Medical toxo (analgesic and antipyretic)DONE

Question 1

ANALGESIC AND ANTIPYRETIC Drugs

Answer 1

Acetaminophen (paracetamol)
salicylates (Aspirin)

Question 2

the remaining amount of acetamenphin is converted by ……….. to ………..

Answer 2

by cytochrome P450 to N-acetyl-p-benzoquinone imine (NAPQI).

Question 3

NAPQI is converted by ………… to non toxic compound

Answer 3

glutathione

Question 4

mechanism of toxicity of acetamenophen

Answer 4

active metabolite NAPQI lead to oxidant cell injury, hepatic failure and death.

Question 5

the four clinical phases of parcetamol overdose

Answer 5

Phase 1 (first 24 hours): anorexia, nausea, vomiting, malaise and pallor.
Phase 2 (24-48):
* initial damage to the hepatocytes.
* right upper quadrant pain
* increases in liver transaminases serum bilirubin , prothrombin time.
Phase 3 (72-96):
* the peak of the hepatotoxic effects.
* metabolic acidosis,
* acute renal failure,
* acute pancreatitis,
* fulminant hepatic failure evidenced by jaundice, extensive coagulopathies, hypoglycemia, and hepatic encephalopathy.
Phase 4 ( 4-14 days): resolution

Question 6

phase 1 of paracetamol toxicity

Answer 6

Phase 1 (first 24 hours): anorexia, nausea, vomiting, malaise and pallor.

Question 7

phase 2 of paracetamol toxicity

Answer 7

Phase 2 (24-48):
* initial damage to the hepatocytes.
* right upper quadrant pain
* increases in liver transaminases serum bilirubin , prothrombin time.

Question 8

phase 3 of paracetamol toxicity

Answer 8

Phase 3 (72-96):
* the peak of the hepatotoxic effects.
* metabolic acidosis,
* acute renal failure,
* acute pancreatitis,
* fulminant hepatic failure evidenced by jaundice, extensive coagulopathies, hypoglycemia, and hepatic encephalopathy.

Question 9

right upper quadrant pain related to

Answer 9

phase 2 of paracetamol toxicity

Question 10

causes acute pancreatitis

Answer 10

paracetamol phase 3

Question 11

Investigations of paracetamol

Answer 11

1. Routine investigation.
   Liver function tests, Renal function tests, ABG and Blood glucose level.
2. Serum Paracetamol levels

Question 12

causes hepatic encephalopathy

Answer 12

paracetamol phase 3

Question 13

treatment of parcetamol toxicity

Answer 13

• ABC
• No GL, AC, Ipecac
• specific antidote: N-acetyl cysteine
• Hemodialysis may be indicated if renal failure, refractory acidosis, or fluid and electrolyte changes occur.
• Symptomatic Treatment of hypoglycemia, hypotension, metabolic acidosis and hepatic encephalopathy.

Question 14

ctivated charcoal is not recommended to be administered in Paracetamol toxicity due to

Answer 14

charcoal may adsorb NAC.

Question 14

Ipecac is not recommended in paracetamol tox

Answer 14

it may interfere with oral NAC.

Question 15

Gastric lavage not recommended in paracetamol tox

Answer 15

it is rapidly absorbed from the GIT.

Question 16

froms of NAC

Answer 16

Oral (Mucomyst)
Intravenous (Parvolex)

Question 17

Two situations in which IV NAC is undoubtedly preferable to oral:

Answer 17

1. Fulminant hepatic failure (FHF)
2. Inability to tolerate oral NAC.

Question 18

accidental intoxication of ………… may occur during treatment because pyrexia

Answer 18

salicylates (aspirin)

Question 19

NAC should be given after paracetamol ingestion.within

Answer 19

8 hours

Question 20

tinnitus related to

Answer 20

salicylates aspirin

Question 21

the only manifestations of salicylates that occur within the therapeutic range

Answer 21

tinnitus

Question 22

aspirin on CNS

Answer 22

Alterations in mental status, cerebral edema and seizures
Tinnitus

Question 23

aspirin on respiratory

Answer 23

acute lung injury
Non cardiogenic pulmonary edema

Question 24

causes acute lung injury

Answer 24

salicylates

Question 25

aspirin on CVS

Answer 25

sinus tachycardia
hypotension due to hypovolemia

Question 26

aspirin on acid base balance

Answer 26

respiratory alkalosis in adults due to hyperventilation
metabolic acidosis in children due to accumulation of lactic acids and ketoacids

Question 27

aspirin on urinary

Answer 27

• Direct nephrotoxicity&raquo_space; renal tubular necrosis&raquo_space; renal failure.
• Indirect effect due to:
  o Decreased renal flow caused by dehydration. .
  o Rhabdomyolysis.

Question 28

causes reyes syndrome in children

Answer 28

aspirin

Question 29

aspirin on blood

Answer 29

Bleeding tendencies is common in chronic intoxication due to inhibition of prothrombin synthesis & platelet aggregation.

Question 30

hyperthermia in aspirin due to

Answer 30

Uncoupling of oxidative phosphorylation with increase in cellular metabolic rate.
-Dehydration.

Question 31

bad prognostic sign of aspirin

Answer 31

hyperthermia

Question 31

causes angioneurotic edema.

Answer 31

aspirin

Question 32

Fluid and electrolyte disturbances due to aspirin

Answer 32

Dehydration due to:
-Hyperthermia (sweating).
-Vomiting.
-Hyperpnea.

Question 33

investigations of aspirin

Answer 33

1)Routine investigations.
-Renal function tests, Electrolytes, Blood glucose level and ABG
2) Coagulation profiles:
-Prothrombin time (PT), prothrombin concentration, PTT (partial thromboplastin time), bleeding time and INR (International Normalized ratio).
3) Serum salicylate levels (mg/dl):
4) Imaging studies.
-Abdominal X-Ray: radiopaque concretions of enteric coated aspirin.
-Chest X-Ray: pulmonary edema.
-Brain CT/MRI: cerebral edema.

Question 34

treatment of aspirin toxicity

Answer 34

ABC
the 4 GIT
no specific antidotes
Forced alkaline diuresis: Effective in moderate toxicity (>40mg/dL in acute toxicity).
Hemodialysis in serum salicylates levels >80

Question 35

hemodialysis in aspirin is indicated in

Answer 35

Serum salicylate levels > 80 mg/dL after acute overdose).
Seizures, coma & cerebral edema.
Pulmonary edema.
Refractory acidosis.
Renal failure.
Severe electrolytes disturbances