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Therapeutics > Poisoning > Flashcards

Poisoning Flashcards

1
Q

Poison

A

Substance that causes disturbances to an organism when a sufficient amount is absorbed.

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2
Q

Toxin

A

Poison produced biologically

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3
Q

Venom

A

toxin injected by bite or sting

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4
Q

Toxicity

A

inherent capacity of a chemical, including drugs, to cause injury.

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5
Q

Nonselective actions

A

Local irritation
Site of exposure
Injury=denaturing macromolecules

Strong acids and alkali

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6
Q

Selective actions

A

Interferes with specific biochemical pathways

Chemical has to be absorbed and distributed to a specific pathway

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7
Q

Describe Organophosphate poisoning

A

Immediate action
Acetylcholinesterase inhibition can cause immediate symptoms

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8
Q

Paracetomol overdose

A

Selective action
depletion of glutathione needed for conjugating the toxic metabolite NAPQI

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9
Q

Rattex poisoning

A

Selective action

(rodenticide/”superwarfarins”) contains warfarin and interferes with the Vitamin K pathway

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10
Q

TCA overdose

A

coma

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11
Q

Describe and provide examples of TCAs.

A

Block the re-uptake of serotonin and noradrenaline from the synapse.

Amitryptiline, Imipramine and Clomipramine

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12
Q

Sign of Opiate overdose

A

Respiratory Depression
Hypoventilation.

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13
Q

Antidote for opiate overdose.

A

Naloxone- Attaches to opioid receptor and blocks/displaces it
Pharmocological antagonist

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14
Q

Criteria for emesis.

A

time since ingestion <1hr
children
charcoal not indicated.

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15
Q

Methods for emesis.

A

stimulation of pharynx
Ipecacuanha: Rarely used (lack of evidence)- considered in alert and conscious, early presentation.
Multiple drugs.

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16
Q

Contraindications to emesis.

A

Impaired level of consciousness
Corrosive substances
Hydrocarbons
Risk of seizures

17
Q

Criteria for gastric lavage.

A

time since ingestion < 1-2 h
Large amount of toxic solid substance
Need to remove whole tablets.
Especially considered in patients who have ingested a toxin for which there isn’t an effective treatment once absorbed.

18
Q

Explain the process of Gastric lavage.

A

Use LARGE-bore catheter (32-40)
200 – 300ml tap water in adults
10ml/kg body temperature saline in kids

Position head down and left lateral position. (Airway protection)
small amounts of water–> this minimise risk of gastric contents entering duodenum.

19
Q

Contraindications for gastric lavage.

A

Corrosive substances and hydrocarbons
Risk of GI haemorrhage
Unprotected airway

20
Q

Indications for Activated Charcoal.

A

Salicylates, paracetamol, barbiturates, digoxin, TCAs
Time since ingestion < 2 h
Longer if delayed gastric emptying

21
Q

When would you consider a MDAC?

A

Severely poisoned patients
Sustained-release tablets
Enterohepatic cycling (estrogen, TCAs)
Drugs secreted into bile or intestine (digoxin)

22
Q

Contraindications for activated charcoal.

A

Strong acids or alkalis
Iron salts
Lithium
Petroleum products
Cyanide
Endoscopy due
Antidote by mouth

23
Q

Adverse effects of activated charcoal.

A

Vomiting
Constipation/diarrhea
Intestinal obstruction

24
Q

Describe whole bowel irrigation.

A

PEG electrolyte solution orally (large volume)
Stimulates peristalsis
Useful in lethal doses iron, Body Packers

25
Q

Contraindications for whole bowel irrigation.

A

Bowel obstruction/perforation
Ileus
Compromised airway

26
Q

Indication for urinary alkalinisation

A

Salicylate overdose

27
Q

What is a sign of salicylate overdose?

A

Hypoglycaemia

28
Q

What is important to monitor in urinary alkalinisation?

29
Q

Uses of Haemodialysis

A

salicylates, lithium, methanol

30
Q

Describe charcoal haemoperfusion

A

Removal of toxic substances by adhesion to activated charcoal
Extracorporeal – large volumes of blood passed over absorbent substance

31
Q

What is charcoal haemoperfusion used for?

A

barbiturates(sedatives, anxiolytic and hypnotic), carbamazepine(mood stabilizer) and theophylline (asthma, bronchitis, emphysema, and other lung diseases)

32
Q

Management of hypotension due to poisoning.

A

fluids, vasopressors, inotropes

33
Q

Management of hypertension due to poison.

A

benzodiazepines, sodium nitroprusside

34
Q

Management of Arrhythmias due to poison.

A

Bradycardia, eg β-blockers: use atropine, pacing

Tachycardia, eg cocaine, stimulants: use benzodiazepines

Stable VT: eg TCAs: use sodium bicarbonate, lidocaine

35
Q

Antidote of digoxin.

A

digoxin immune fab

36
Q

Antidote for paracetamol.

A

acetylcysteine

37
Q

Antidote for benzodiazepine.

A

Flumazenil

38
Q

Antidote for Iron.

A

Deferoxamine

39
Q

Antidote for heparin.

A

Protamine sulfate

Therapeutics (12 decks)

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