management according to PADIS?

A

ABC’s – Severe toxicity risk
D – Potentially useful
E – None

F – Naloxone
* Usual dose is 0.4-2.0 mg IV
* Suspected opioid dependence would start as low as 0.04mg and
titrate up
* Repeat every 2-3 minutes up to 10 mg * Doses of 10-20mg rarely needed except in high potency opioids
* IV infusion – 2/3 dose that worked/hr

G – Supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 classes of agents that have ANTICHOLINERGIC PROPERTIES?

A

Antihistamines – diphenhydramine,
dimenhydrinate

Anticholinergic Plants – Jimson weed

TCA’s (Initial phases of toxicity)

Antidepressants and antipsychotics

Others: Atropine, benztropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the anticholinergic toxidrome…

  • CNS:
  • pupils:
  • vitals:
  • temp:
  • skin/mucous membranes:
  • GI/GU:
A

recall cholinergics mediate the PARASYMPATHETIC syst. Anything that blocks muscarinic and cholinergic receptors leads to unopposed sympathetic system, hence sx similar to sympathomimetic toxidrome.

  • CNS: mad as a hatter–> delirious, hallucinating, piccking at the air.
  • pupils: dilated
  • vitals:
    HR, BP, RR
    –> elevated HR and BP with wide QRS.
  • temp: elevated
  • skin/mucous membranes: DRY & flushed !!!
  • GI/GU:
  • dcr bowel sounds!!***
  • urinary retention/constipation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the ABCDEFG’s of anticholinergic management?

  • what are the major concerns with the primary ABCs?

D- is AC indicated?
E- any role for dialysis, alkalinization or MDAC?

F- any antidote?

G- role?

A

ABC’s – Seizures, widened QRS are possible

D –Activated charcoal effective

E – No role for urinary alkalinization, MDAC, or hemodialysis

F – Physostigmine – Consult with Medical toxicologist –
Potential side effects,
Short duration of action
Special access drug

G –Mainstay of management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 5 CHOLINERGIC AGENTS?

A

PESTICIDES (Organophosphate pesticides, Carbamate pesticides)

Nicotine
Pilocarpine
Dementia Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristic sx of cholinergic toxidrome (acaronym?)?

A

SLUDGE:
salivation, lacrimation, urination, diarrhea, GI upset, emesis

{drowning in own secretions}

17
Q

What is the acronym for Nicotinic toxicity? what do the days of the week stand for?

A
  • Mydriasis (dilated pupils)
  • Tachycardia
  • Weakness
  • tHypertension
  • Fasticulations
  • Seizures
18
Q

\what are the 2 antidotes for cholinergic toxidrome?

A

atropine and pralidoxime.

19
Q

Sympathomimetic Sx?

CNS

pupils

vitals

temp

skin/mucous membranes:

gi/gu:

A

CNS: agitation, tremor, hallucinations.

pupils: dilation

vitals: tachy, HTN,

temp: increased (hyperthermia)

skin/mucous membranes: excessive sweating. (diff from anticholinergic)

gi/gu: bowel sounds.

(anything that acts on beta or adrenergic receptors)

20
Q

What is the A-G management for SYMPATHOMIMETIC TOXIDROME?

  • ARE ABCs a concern with sympthatomimetic toxicty?
  • may consider what 2 decontamination methods?
  • any elim methods?
  • is there an antidote?
  • what drug si commonly given for general managemetn of vitals and CNS agitation?
A

ABC’s – severe toxicity risk
D – possibly AC/WBI
E – none
F – none
G – benzodiazepines
* for agitation, tremors, tachycardia, hypertension, and hyperthermia.

  • BENZOS ARE KEY to preventing severe toxicity
    (dcr seizures/hyperthermia/AKI)
  • be prepared to provide airway support
  • also provide cooling measures: cooling blankets etc.
21
Q

What is the acronym for SEROTONIN SYNDROME SX? what does it stand for?

A

CAN. CAN you spot serotonin toxciity?

Cogntiive sx: Agitation, anxiety, confusion, seizures

Autonomic instability:
–> vitals go into overdrive!
Hypertension, tachycardia, HYPERTHERMIA** –> big issuse with serotonin (requires benzos to control otherwise can be FATAL),
diaphoresis

Neuromuscular Abnormalities:
- RIGIDITY**
- tremor and **CLONUS**
- hyperreflexia, shivering etc.

22
Q

What is the drug of abuse that is serotonergic?

A

MDMA/ecstasy.

23
Q

What are 3 hidden sources that could cause serotonergic syndrome if used in combo with other serotonergic agents?

A

tramadol, Dextrometherophan, lithium.

24
Q

What are the A-G’s of Serotonin Syndrome Management?

  • Are ABCs a concern?
  • Any decontamination measures?
  • elim?
  • Is there an antidote?
  • what kind of supportive care should be provided? what med is really useful?
A

ABC’s – yes, severe toxicity risk. can be fatal.
D – none
E – none
F – ANTIDOTE: CYPROHEPTADINE***
* 1st generation histamine-1 blocker with non-specific
serotonin (5HT) antagonism [must give AFTER AC tho]

G – supportive care focusing on stopping muscle hyperactivity
and hyperthermia
* high dose BENZOS and external cooling critical.

25
Q

What signs are characteristic of SEDATIVE-HYPNOTIC TOXIDROME?

CNS?
vitals?
temp?
muscle tone?

A
  • ↓CNS
  • ↓ RR
  • ↓BP, HR, temp
  • Ataxia, Hyporeflexia
26
Q

What are the A-G’s of SEDATIVE TOXIDROME management?

  • what sometimes need to be done with airway??
  • how is breathing?
  • circulation? are sedatives typically cardiotoxic?
  • What can u use for decontam?
  • elim?
  • Is there an antidote available? do we use it typically?
A

Mangement:
* Airway: may need to be captured
* Breathing: can be shallow
* Circulation: Not usually cardiotoxic
but can be decreased
* Decontamination: AC binds
* Elimination: No role
* Find Antidote:

–> ANTIDOTE: FLUMAZIDONE EXISTS, but we don’t use it.

Pharm 401 Midterm #2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions