Pharm 41 - Poisons & Antidotes

Question 1

Administration of CroFab

Answer 1

i. Infuse very slow and increase as tolerated
ii. The sooner the antivenom is used, the better the outcome/less product required
Vitals, I & O, labs, platelet count, wound assessment every hour and baseline

Question 2

Preparation of CroFab

Answer 2

An antivenom that requires extensive mixing of vials and prep before administration

Question 3

Causes of anticholinergic toxidromes (5)

Answer 3

TCAs, Antihistamines, Antipsychotics, cyclobenzaprine, scopolamine

Question 4

Presentation of anticholinergic toxidrome: early and late sx

Answer 4

1) “Can’t see, can’t pee, can’t shit, can’t spit”
2) Dry mouth, blurry vision, increased HR/irregular pulse, urinary retention, constipation
3) Later sx: ataxia, agitation, delirium, hallucination, coma

Question 5

Anticholinergic toxidrome antidote

Answer 5

1) Reversible acetylcholinesterase inhibitor: physostigmine slow IV push
2) Pralidoxime if skeletal muscle paralysis

Question 6

Cholingeric toxidrome causes (3)

Answer 6

1) Organophosphate poisoning
2) Edrophonium
3) Physostigmine

Question 7

Cholingeric toxidrome presentation

Answer 7

SLUDGE: salivation, lacrimation, urination, diaphoresis, GI upset, emesis

Question 8

Cholingeric toxidrome antidote

Answer 8

Atropine

Question 9

What’s Flumazenil used for?

Answer 9

i. Benzo reversal agent that is reserved only in cases where you know that reversing the benzo will not induce a seizure
ii. Most appropriate when the benzos have been administered in the hospital

Question 10

What’s NAPQI

Answer 10

Toxic metabolite of APAP OD

i. CYP450 converts the APAP into toxic metabolite NAPQI
	i. Causes hepatic necrosis

Question 11

Antidote to APAP OD

Answer 11

• recent ingestion: activates charcoal

- NAC

Question 12

What’s NAC? How is it used?

Answer 12

ii. NAC: N-acetylcysteine that is used IV to treat based on the levels of serum APAP
i. Serum APAP levels are clinically significant starting at four hours post ingestion
ii. NAC is used based on the levels of APAP and the nomogram graph

Question 13

1) Rapidly progress to coma, shock, respiratory failure, death
2) Will lose consciousness in a few breathes if inhaled
3) Bitter almond odor
4) MCC of poisoning due to a fire/will be a burn patient

Answer 13

Presentation of cyanide poisoning

Question 14

1) Activated charcoal for ingestion
2) Water for skin/eyes
3) Hydroxocobalamin (Cyanokit): converts the cyanide into cyanocobalamin to renally excrete
a) Turns blood and urine red
4) Amyl nitrite inhalation kit
5) Cyanide antidote kit: sodium nitrite IV and then sodium thiosulfate IV

Answer 14

Cyanide antidote

Question 15

Treatment of cyanide poisoning

Answer 15

Hemodialysis to correct metabolic acidosis & remove cyanide

Question 16

Carbon monoxide toxidrome presentation

Answer 16

Viral like without a fever

Forms carboxyhemoglobin

Question 17

Carbon monoxide toxidrome antidote

Answer 17

Hyperbaric oxygen/100% oxygen

Question 18

Management of warfarin overdose

i. Emergency:

Answer 18

i. Kcentra: urgent and immediate reversal of warfarin that requires immediate administration of vitamin K following Kcentra to remake the clotting factors

Question 19

Management of warfarin overdose

i. INR< 10:

Answer 19

No concern for bleeding - hold warfarin and wait

Question 20

Management of warfarin overdose

i. INR > 10:

Answer 20

or need reversal quickly:

Hold warfarin, PO vitamin K

Question 21

i. Renal injury, hematopoietic effects, GI effects, neuro effects
ii. Anemia, lead lines on teeth/x-ray, reduced renal function

Answer 21

Lead toxidrome presentation

Question 22

Lead toxidrome antidote

Answer 22

• chelators
  i. Calcium EDTA
  ii. Dimercaprol (BAL)
  iii. Succimer
  iv. D-penicillamine

Question 23

When do you treat lead toxidrome

Answer 23

Only given parenterally when have sx of encephalopathy, very high blood lead levels, or cannot tolerate oral meds

Question 24

i. GI upset, hypoperfusion, metabolic acidosis, systemic toxicity, bowel obstruction
Destroys the GI mucosa

Answer 24

Presentation of Iron toxidrome

Question 25

Antidote of Iron toxidrome

Answer 25

Deferoxamine: iron chelator

Question 26

Can you use activated charcoal to treat Iron toxidrome?

What can you try ?

Answer 26

NOPE

Gastric lavage may help adults directly after ingestion