Psych/ Neuro I Flashcards
_________ weight/volume not considered intoxicated
< 0.05%
Salicylate OD tx: Correction of acid-base disturbances
by ?
IV crystalloid solution
Sodium bicarbonate
Hemodialysis
Acetaminophen notes ?
Antipyretic and analgesic -> works at CNS level not peripheral
Since at CNS it has very limited anti-inflammatory effects
When is a Urine toxicology (UTOX) used ?
Pt with altered mental status
Determining capacity to make decisions
Before giving meds to certain patients
Legal implications
Psych evaluations
** anxious depressed suicide, want to make sure they dont have a drug addiction problem and make sure there is not a drug causing the psychosis and we need to know what is in there system before labs are run **
Nomogram for prediction ?
of acetaminophen hepatotoxicity following acute overdosage.
**assume a one time large scale ingestion of acetaminophen
helps you decide if you need to treat them with NAC or not
5 hours at 30 is not toxic
grey area inbetween the two line : in grey grey area and above we treat it
rule of 150 with acetaminophen**
Phenytoin caution ?
renal failure patients
When is ETOH used ?
To determine the blood alcohol content
Lithium: Therapeutic range ______ mmol/L
0.6 - 1.2
Lithium OD tx: Gastric Lavage within _ hr
1
THC intoxication sxs: Acute ?
relaxation, mild euphoria, resembles mild to moderate ETOH intox
Acetaminophen (APAP) molecule ?
N-Acetyl-Para-AminoPhenol (APAP)
Valproic Acid is used as a ?
psych med (i.e. Bipolar),
seizure disorder, and
migraine med
THC intoxication sxs: Chronic ?
associated with “amotivational syndrome” and maturational dysfunction
Harrison’s Ch. 394
Cocaine UTOX detects what ?
Benzoylecgonine (Benzo-lek-GO-neen)
Tylenol metabolism is mostly by the ______ ( mi=ostly effects the liver)
liver
Acetaminophen OD may be ______ in early ingestion or have _____ ?
asxs.
A/N. RUQ pain
Opiates UTOX how long does it last ?
2 hrs – 3 days
Phenytoin trade ?
Dilantin
Lithium: May cause ?
kidney disease (monitor BUN and creatinine)
hypothyroidism (monitor TSH)
Poison help # ?
1-800-222-1222
______ is considered intoxicated in most states
> 0.10%
Lithium is a _____________ that does not bind to charcoal; therefore, activated charcoal has NO role
monovalent cation
What is Ethanol (ETOH) ?
Serum test showing the level of alcohol in the blood
Opiates Intoxication sxs. ?
Somnolence, dysarthria, euphoria
Respiratory depression
OD and stop breathing
Salicylate OD: Toxicity occurs at levels ? And serum levels of what are significant ?
> 150 mg/kg (that is ingested)
Serum levels >30 mg/dL are significant
Caveat: This scale assumes a ___________ ingestion. It does not account for ________ overdose or comorbidities such as liver failure
SINGLE LARGE
chronic
Lithium OD tx: Fluids for what ?
to enhance elimination
The total phenytoin reference range varies by age: Toxic phenytoin levels are defined as greater than ?
30 µg/mL
Opiates OD tx ?
OD: give them narcan they wake up and they are angry have N and they want to fight
does not have the sedating properties that other opioids have ( so you can give alot of it ) it is still an opioid
has a higher affinity and is a bigger molecule than the opioids to the Mu receptors
Acetaminophen: Rule of 150: Give NAC at 150 mg/kg __ ?
IV
140 mg/kg PO)
Valproic Acid has a __________ TW ?
very narrow
TDM: Peak level = ?
highest concentration
early on ( 30 min - 1 hours after dose is given)
Valproic Acid The toxic level is greater than _____ ?
150 µg/mL.
Salicylate OD tx ?
Charcoal early
Whole bowel irrigation
Correction of acid-base disturbances
Amphetamines UTOX lasts how long ?
3 hrs - 2 days
ETOH level of >100 mg/dL sxs. ?
CNS depression
Acetaminophen: Rule of 150: ____ mg/kg is toxic ?
150
Lithium OD tx: Why NO charcoal ?
Lithium is a monovalent cation that does not bind to charcoal; therefore, activated charcoal has NO role
Salicylate OD notes ?
150 sig. in tylenol serum
150 with ASA is only in ingested dosage
can give charcoal early and full bowel irrigation
if it has been hours or days - not much you can do , supportive tx . and hope for the best - monitor glucosee and acid base balance
TDM: Trough level = ?
lowest concentration
right before next dosing ( so draw these levels right before next dose)
It is formed in the liver by the metabolism of cocaine ?
Benzoylecgonine (Benzo-lek-GO-neen)
Lithium OD tx: Gastric Lavage ?
cause charcoal does not work
you need to wash stomach out and hopefully get pills with it and only within 1 hours so the pills are not broken down
________ in Ohio is intoxicated
> 0.08%
THC notes ?
Significant decrements in pulmonary vital capacity found in regular daily use
May precipitate angina – strongly caution those with cardiovascular disease to NOT use this substance
Impaired fetal growth if used during pregnancy
Rapidly develop tolerance and may smoke it more frequently
** 2 weeks sometimes in chronic, fat and hair in high levels it leakes out, the more they smoke the more it leaks into tissues and longer it stays in system **
Salicylate OD: early OD sxs ?
N V
The total phenytoin reference range varies by age: Children and adults ?
