Brainscape's Knowledge GenomeTM

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


See full index

CDM 2 Exam 3 > Lecture 3 - Management of Acute Toxicologic Emergencies > Flashcards

Lecture 3 - Management of Acute Toxicologic Emergencies Flashcards

1
Q

PK factors to consider when evaluating potential drug OD?

A
  1. Drug susceptible to Bezoar formation?
  2. Was a time-release/SR formulation ingested?
  3. Does drug have anticholinergic properties that may reduce gastric emptying
  4. If pt Hypotensive (SBP <90), see dec absorption, clearance, metabolism maybe
  5. Is drug metabolism saturable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sources of False positive results for Amphetamines

A

Pseudoephedrine
Phenylephrine
Trazadone
Raniditine

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

Sources of False positive results for Benzo

A

Sertraline

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

Sources of False positive results cannabinoid

A

Ibuprofen

Naproxen

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

Sources of False positive results coke metabolite

A

“caine” anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sources of False positive results Opioids

A

Rifampin
Fluoroquinolone antibiotics
Synthetic opioids may not be detected

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

If inhaled poison then…

A

get person to fresh air ASAP, start artificial respiration prn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If poison on skin…

A

remove contained clothing, Flood skin with water, wash with soap

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

if poison in the eye…

A

flush the open eye with room temp water for 10-15min, remove contacts

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

If swallowed poison….

A

give 2-4oz of water, seek further help

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

Using Ipecac syrup in OD?

A

no role in ANY OD situation

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

Approach to poisoning in Hospital?

A

Support airway
Manage seizures, arrthymias, electrolytes, etc
Gastric lavage = only if ingestion within last hr**

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

Activated Charcoal

A
  1. Highly absorbent that binds many toxins
  2. no effective w/ Lithium and iron
  3. given up to 6hrs after ingestion, best within 1hr
  4. use Sorbitol w/ 1st dose only
  5. don’t give at home
1-12 = 25-50g
Adults = 25-100g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Whole bowel irrigation

A
  1. using a PEG solution
  2. Large volume admin over 12hrs to clear GI
  3. Few risks, but little evidence suggesting benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to use Whole-Bowel irrigation

A
  1. ingestion several hrs prior to hospital presentation
  2. Ingestion of SR or enteric coated formulations
  3. substances like iron that dont absorb to charcoal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acetaminophen antidote

A

Acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anticholinergic antidote

A

Physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Warfarin antidote

A

Phytonadione

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Benzo antidote

A

Flumazenil = short duration tho

20
Q

Digoxin antidote

A

Digoxin immune fab

21
Q

Ethylene glycol antidote

A

Fomepizole

22
Q

Iron antidote

A

Deferoxamine

23
Q

Isoniazid antidote

A

Pyridoxine

24
Q

Opioid antidote

A

Naloxone

25
Q

Acute Acetaminophen Toxicity (Time 0-24hrs after ingestion)

A

May sea N,V, diaphoresis but many patients are asymptomatic

26
Q

Acute Acetaminophen Toxicity (Time 2-3 days after ingestion)

A

Asymptomatic ise in AST/ALT and bilirubin

27
Q

Acute Acetaminophen Toxicity (Time 3-5 days after ingestion)

A

Signs + symptoms of hepatic injury

  1. Jaundice, RUQ tenderness, hypoglycemia,encephalopathy, elevated INR
  2. hepatic failure may progress to hepatic coma and death
28
Q

Mechanism of Acetaminophen toxicity

A

w/ OD, sulfate stores are rapidly depleted and inc acetaminophen is metabolized through CYP 450

~ 90% cleared via glucuronidation but its saturated in OD

~5% CYP450 metabolized but produces active metabolite NAPQI which is bad, it depletes glutathiones

Increased NAPQI = hepatotoxicity

can also see acute renal failure

29
Q

Factors to influence risk for Hepatotoxicity w/ Acetaminophen

A

Inc risk in adults, dec risk in kids

Pts frequently dont know they’re taking excessive acetaminophen

pts with induced CYP2E1 (alcoholic) = inc risk

inc risk w/ dose > 10g, repeated high doses 2-6g over 24hrs, or 6g/day for 5+ days.

