Lec 14 - PADIS Flashcards
What does PADIS stand for?
poison and drug info service
are the 2 branches of PADIS and what service do they provide?
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?
Who staffs PADIS?
- 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.).
What are the top 10 categories PADIS gets called about?
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)
What are the top 10 SUBSTANCES padis gets called about?
- 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
What is the purpose of the National Poison Data System? (NPDS)
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.
What are the steps when approaching a toxicology patient? What do A-G acronym stand for?
- Airway
- Breathing
- Circulation
- Decontamination
- Elimination
- Find an antidote
- General management
- must address these in order of priority!
When calling PADIS, What are the 6 categories of Physical Assessment info is most crucial?
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)
Review:
- what are the 7 most common toxidromes?
Sympathomimetics
anticholinergics
cholinergics
opioids
sedative-hypnotic
Serotonin syndrome
withdrawal
What are the 3 cardinal sx of opioid overdose?
Decreased LOC, Decreased respiratory rate, Pinpoint pupils
What are the ABCDEFG’s of opioid management according to PADIS?
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
What are the 4 classes of agents that have ANTICHOLINERGIC PROPERTIES?
Antihistamines – diphenhydramine,
dimenhydrinate
Anticholinergic Plants – Jimson weed
TCA’s (Initial phases of toxicity)
Antidepressants and antipsychotics
Others: Atropine, benztropine
Describe the anticholinergic toxidrome…
- CNS:
- pupils:
- vitals:
- temp:
- skin/mucous membranes:
- GI/GU:
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.
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?
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
What are 5 CHOLINERGIC AGENTS?
PESTICIDES (Organophosphate pesticides, Carbamate pesticides)
Nicotine
Pilocarpine
Dementia Drugs
What are the characteristic sx of cholinergic toxidrome (acaronym?)?
SLUDGE:
salivation, lacrimation, urination, diarrhea, GI upset, emesis
{drowning in own secretions}
What is the acronym for Nicotinic toxicity? what do the days of the week stand for?
- Mydriasis (dilated pupils)
- Tachycardia
- Weakness
- tHypertension
- Fasticulations
- Seizures
\what are the 2 antidotes for cholinergic toxidrome?
atropine and pralidoxime.
Sympathomimetic Sx?
CNS
pupils
vitals
temp
skin/mucous membranes:
gi/gu:
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)
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?
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.
What is the acronym for SEROTONIN SYNDROME SX? what does it stand for?
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.
What is the drug of abuse that is serotonergic?
MDMA/ecstasy.
What are 3 hidden sources that could cause serotonergic syndrome if used in combo with other serotonergic agents?
tramadol, Dextrometherophan, lithium.
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?
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.
What signs are characteristic of SEDATIVE-HYPNOTIC TOXIDROME?
CNS?
vitals?
temp?
muscle tone?
- ↓CNS
- ↓ RR
- ↓BP, HR, temp
- Ataxia, Hyporeflexia
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?
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.
