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Management Of Poisoned Patient Flashcards

1
Q

Denotes the altered pharmacodynamics of a drug when given in toxic dosage, since normal receptors and effector’s mechanisms may be altered.

A

Toxicodynamics

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2
Q

applied to the pharmacokinetics of toxic doses of chemicals, since the toxic effects of an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material

A

Toxicokinetics

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3
Q

apparent volume into which a substance is distributed

A

Volume of Distribution (Vd)

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4
Q

A large VD implies that the drug is ___________ accessible to measures aimed at purifying the blood, such as hemodialysis

A

not readily

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5
Q

Drugs with large volumes of distribution

A

PANAVA
1. Antidepressants
2. Antimalarials
3. Narcotics
4. Propranolol
5. Antipsychotics
6. Verapamil

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6
Q

Drugs with relatively small volumes of distribution

A
  1. Salicylate
  2. Phenobarbital
  3. Lithium
  4. Valproic Acid
  5. Warfarin
  6. Phenytoin
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7
Q

a measure of the volume of plasma that is cleared of drug per unit time

A

Clearance

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8
Q

the sum of clearances by excretion by the kidneys and metabolism by the liver

A

Total clearance

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9
Q

Cardiovascular toxicity

A

● Hypotension
● Peripheral Vascular Collapse
● Lethal arrhythmia

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10
Q

Comatose patients frequently lose their ____________ and their ____________.

A

airway protective reflexes & respiratory drive

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11
Q

occurs in spite of adequate ventilation and oxygen administration

A

Cellular hypoxia

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12
Q

Signs and symptoms of Hypoxia

A
  1. Hypotension
  2. Tachycardia
  3. Severe Lactic Acidosis
  4. Signs of Ischemia on the ECG
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13
Q

Drugs that can often cause seizures

A
  1. Antidepressants
  2. Theophylline
  3. Isoniazid (INH)
  4. Diphenhydramine
  5. Antipsychotics
  6. Cocaine
  7. Amphetamines
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14
Q

Decrease Blood Volume

A

Hypovolemia

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15
Q

Drugs/substances that cause pulmonary fibrosis

A

Paraquat, Bleomycin, Amiodarone

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16
Q

Massive hepatic necrosis due to poisoning by ____________ or ________________

A

acetaminophen or certain mushrooms

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17
Q

Massive hepatic necrosis due to poisoning by acetaminophen or certain mushrooms results in

A

hepatic encephalopathy

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18
Q

Massive hepatic necrosis due to poisoning by acetaminophen or certain mushrooms results in hepatic encephalopathy and death _________ hours or longer after ingestion.

A

48–72

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19
Q

Intoxication with alcohol and other sedative-hypnotic drugs is a frequent contributing factor to

A

motor vehicle accidents

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20
Q

Most common factor contributing to death from drug overdosed is usually caused by a problem in

A

Airway

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21
Q

Patients under the influence of ________, such as phencyclidine (PCP) or LSD may die in fights or fall from high places.

A

hallucinogens

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22
Q

AIRWAY Obstruction is caused by:

A

flaccid tongue, pulmonary aspiration of gastric contents, or respiratory arrest

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23
Q

For many patients, simple positioning in the __________________ position is sufficient to move the flaccid tongue out of the airway

A

lateral decubitus

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24
Q

Ideal position for a patient with obstruct airway

A

lateral decubitus

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25
Q

Two routes for endotracheal intubation:

A

Nasotracheal intubation & Orotracheal intubation

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26
Q

A soft, flexible tube is passed through the nose and into the trachea.

A

Nasotracheal intubation

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27
Q

The tube is passed through the mouth into the trachea.

A

Orotracheal intubation

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28
Q

What technique is used in using Nasotracheal intubation?

A

Blind technique

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29
Q

Orotracheal intubation is done under ___________ vision

A

Direct

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30
Q

May be performed in a conscious patient without requiring neuromuscular paralysis.

A

Nasotracheal intubation

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31
Q

Once placed, it is better tolerated than an orotracheal tube.

A

Nasotracheal intubation

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32
Q

Disadvantages of Nasotracheal intubation

A
  1. Perforation of the nasal mucosa, with epistaxis.
  2. Stimulation of vomiting in an obtunded patient.
  3. Patient must be breathing spontaneously.
  4. Anatomically more difficult in infants because of anterior epiglottis.
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33
Q

Performed under direct vision, making accidental esophageal intubation unlikely.

