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Clinical Science > Lecture 15: Toxicology, Drugs of Abuse, Therapeutic Drugs, etc. > Flashcards

Lecture 15: Toxicology, Drugs of Abuse, Therapeutic Drugs, etc. Flashcards

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1
Q

APAP

A

Tylenol/ acetaminophen

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2
Q

hydrocodone with APAP

A

Vicodin

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3
Q

oxycodone with APAP

A

Percocet

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4
Q

tramadol with APAP

A

Ultracet

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5
Q

What is the minimum single adult dose for acetaminophen?

A

greater than or equal to 7.5 -10 grams is usually toxic

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6
Q

What is the most common cause of acute liver failure in the U.S.?

A

Tylenol toxicity (50% of cases)

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7
Q

What is Phase 1 of acetaminophen toxicity?

A

30 minutes- 24 hours after use; anorexia, fatigue, nausea vomiting, diarrhea, diaphoresis

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8
Q

What is Phase 2 of acetaminophen toxicity?

A

18-72 hours after; RUQ abdominal pain, nausea, vomiting, tachycardia, hypotension, oliguria

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9
Q

what is the toxic level of serum acetaminophen?

A

> 250 mcg/mL

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10
Q

When can Reye Syndrome occur?

A

when a patient with a viral illness ingest or uses aspirin as a fever reducer of anti-inflammatory

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11
Q

What are the manifestations of Reye Syndrome?

A

vomiting, lethargy, neurologic symptoms- irritability, restlessness, delirium, seizures, coma

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12
Q

What are salicylates?

A

class of medication known as NSAIDs

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13
Q

What is Serum alcohol level/ BAC (Blood Alcohol Content)?

A

percentage of alcohol or mass units of alcohol in the blood

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14
Q

What is the rate that the body typically clears alcohol?

A

0.015 of BAC per hour

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15
Q

What is methanol and ethylene glycol typically found in?

A

antifreeze, windshield wiper solution, solvents, cleaners, fuels, industrial products

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16
Q

What are some of the symptoms of methanol intoxication?

A

vision blurring, central scotomata (darkening of a visual field), blindness

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17
Q

What are some of the symptoms of ethylene glycol intoxication?

A

flank plain, hematuria, oliguria

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18
Q

What is the estimated lethal dose of isopropyl alcohol (rubbing alcohol)?

A

250 mL in humans

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19
Q

What are the critical values for lead toxicity?

A

under age 16= >20 mcg/dL

over age 16= >70 mcg/dL

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20
Q

What is the most common cause of acute liver failure in the U.S.?

A

acetaminophen; symptoms don’t usually appear until 24-48 hours after ingestion

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21
Q

What can cause Reye Syndrome?

A

Aspirin –> NSAIDs

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22
Q

When can Reye Syndrome occur?

A

when a patient with a viral illness ingests or uses aspirin as a fever reducer of anti-inflammatory

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23
Q

What are the manifestations of Reye syndrome?

A

vomiting, lethargy, neurologic symptoms

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24
Q

What is the rate at which the body clears alcohol?

A

.015 BAC per hour

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25
Q

Where is methanol and ethylene glycol typically found?

A

antifreeze, windshield wiper solutions, cleaners, fuels, and industrial products

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26
Q

What are the symptoms of methanol intoxication?

A

vision blurring, central scotomata, blindness

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27
Q

What are the symptoms of ethylene glycol intoxication?

A

flank pain, hematuria, oliguria

28
Q

Were is isopropyl alcohol found?

A

disinfectants, antifreeze, solvents, and most commonly rubbing alcohol

29
Q

What will patients with lead poisoning present with?

A

decline in mental status, muscle weakness, headaches, memory loss, mood disorder, premature birth, multiple renal, gastrointestinal, neurologic and hematologic manifestations , and hearing loss

30
Q

Where is mercury found?

A

thermometers, mining, contaminated fish, Chinese medicine

31
Q

What can severe exposure of mercury lead to?

A

fatal pneumonitis, intention tremor, gum inflammation, excessive salivation, psychiatric symptoms
children can develop pink disease
excessive can cause renal toxicity

32
Q

Where can arsenic be found?

A

volcanic eruptions, contaminated water, pesticides, mining, Asian herbal remedies, some apple or grape juices

33
Q

What are the presentations of arsenic poisoning?

