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pharmacology > Poisoning > Flashcards

Poisoning Flashcards

1
Q

what is the definition o these 3 words ?
1. Poison
2. Toxin
3. Venom

A
  1. Poison: Substance that causes disturbances to an organism when a sufficient amount is absorbed
  2. Toxin: produced biologically
  3. Venom: toxin injected by bite or sting
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2
Q

poisoning

A

any illness that is caused by exposure to toxic substance

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3
Q

Toxicity

A

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

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4
Q

routes for poisoning

A
  1. Skin contact
    2.Inhalation
    3.Ingestion
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5
Q

what are the common target tissues ? and what type of substabce affect that organ ?

A
  1. Lungs (vapors or toxic gases)
  2. Liver (ingested drugs)
  3. Brain (bcoz of high blood flow )
  4. Kidneys (bcoz of high blood flow )
    5.Heart (ionic gradient disturbances)
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6
Q

What is Toxicology?

A

The characterization of potentially adverse effects of foreign chemicals, including dose-response relationships, aimed at public health protection.

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7
Q

What are nonselective toxic actions of chemicals?

A
  1. Local irritation/ caustic effects( Local irritation or caustic effects at the site of exposure/application, causing injury by denaturing macromolecules.)
  2. Strong alkali or acids

these do not select ,they damage anything they are in contact with .e.g

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8
Q

What are selective toxic actions of chemicals?

A
  1. Interferes with specific biochemical pathways
  2. Chemical has to be absorbed and distributed
    to a specific pathway
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9
Q

Give examples of selective toxic actions of a chemical and how are they selective

A
  1. Rattex (rodenticide/”superwarfarins”) contains
    warfarin and interferes with the Vitamin K pathway
  2. Paracetamol – depletion of glutathione needed for
    conjugating the toxic metabolite NAPQI
    - they have to e bdistributed toa specofic pathway.
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10
Q

Rattex

A

rodenticide/”superwarfarins

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11
Q

what are the 2 toxic actions that leads to symptoms quickly following the exposure ?

A
  1. Organophosphate poisoning
    - Acetylcholinesterase inhibition can cause immediate
    symptoms
  2. Severe iron poisoning
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12
Q

What are the phases of severe iron poisoning?

A

-Early phase (0.5-2hrs)
-Quiescent phase (up to 12 hours)
-life-threatening phase

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13
Q

What are the key steps in the management of poisoning?

A

A-Airway
B-Breathing and oxygenation
C-Circulation and cardiac monitoring
D-Diagnosis and Decontamination
E-Enhancing drug clearance
F-Frequent re-evaluation and Further
symptomatic care
G-Give antidote
H-Help

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14
Q

What are important factors to consider during diagnosis of poisoning?

A

1.History from the patient and relatives about the toxic substance, time of ingestion, amount ingested,
2. On examination there might be clinic syndromes ( dilated or constricted pupils together with other signs )
3.Special investigations :arterial blood gas, electrolytes, liver and kidney function tests, FBC, urinalysis, ECG, and plasma poison concentration.

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15
Q

special investigations for suspected poisoning /poisoning

A

1.arterial blood gas
2.Electrolytes
3.Liver and kidney function tests
4.FBC
5.Urinalysis
6.ECG
7.Plasma poison concentration e.g paracetamol

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16
Q

Describe the decontamination methods for poisoning.

A

1.Skin decontamination
2.eye decontamination
3.airway decontamination
4.gastric decontamination

remove the pt contaminanted cloths ( put in the biohazard babgs ) and make sure you have your own PPE

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17
Q

what way can gastric decontamination be done ?

A

1.Gastric emesis/lavage
2. Activated charcoal
3.Whole bowel irrigation

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18
Q

When is emesis indicated ?

A

emesis= vomiting /throwing up
1. Time since ingestion < 1 hour
2.Children
3.If charcoal not indicated

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19
Q

what are the contraindications of emesis?

A

1.Impaired level of consciousness
2.Corrosive substances
3.Hydrocarbons
4.Risk of seizures

20
Q

name ans explain the the 2 methods of emesis

A

1.Stimulation of pharynx=Mechanically stimulating the back of the throat to induce vomiting
2.Ipecacuanha=Administering ipecacuanha syrup, which is a plant extract that induces vomiting through its action on the stomach lining and the brain’s vomiting center.

21
Q

what is gastric lavage ?

A

Gastric lavage, also commonly called stomach pumping, is an invasive procedure involving cleaning and removing stomach contents. A large tube is inserted through the mouth or nose into the stomach. Stomach contents are subsequently aspirated, and the stomach is later flushed with copious amounts of water or normal saline. During this procedure, the individual may be awake or under general anesthesia.

22
Q

What is the role of gastric lavage in poisoning?

