Prevention and Treatment of Poisoning

Question 1

What is a poison?

Answer 1

Any chemical capable of producing a deleterious response in a biological system, injuring function or producing death

Question 2

What constitutes supportive care?

Answer 2

airway patency, O2 status
cardiac monitoring
IV fluids to tx hypotension
Tx acid-base and electrolytes
Use antidotes/antagonists to stabilize patient

Question 3

What is the AMPS acronym for poisoning?

Answer 3

allergies, medications, past mediation history, situation at present

Question 4

How are geriatric patients different from younger adults with toxicant distribution?

Answer 4

smaller body mass
increased adipose tissue = higher Vd of lipophilic
Decreased Total Body Water = lower Vd of hydrophilic
Reduced liver, kidney function
Reduced Cardiac Output

Question 5

How are kids different than adults with toxicant distribution?

Answer 5

High total body water = high Vd for hydrophilic
Decreased adipose tissue = lower Vd for lipophilic drugs
Poor renal elimination
Slow liver metabolism of drug
Reduced plasma protein binding

Question 6

How can you prevent absorption of a toxicant?

Answer 6

1. decontaminate hair, nails, skin
2. remove from source of toxicant
3. Emesis with Serum of Ipecac (used infrequently)
4. Gastric lavage - at best 2/3 removed
5. Activated charcoal

Question 7

When do you use Syrup of Ipecac?

Answer 7

use only if over 2 hours from ER, patient is over 6 months. Ipecac is cardiotoxic, neurotoxin.

Question 8

What is activated charcoal?

Answer 8

inert, non-toxic with large surface area. Give 10x estimated weight of toxicant. CI with caustics, heavy metals, alcohols, cardiac drugs, aspirin, lithium. Use serial dosing.

Question 9

How can you enhance elimination of a toxicant?

Answer 9

whole bowel irrigation - polyethyene glycol
Interruption of enterohepatic circulation - charcoal
Forced diuresis - trap ion in tubular lumen
Dialysis - use for chemicals with small Vd

Question 10

What is the antidote for acetaminophen?

Answer 10

N-acetylcysteine, replenishes glutathione

Question 11

What is the antidote for AChE inhibitors/organophosphates?

Answer 11

Atropine, followed by pralidoxime

Question 12

What is the antidote for amphetmines?

Answer 12

Ammonium Chloride, NH4Cl - acidifies urine

Question 13

What is the antidote for antimuscarinic, anticholinergic agents

Answer 13

Physostigmine, control hyperthermia

Question 14

What is the antidote for benzos?

Answer 14

Flumazenil

Question 15

What is the antidote for Beta Blockers

Answer 15

Glucagon

Question 16

What is the antidote for Carbon monoxide?

Answer 16

100% oxygen, hyperbaric oxygen

Question 17

What is the antidote for copper, arsenic, and gold?

Answer 17

Penicillamine

Question 18

What is the antidote for cyanide

Answer 18

Nitrite and thiosulfate, hydroxocobalamin

Question 19

What is the antidote for Digitalis:

Answer 19

Anti-dig Fab fragments

Question 20

What is the antidote for heparin?

Answer 20

Protamine sulfate

Question 21

What is the antidote for lead poisoning?

Answer 21

EDTA, dimercaprol, succimer, penicillamine

Question 22

What is the antidote for iron poisoning?

Answer 22

Deferoxamine, deferasirox

Question 23

What is the antidote for mercury?

Answer 23

Dimercaprol, succimer

Question 24

What is the antidote for methanol or ethylene glycol (antifreeze)?

Answer 24

Fomepizole > ethanol, dialysis

Question 25

What is the antidote for methemoglobin?

Answer 25

Methylene Blue, vitamin C

Question 26

What is the antidote for opioids?

Answer 26

Naloxone

Question 27

What is the antidote for Salicylates, TCAs

Answer 27

Sodium bicarb

Question 28

What is the antidote for tPA, streptokinase, and urokinase?

Answer 28

Aminocaproic acid

Question 29

What is the antidote for warfarin?

Answer 29

Vitamin K, plasma if active bleeding