Lecture Flashcards
Anticholinergic drug examples
atropine, antihistamines, antipsychotics
Anticholinergic mnemonic
Blind as a bat Red as a beet Hot as a hare Dry as a bone Mad as a hatter Blotted as a toad The heart runs alone (tachycardia)
Anticholinergic signs and symptoms
Increase; HR, Temp, Pulip
Decrease; Bowel, Diaphoresis
What is a poison?
Toxic by nature, no matter the dose or route of entry
What is a drug?
Substance with a therapeutic effect when given at an appropriate dose and circumstance
Dose-dependent and route dependent
Bioavailability
The extent to which a drug is present in sufficient amounts to produce the desired result
Half life
The point when bio availability of a drug has decreased to 50%
Peak time concentration
How long it takes a drug to exert its maximum clinical effects
Excretion
How a drug is removed from the body
Potentiation
Enhancement of the effect of one class of drug by taking it with another drug of a different class
Synergism
Action of two drugs in the same class in which the effects are greater then the independent effects
Antagonist
Drug with affinity for cell receptor, binds but does not activate it. Preventing the normal cell from activating it. Blocks the receptor
Agonist
Binds to a receptor and activates it
How do toxicokinetics differ from pharmacokinetics
When a drug is taken in overdose, normal pharmacokinetics don’t apply due to saturated metabolic pathways and a change in the desired effect, half-life and excretion time
Six common routes of absorption
Ingestion Inhalation Injection Absorption Ocular Rectal
What does ABCD referred to in the approach to a poisoned patient
Airway
Breathing
Circulation
Decontamination - protect yourself and decontaminate the patient as needed
Common OPQRTS and SAMPLE questions to include
What was taken, when, route, how much, why, acute or chronic reaction, other exposures, vomiting nausea aspiration, suicidal
What are significant findings for the following body systems in the poisoned patient?
Eyes, Mucous membranes, Bowel sounds, Skin, Neuro
Eyes - pupils and nystagmus Mucous- hydration Bowel - hypo/hyperactive Skin- Rash, dry, diaphoretic Neuro - reflexes
AEIOUTIPS for a neuro exam
Alcohol Endocrine/ Epilepsy Intoxication Oxygen Uremia Trauma/Tumor Infection Psychological Shock/Stroke
OTIS CAMPBELL for seizure/neuro exam
Organophosphates Tricyclics Insulin Sympathomimetics Cocaine Amphetamines PCP Benz withdrawal Ethanol Lead/Lithium Lidocaine
Anticholinergic toxidrome
\+HR =RR \+Temp pupil dilation -bowel sounds -diaphoresis
Cholinergic toxidrome
=HR =RR =Temp pupil constriction \+bowel sounds \+diaphoresis
Sympathomimetic toxidrome
\+HR \+RR \+Temppupil dilation \+bowel sounds \+diaphoresis
Sedative Hypnotic toxidrome
-HR
-RR
-Temp
=pupils
-bowel sounds
-diaphoresis
Opioid toxidrome
-HR
-RR
-Temp
pupil constriction
-bowel sounds
-diaphoresis
6 examples of anticholinergic agents
Atropine Antihistamines Antipsychotics Scopolamine TCA's Jimson Weed
Treatment for anticholinergic toxicity
Supportive care
Typical S&Sy of anticholinergic OD (mneumonic)
Hot as a hare Blind as a bat Dry as a bone Red as a beat Mad as a hatter
Causes of cholinergic toxicity
Organophosphates
Carbonates
Nerve Agents
Treatment for cholinergic toxicity
Atropine Pralidoxime (2PAM)
S&Sy of cholinergic toxicity
Muscarinic Sy - SLUDGE
Nicotinic Sy - MTWTF
(Muscle Cramps, Tachycardia, Weakness, Twitching, Fasciculations)
