Poisoning And STOPP-START

Question 1

Describe mechanism of action of MESNA.

Answer 1

Concentrates in the bladder where acrolein accumulates.

Forms conjugate with acrolein increasing its excretion - rendering it harmless also

-thiol groups - anti oxidant properties - cytoprotective also

Question 2

Give two reasons why gastric lavage is not used.

Answer 2

Because people with poisoning typically will present later after absorption

Aspiration risk

Question 3

How does sodium bicarbonate work as an antidote?

What types of drugs is it good against?

Answer 3

Causes an alkaline diuresis

Weak acids (salicylates, barbituates)

Question 4

When may haemodialysis be indicated?

Answer 4

Low Vd in seriously ill patient.

Question 5

How does fomepizole work and what can it be used for?

What else can be used for these purposes?

Answer 5

Inhibits alcohol dehydrogenase which are involved in converting ethylene glycol and methanol to toxic metabolites.

Ethanol due to higher affinity for alcohol dehydrogenase.

Question 6

Give four things to be considered during a drug review.

Answer 6

DDI
Contraindications
Adverse effects
Concordance

Question 7

What is concordance?

Answer 7

Understanding of why they are being prescribed a medication and mutualistic relationship between clinician and patient themselves.

Question 8

What can be given for cyanide poisoning?

MOA?

Answer 8

Sodium nitrate and sodium thiosulfate.

Cheating agents.