A

Orotracheal intubation

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34
Q

Insignificant risk of bleeding.

A

Orotracheal intubation

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35
Q

Patient need not be breathing spontaneously.

A

Orotracheal intubation

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36
Q

Higher success rate than that with nasotracheal route.

A

Orotracheal intubation

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37
Q

Disadvantages of Orotracheal intubation

A
  1. Frequently requires neuromuscular paralysis, creating a risk of fatal respiratory arrest if intubation is unsuccessful.
  2. Requires neck manipulation, which may cause spinal cord injury after neck trauma.
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38
Q

major cause of morbidity and death in patients with poisoning or drug overdose

A

Breathing difficulties

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39
Q

Complications in breathing:

A

ventilatory failure, hypoxia, bronchospasm

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40
Q

The ____________ should be cleared of vomitus or any other obstruction.

A

airway

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41
Q

Medical term for nosebleed

A

Epistaxis

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42
Q

Done to unconscious or paralyzed patients

A

Orotracheal intubation

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43
Q

measures the degree of oxygen saturation

A

Oximeter

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44
Q

Breathing should be assessed by observation and oximetry and, if in doubt, by measuring _____________________.

A

arterial blood gases

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45
Q

Breathing Treatment

A

• correct hypoxia
• treat pneumonia
• treat bronchospasm

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46
Q

If carbon monoxide poisoning is suspected, give _______

A

100% oxygen

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47
Q

For beta blocker-induced wheezing

A

Aminophylline, 6 mg/kg IV over 30 minutes

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48
Q

For patients with bronchospasm and bronchorrhea caused by organophosphate or other anticholinesterase poisoning, give

A

Atropine

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49
Q

The circulation should be assessed by continuous monitoring of the following:

A
  1. pulse rate
  2. blood pressure
  3. urinary output
  4. evaluation of peripheral perfusion
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50
Q

number of heartbeats per minute

A

Pulse rate

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51
Q

Normal pulse rate

A

60-100 bpm

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52
Q

measure of the force that the heart uses to pump blood around the body

A

Blood pressure

53
Q

Average urination per day

54
Q

An intravenous line should be placed and blood drawn for ____________ and other routine determinations.

A

serum glucose

55
Q

Normal BP

A

<120mmHg and <80mmHg

56
Q

Elevated BP

A

120-129mmHg and <80mmHg

57
Q

HTN stage 1

A

130-139mmHg or 80-89mmHg

58
Q

HTN stage 2

A

140mmHg or higher or 90mmHg or higher

59
Q

Hypertensive crisis BP

A

> 180 and/or >120

60
Q

What blood sugar level is required to give concentrated dextrose?

A

70mg/dL and below

61
Q

Normal blood sugar level for non-diabetic person

A

80-100 mg/dL

62
Q

Normal blood sugar level for diabetic person

A

100-120 mg/dL

63
Q

Adults are given of how many g of dextrose?

A

25 g (50 mL of 50% dextrose solution) IV

64
Q

Children are given of how many g of dextrose?

A

0.5 g/kg (2 mL/kg of 25% dextrose)

65
Q

Alcoholic or malnourished patients should also receive ________________ or in the IV infusion solution at this time to prevent Wernicke’s syndrome.

A

100 mg of thiamine IM

66
Q

Thiamine deficiency

A

Wernicke’s syndrome

67
Q

Opioid antagonist

A

Naloxone, Naltrexone

68
Q

The opioid antagonist naloxone may be given in a dose of

A

0.4–2 mg IV

69
Q

Antidote for propoxyphene overdose

70
Q

narcotic, pain reliver with cough suppressant property

A

Propoxyphene

71
Q

narcotic cough suppressant

72
Q

may be needed for patients with overdose involving propoxyphene, codeine, and some other opioids

A

Larger doses of naloxone

73
Q

Potent, short-acting synthetic opioid. Derivative of Fentanyl

A

Alfentanil

74
Q

Narcotic nasal spray, used for migraine

A

Butorphanol

75
Q

Powerful synthetic opioid analgesic, similar to morphine. (50 to 100x more potent than morphine)