Muscular effects of cholinergic toxicity
weakness, fasciculation, paralysis, similar to Succs, don’t use Succs to intubate
Cardiovascular effects of cholinergic toxicity
Sinus tachydysrhythmias, bradycardia, QT prolongation causing Torsades
S&Sy of sedative-hypnotic toxicity
sleepy, decreased RR
+/- variable BP, HR, Temp
Treatment of sedative-hypnotic toxicity
Supportive care, monitor RR
Causes of sedative-hypnotic toxicity
Benzodiazepines, barbiturates, zolpidem
S&Sy of opioid toxicity
Sleepy, - RR, pinpoint pupils
Causes of opioid toxicity
heroin, morphine, oxycodone, fentanyl, methadone
Treatment for opioid toxicity
Narcan, supportive, monitor RR
S&Sy of sympathomimetic toxicty
Altered, agitated, mydriasis (dilation of the pupil), diaphoretic
elevated HR, RR, BP
Causes of sympathomimetic toxicity
amphetamines, cocaine, bath salts, huffing
Major concerns of Sympathomimetic toxicity
Rhabdo, Hyperthermia, Safety
Treatments for sympathomimetic toxicity
High doses of Benzodiazepines in hopes of decreasing neural output and preserve ATP
Use non-depolarizing paralytics to preserve ATP
Actively cool if hyperthermic (tylenol ineffective)
Examples of TCA OD
amitriptyline, nortriptyline, amoxapine
S&Sy of TCA OD
cardiovascular and neurologic toxicity
tachycardia, drowsiness, N/V, monitor for peaked T waves, Widened QRS, Prolonged QT, ALOC, hypotension, seizures
Treatment for TCA OD
Widened QRS (50mEq IV Bicarb), QT prolongation Mag 2g if needed, Maintain BP with Dopamine as needed
Causes of SSRI Toxicity
SSRI, MAOI, cocaine, dextromethorphan
S&SY of SSRI Toxicity
AMS, Clonus, Rigidity, Hyperthermia
Treatment of SSRI Tocicity
Benzodiazepine, Ciproheptadine
Causes of Ca++Channel Blocker Toxicity
amlodopine, diltiezam, verapamil, felodipine
S&SY of Ca++ channel blocker toxicity
Hypotension, Brady dysrhythmias, prolonges R-R, Cardiac arrest, seizure, syncope, N/V, ALOC, Hyperglycemia, Hypokalemia
Treatment of Ca++ channel Blockers
Ca++Cl- 500-1000 SLOW IVP consider 2nd dose with base contact
IV fluids, vasopressor, consider TCP, supportive care
Causes of Beta Blocker Toxicity
Atenolol, Metoprolol, sotalol, propanolol
S&Sy of Beta Blocker toxicity
Bradycardias, AV Blocks, prolonged R-R, Torsades, drowsiness, hypotension, CHF type symptoms
-HR, -inotropic, -dromotropic
Treatments for Beta Blocker toxicity
Glucagon 3-5mg IV over 10 min (will cause vomiting)
Dopamine to maintain BP >100
what is the level to consider acetaminophen Toxicity
Acute within 8 hr period
Adult: >6g
Children: >200mg/kg
Describe the 4 phases of acetaminophen toxicity
P1: 0-24hrs N/V
P2: 24-72hrs RUQ Px, Elevated liver enzymes and INR
P3: 72-96hrs hepatic necrosis, renal failure
P4: 4days-weeks
resolution of S&Sy if pts survive this long
Salicylate Toxicity S&Sy
Tinnitus, GI upset, respiratory stimulant, AMS, acute lung injury, Central hypoglycemia (give D50)
CO poisoning S&Sy
flu-like, dizzy, bounding pulse, dilated pupils, cyanosis, cherry red skin
CO treatment and management
high flow O2, reduce anxiety, monitor EKG and LOC
Cyanide Poisoning S&SY
burning sensation in ENT, cyanosis, shock, seizures
Cyanide Poisoning Treatment
High flow O2, irrigate eyes and skin
Nicotine OD S&SY
Tachycardia, N/V and seizures, bradycardia
Parasympathomimetic alkaloid
Lethal dose of nicotine
30-60mg (.5-1.0mg/kg)
ave e-cigarette contains 9mg, but less than 1 mg is ingested
Have 0-48mg/ml of nicotine solution