A

nausea, EKG abnormalities, hypotension, arrhythmias, seizures, hepatices, skin lesion(hyperpigmentation is common as an early sign), cancer

34
Q

What does the basic urine drug screen test for?

A

amphetamines, cocaine, marijuana, opioids, phencyclidines (PCP)

35
Q

What can be used for a drug of abuse screening?

A

urine- most common, blood/serum- 2nd most common, hair, feces, sweat, saliva

36
Q

Addition of what substance alters DOA screening result?

A

Zinc sulfate

37
Q

What all can be measured to avoid subversion tactics in DOA screenings?

A

urine specific gravity, temperature, pH, creatinine

38
Q

What things can produce false positive amphetamine results?

A

OTC products, nasal decongestants, ephedrine, bupropion, and selegiline

39
Q

What does a cocaine drug screen detect?

A

benzoyleconine (a cocaine metabolite)

40
Q

Are false positives common in DOA screenings for cocaine?

A

no extremely uncommon

41
Q

What doe THC drug screen detect?

A

metabolite Delta-9-THC

42
Q

What are some benzodiazepines?

A

alprazolam, diazepam, Lorazepam, clonazepam, midazolam, triazolam… does not detect sleep medications such as Zolpidem etc.

43
Q

What is digoxin?

A

antiarrhythmic agent used in atrial fibrillation, congestive heart failure… has a narrow therapeutic index

44
Q

What are the causes of digoxin poisoning?

A

arrhythmias, nausea, vomiting, confusion, weakness, visual changes

45
Q

What patients should digoxin be monitored in?

A

elderly, renal impairment, low potassium or magnesium

46
Q

When does the baseline level for digoxin occur?

A

7 days after initiating digoxin

47
Q

What are the anticonvulsants that require monitoring?

A

carbamazepine, divalproex sodium, valproate sodium, phenobarbital, phenytoin, primidone

48
Q

What is the indication of lithium?

A

used in the treatment of bipolar disorder as an anti-manic agent and to reduce risk of suicide

49
Q

What are the signs of lithium toxicity?

A

nausea, vomiting, dehydration, ECG changes, bradycardia, ataxia, confusion, agitation, tremors, jerks

50
Q

What can occur because of vancomycin?

A

nephrotoxicity and renal failure

51
Q

What is vancomycin used for?

A

gram positive infections, C, diff, MRSA, meningitis, community/hospital acquired pneumonia

52
Q

How can you avoid toxicity from vancomycin?

A

draw trough levels

53
Q

When are trough levels checked in vancomycin?

A

just before the 4th dose- steady state

54
Q

What is theophylline?

A

medication used to treat reactive airway disease and works as a bronchodilator

55
Q

When should you check theophylline levels?

A

when increasing the dosage, symptoms of toxicity are present, symptoms are worsening, when treatment or medication changes are made that affect theophylline

56
Q

What is methotrexate used to treat?

A

severs psoriasis, rheumatoid arthritis, acute lymphoblastic lymphoma, breast cancer, non Hodgkin’s lymphoma, other cancer therapy

57
Q

Low dose methotrexate therapy

A

Pulmonary toxicity, hepatotoxicity, myelosuppression and GI distress

58
Q

high dose methotrexate therapy

A

Above + Stomatitis, nephrotoxicity, neurologic toxicity, severe rash than can lead to desquamation

59
Q

What should you administer if a person has toxic levels of methotrexate?

A

leucovorin

60
Q

carbon monoxide binding affinity

A

Carbon monoxide demonstrates a higher binding affinity for the heme portion of hemoglobin than oxygen by a factor of 240!

61
Q

How can one screen for carboxyhemoglobin?

A

patient history plus carboxyhemoglobin level done on arterial blood gas

62
Q

What are some causes of increase methemoglobin?

A

congenital Methemoglobinemia ; most cases autosomal recessive

63
Q

What is methemoglobin?

A

Normally, the iron moiety in hemoglobin is found in the ferrous Fe2+ state but a small percentage (~1%) exists in the oxidized ferric state Fe3+

64
Q

acquired Methemoglobinemia

A

TOXINS

nitrites, medications such as dapsone and topical anesthetics, well water, chlorates

65
Q

What is the clinical presentation of methemoglobin?

A

blue color skin, cyanosis, headache, dyspnea, lightheadedness (even syncope), weakness, confusion, palpitations, chest pain, altered mental status, delirium, some death

Clinical Science (15 decks)

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