30
Q

Treat pt with NAC if….

A

Line on Nomogram is above the Nomogram treatment line

Usually stay on side of caution and start NAC

31
Q

Always start NAC if….

A

time of ingestion is unknown or 8 hrs have elapsed since acute ingestion and serum acetaminophen lvl is not back

if start, always finish full course of NAC

32
Q

IV NAC dosing

A

Given over 21 hrs

$$$$

33
Q

Oral NAC dosing

A

Given over 72 hrs

tastes bad

$

34
Q

CCB OD results from….

A

1g of Diltiazem, nifedipine or verapamil = severe symptoms

acute or chronic poisoning = symptoms w/ lower doses

35
Q

Possible Symptoms of CCB OD

A

Hypotension
Bradycardia = none with nifedipine or amlodipine*****
Hyperglycemia

Symptoms usually within 1-2hrs of ingestion, delayed effect is CD or SR product

36
Q

CCB OD treatment to stabilize pt

A

Give charcoal within 2hrs of ingestion

Intubate

Aggressive IV fluid resuscitation and place pt in reverse Trendelenberg position

Dopamine infusion if SBP < 90
Atropine 1mg IVP q5min X 2 if HR < 50

37
Q

How long within ingestion can you give Charcoal for Acetaminophen OD?

A

Within 4hrs

38
Q

CCB OD treatment after pt is stabilized

A

Intralipid 20% 100ml IVP X 1, then 100ml/hr weaning off as signs of toxicity resolve

Start regardless of HR/BP

39
Q

2 potential mechanism for Intralipid

A
  1. binds to lipid drugs like CCB = Lipid sink phenomenon

2. rapid energy source to cardiac cells, increasing contractility

40
Q

If pt will has dec HR or BP after intralipid then give…

A
  1. IV calcium Cl (IVP -> infusion)= IVP is test dose, if HR or SBP dont inc by > 10% then move on to regular insulin
  2. Regular insulin (IVP-> Infusion) = if inadequate response < 10%, move to glucagon…HR < 50, SBP < 90
  3. Glucagon (IVP -> Infusion)
41
Q

TCA OD symptoms

A

Neurologic = lethargy, coma, seizures

CV = Tachycardia, Prolonged QRS interval ( > 160msec = predictive of severe effects), Hypotension

42
Q

TCA OD treatment

A
  1. Activated Charcoal 50g PO X 1…can repeat
  2. Sodium bicarb 50mEq IVP X 1 Q30min IF QRS interval > 160msec, SBP < 90 or Vtach
  3. Lidocaine 1g IVP X 1 IF Vtach…dont use procainamide or amiodarone as it can worsen QRS prolongation
43
Q

Who is at risk for Acute Opioid Toxicity

A
  1. Anyone using/abusing opioid drugs
  2. pts on high dose for pain management
  3. elderly
  4. IV drug abuse
  5. Users recently out of Detox
  6. Mixing with bento + booze
  7. Comorbid conditions
  8. Potency of street opioids
44
Q

Acute opioid poisoning

A

Respiratory depression
Sedation
Pinpoint pupils
Absence of bowl sounds

Seizures w/ meperidine or tramadol
Muscle rigidity w/ Fentanyl

45
Q

Mechanism of Naloxone

A

Knocks of opioids from Mu receptors

46
Q

Opioid OD treatment

A

IVP dose: 0.5,2,4,8,16mg.
start with 0.5, if RR < 10min after 2 min and continue until RR > 10.

If methadone or SR opioid…start IV infusion of naloxone at hrs dose that is 50% of last effective bolus dose

47
Q

rare side effects of naloxone?

A

Poop
Agitation

1/2life shorter than most opioids so symptoms of OD can return

CDM 2 Exam 3 (13 decks)

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