A

1.Useful if the time since ingestion is < 1-2 hours and a large amount of toxic solid substance has been ingested (2)

a substance that takes long to be absorbed

23
Q

How is gastric lavage done done ?

A

A large tube is inserted through the mouth or nose into the stomach. Stomach contents are subsequently aspirated, and the stomach is later flushed with copious amounts of water or normal saline.
- Use LARGE-bore catheter (32-40)
◼ 200 – 300ml tap water in adults
◼ 10ml/kg body temperature saline in kids
- protect the airway (ETtube and position sightly on their side )
monitor the decontamination

24
Q

what are the contractraindication of gastric lavage ?

A
  1. Corrosive substances and hydrocarbons
    2.Risk of GI haemorrhage
    3.Unprotected airway
25
Q

: When is activated charcoal used,considered in and what are its contraindications?

A

when is it used ?
1.Salicylates, paracetamol, barbiturates,
digoxin, TCAs
2.Time since ingestion < 2 h
3.Longer if delayed gastric emptying
Consider MDAC in :
1.Severely poisoned patients
2.Sustained-release tablets
3.Enterohepatic cycling (estrogen, TCAs)
4.Drugs secreted into bile or intestine (digoxin)

contraindications:
1.Strong acids or alkalis
2.Iron salts
3.Lithium
3.Petroleum products
4.Cyanide
5.Endoscopy due
6.Antidote by mouth

26
Q

what is the dose of activated charcoal and how to monitor it ?

A

Dose :
- Oral/NG tube
-Adults 50-100g in slurry with 500ml water
-Kids 10-50g in 100-300ml water

Monitoring :
- in stool 6 hours later
-hyydration

Activated charcoal is negatively charged and binds positively charged molecules such as toxins , trapping them and preventing them from being absorbed -> charcoal is not absorbed by our body -> excreted in stool-> hence monitoring the stool

27
Q

what is whole bowel irrigation ?

A

nvolves orally administering a large volume of polyethylene glycol (PEG) electrolyte solution(in large volume ) to stimulate peristalsis and flush out the entire gastrointestinal tract.

28
Q

When is whole bowel irrigation indicated?

A

Useful in lethal doses of iron and for body packers
body packeers= Individuals who swallow or insert packets of drugs into body cavities to smuggle them across borders.

29
Q

what are the contraimdications for whole bowel irrigation ?

A

-Bowel obstruction/perforation
-Ileus
-Compromised airway

30
Q

What is urinary alkalinisation used for and how is it administered?

A

Used in salicylate overdose to increase elimination by maintaining urine pH > 7.5. Administered via IV sodium bicarbonate, requires high care facility and potassium monitoring.

31
Q

What is haemodialysis and when is it used in poisoning?

A

defination : The diffusion of solutes across a semi-permeable membrane,
-in Renal impairment or clinical deterioration
despite supportive treatment
used for:
- salicylates
- lithium
- methanol

32
Q

Describe charcoal haemoperfusion.

A

Removal of toxic substances by adhesion to activated charcoal
Effective for : barbiturates, carbamazepine, and theophylline.

33
Q

What are some symptomatic care measures for poisoned patients?

A

Monitor patient and treat:
-Seizures eg cocaine
-Hypoventilation eg opiates
-Hypoglycaemia eg salicylates
Hypothermia/hyperthermia
-CVS compromise
-Liver/kidney failure

34
Q

How is cardiovascular compromise managed in poisoning?

A

1.Hypotension
- Hypovolaemia, vasodilation
- Use fluids, vasopressors, inotropes
2. Hypertension
- Often short duration
-Use benzodiazepines, sodium nitroprusside
3. Arrhythmias
-Bradycardia, eg β-blockers: use atropine, pacing
-Tachycardia, eg cocaine, stimulants: use
benzodiazepines
- Stable VT: eg TCAs: use sodium bicarbonate,
lidocaine

35
Q

Antidote for digoxin ?

A

digoxin immune fab

36
Q

Antidose for paracetamol ?

A

acetylcysteine

37
Q

Antidote for opiods ?

A

Naloxone

38
Q

Antidote for Benzodiazepines ?

A

Flumazenil

39
Q

Antidore for carbon monoxide?

A

oxygen (+/- hyperbaric chamber)

40
Q

Antidore for Iron?

A

Deferoxamine

41
Q

Antidore for anticholinergic agents?

A

physostigmine

42
Q

Antidore for organophasphates?

A

Atropine
pralidoxime

43
Q

Antidore for methanol ethylene gycol

A

fomepizole

44
Q

Antidore for heparin ?

A

protamine sulfate

45
Q

Antidore for lead?

A

Dimercaptosuccinic acid

pharmacology (12 decks)

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