76
Q

Semisynthetic hydrogenated ketone. Derivative of morphine

A

Hydromorphone

77
Q

Hydromorphone

78
Q

Levomethadyl acetate

79
Q

Levorphanol

A

Levo-Dromoran

80
Q

Used widely for therapy of moderate to severe pain

A

Meperidine

81
Q

Meperidine

82
Q

Pain relief and tx of drug addiction

83
Q

Methadone

84
Q

Nalbuphine

85
Q

Semisynthetic opioid analgesic derived from Thebaine (alkaloid). Has high risk of addiction

86
Q

main alkaloid of Opium, potent analgesic, and high risk of depedence

87
Q

Derived from Thebaine.
6 - 8x stronger than morphine

A

Oxymorphone

88
Q

Oxymorphone

89
Q

Treat moderate to severe pain in adults and children 12 yrs old and above.

A

Pentazocine

90
Q

Pentazocine

91
Q

Narcotic pain reliver with cough suppressant (weaker than codeine)

A

Propoxyphene

92
Q

Propoxyphene

A

Darvon Pulvules

93
Q

Very short-acting opioid

A

Remifentanil

94
Q

Remifentanil

95
Q

Sufentanil

96
Q

Analogue of codeine, very strong pain killer used by cancer px

97
Q

Tramadol

98
Q

Empirin Compound

A

Codeine/aspirin

99
Q

Percocet, Tylox

A

Oxycodone/acetaminophen

100
Q

Percodan

A

Oxycodone/aspirin

101
Q

Darvon

A

Propoxyphene/aspirin or acetaminophen

102
Q

Opioid Antitussives

A

● Codeine
● Dextromethorphan

103
Q

Dextromethorphan

A

Benylin DM, Delsym

104
Q

DOC for benzodiazepine overdose

A

Flumazenil

105
Q

Should not be used if there is a history of tricyclic antidepressant overdose or a seizure disorder

A

Flumazenil

106
Q

If a px has a history of TCA overdose or seizure disorder, the use of Flumazenil may induce ______

A

Convulsions

107
Q

a constant amount of drug is eliminated per unit time

A

Zero order kinetics

108
Q

This concentration would affect the rate of drug elimination.

A

First Order Kinetics

109
Q

It is a concentration-dependent process.

A

First Order Kinetics

110
Q

Drug Examples of zero-order kinetics

A

Ethanol, Omeprazole, Salicylates, Aspirin, Cisplatin (SACOE)

111
Q

Ratio of dose of the drug to the concentration of the drug in the body

A

Volume of Distribution

112
Q

Special aspect of toxocokinetics

A

Volume of Distribution

113
Q

necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasma

A

Volume of Distribution

114
Q

a theoretical volume wherein a drug is not readily accessible to measure

A

Volume of Distribution

115
Q

Caused by pulmonary aspiration of gastric contents.

116
Q

Low levels of oxygen in the blood

117
Q

Blood oxygen concentration of hypoxic patient

118
Q

Examples of hallucinogens

A

Phencyclidine (PCP) or Lysergic acid diethylamide (LSD)

119
Q

ABCD meaning

A

Airway, Breathing, Circulation, Diagnosis/Decontamination

120
Q

Compensatory reaction of a person with hypoxia

A

Tachycardia

121
Q

Low cardiac contractility

A

Hypotension

122
Q

Drugs that can cause ventricular tachycardia [VT - CADET]

A

Cocaine, amphetamine, digitalis, ephedrine, TCA (CADET)

123
Q

Drugs that can cause hypothermia

A

Beta blockers, Antipyretics

124
Q

Drugs that can cause hyperthermia

A

Antipsychotic drugs

125
Q

Adr of antipsychotic drugs

A

Neuroleptic malignant syndrome (NMS)

126
Q

Substances that can cause hypoxia

A

Cyanide, hydrogen sulfide, carbon monoxide

127
Q

Acute toxity of Isoniazid causes

128
Q

Chronic toxicity of Isoniazid causes

A

Peripheral neuropathy/neuritis

129
Q

Dose of aminophylline given for beta-blocker induced wheezing

A

6mg/kg IV over 30 mins

PHCT (5 decks)

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