S14: poisoning & STOPP-START

Question 1

Describe biochemical toxicity

Answer 1

A drug or active metabolite which causes cellular damage
-macromolecules inc. structural proteins and enzymes
Balance of elimination of a drug or metabolites will dictate the potential harm that may be caused

Question 2

Describe the use of mesna alongside cyclophosphamide

Answer 2

Cyclophosphamide – highly toxic metabolites eliminated in urine and cause haemorrhagic cystitis due to cell damage in bladder
Mesna – thiol group for cytoprotection and polar group -> high renal excretion and protection at bladder epithelium

Question 3

Outline key management principles of drug overdose

Answer 3

Prevention of absorption 
Immediate actions 
Antidotes 
Enhance elimination 
Supportive measures

Question 4

What is STOPP-START?

Answer 4

Screening tool of older people’s prescriptions and screening tool to alert to right treatment
For use in older patients > 65
Used in conjunction with clinical judgement