10-20 µg/mL
Salicylate OD: __________ is prominent in children
Hypoglycemia
Cocaine intoxication sxs. ?
Increased temp., enhanced mood, increased HR and BP
Hyperprolactinemia, galactorrhea, amenorrhea, infertility, loss of libido (chronic)
** they are hot increased HR and BP **
How is ETOH tested ?
Peripheral blood in a live patient
Drawn from aorta of an expired patient
The total phenytoin reference range varies by age: The reference range of free phenytoin is ?
1-2.5 µg/mL.
Above Therapeutic Range is ?
toxic
Lithium: Serum draw ____after last dose
12 hrs
** monitor levels in the serum!**
Cocaine UTOX lasts how long ?
1hr – 3 days
OTC meds that contain APAP
OTC medication : ASA and tylenol ( acetomenophel and sailcylates)
The total phenytoin reference range varies by age: Neonates ?
8-15 µg/mL
Lithium trade ?
Lithobid, Eskalith
Valproic Acid OD tx ?
ABC’s
Activated charcoal if within 1 hour
Whole bowl irrigation
Acetaminophen: Rule of 150: max dose Peds ?
75 mg/kg/day
250 mg/kg is toxic
What is a Urine toxicology (UTOX) ?
Urine test to determine presence of certain substances
Done from urine specimen
Ethanol (ETOH) is used to dx ?
intoxication
TDM determines _______ dose and prevents ________.
effective
toxicity
**cause we want to make sure they are woking and that they are in therapeutic range **
Phenytoin ( Dilantin) OD tx ?
ABC’s
Multiple dose activated charcoal every 2-6 hours until passage of charcoal stool, loss of bowel sounds, or improved clinical condition is observed.
**may have to give it more thn once **
Nonogram: The ________ defines serum acetaminophen concentrations known to be associated with _________ .
upper line
hepatotoxicity
Lithium OD tx: ABC’s ?
airway breathing circulation
Lithium has many ?
drug-drug and supplement interactions so use extreme caution
OTC cold meds and weight loss meds may contain ___________ ?
amphetamines
The _________ defines serum levels __% below those expected to cause hepatotoxicity. To give a margin for error, the lower line should be used as a ?
lower line
25%
guide to treatment
Acetaminophen: Rule of 150: max dose adults ?
4 g/day
ETOH level of >80 mg/dL sxs. ?
Impaired vision
Flushing
Slowed reflexes
Amphetamines Notes ?
meth causes “dry mouth” (xerostomia), and without enough saliva to neutralize the mouth’s harsh acids, those acids eat away at the tooth and gums, causing weak spots that are susceptible to cavities.
sedafed , people make meth out of it
side effects: anticholinergic effects
dry as a bone etc…
opioid use gets this tooo, need saliva for protection of teeth and gums , see this alot in heroin as well
Lithium OD tx ?
ABC’s
Gastric Lavage
Fluids
NEVER activated charcoal
Marijuana (THC) UTOX lasts how long ?
1 hr – 3 days
Even passive inhalation can be detected
Valproic Acid trade ?
Depakene
ETOH level of >400 mg/dL sxs. ?
Could be fatal
Valproic Acid may cause
liver disease
so monitor LFT
this one we want to monitor LFTs
Valproic Acid: The therapeutic range for valproic acid (total) is _________
50-125 µg/mL.
- *(Note some will report “free” levels so use caution when interpreting)
- *
Phencyclidine (PCP) UTOX how long does it last ?
6 hrs – 3 days
Below Therapeutic Range is ?
ineffective
___________ is antidote if indicated for APAP OD ?
N-acetylcysteine
NAC
** if they come in after a while they they will gove them NAC - it inactivated they bad problems tylenol causes in the liver **
Use the ________________ nomogram to predict level of Acetaminophen toxicity
Rumack-Matthew
Lithium: Has a ___________ therapeutic window
very narrow
very drunk people live in the ???
200 range
ASA - metabolism mostly by the ________ ( why you get acid base disturbances with is OD)
kidneys
Therapeutic drug monitoring (TDM) measures ______ drug levels
blood
ETOH critical values ?
> 300
Lithium is used as ?
psych med (i.e. Bipolar)
Phenytoin used as ?
abortive and preventive medication in seizure management
Phencyclidine (PCP) is NL used as a ?
Vet tranquilizer
Benzoylecgonine can also bet detected in blood for what ?
to give exact last time of use
Salicylate OD: ________ Alkalosis is replaced with a severe ________ acidosis
respiratory
metabolic
Phencyclidine (PCP) intoxication sxs. ?
Horizontal/vertical nystagmus
Disorganized thoughts/distorted body image
Anxiety, paranoia, hallucinations
Dysarthria
Acute psychosis
**Wu tang - anderson - cut penis off and jump off building, this is super bad, they get super strong cause they do not feel pain, they are out of there minds **
The total phenytoin reference range varies by age: Lethal levels are defined as greater than ?
100 µg/mL
Amphetamines SEVERE intoxication sxs ?
HTN
arrhythmia
SAH
CVA
coma
Acetaminophen OD ______ is given early
Activated charcoal
- *charcoal will bind to tylenol and inactivate it and make it not cause damage -
- *
Amphetamines Intoxication sxs. ?
Euphoria,
decreased fatigue ( can stay up for days )
Acetaminophen: Rule of 150: Give NAC is level is >____ mag/ml _ hrs post ingestion
150
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