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PHAR324 > Salicylates > Flashcards

Salicylates Flashcards

1
Q

What are examples of salicylates?

A

oral:
-ASA, bismuth subsalicylate, sodium salicylate
-willow bark
topical:
-methyl salicylate
-trolamine salicylate
-oil of wintergreen

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2
Q

What is the issue with oil of wintergreen?

A

5 ml of wintergreen = 7 g salicylate (21.5 ASA tabs)
-easy for kids to overdose

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3
Q

Do salicylates change the course of disease?

A

do not generally change the course of disease
-symptomatic relief

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4
Q

Describe salicylate metabolism.

A

salicylate –> salicylic acid (hydrolysis)
salicylic acid –> glycine/glucuronide (conjugatin, saturable)
salicylic acid –> renally excreted unchanged

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5
Q

What is responsible for therapeutic and toxic effects of salicylates?

A

salicylic acid

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6
Q

Describe salicylate ADME at therapeutic doses.

A

absorption:
-Tmax <1h
PPB:
-90%
t1/2:
-2-4h
metabolism/elimination:
-first order kinetics

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7
Q

Describe salicylate ADME at toxic doses.

A

absorption:
-reduced rates, tmax > 4-6h
PPB:
-<75% (saturated)
t1/2:
-18-36h (6-8h if urine pH > 7.4)
metabolism/kinetics:
-zero order kinetics

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8
Q

At what concentration do toxicities of salicylate occur?

A

> 30 mg/dL

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9
Q

At what concentration must we do hemodialysis for salicylates?

A

> 80 mg/dL
-regardless of symptoms

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10
Q

What is the key presentation of early toxicity due to salicylates?

A

respiratory alkalosis
metabolic acidosis

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11
Q

What is the presentation of blood glucose levels in early salicylate poisoning?

A

periphery only: normo-hyperglycemia
CNS glucose may be low

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12
Q

What is the key presentation of late toxicity due to salicylates?

A

respiratory acidosis
metabolic acidosis
hypoglycemia

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13
Q

Summarize the major findings of salicylate toxicity.

A

early –> metabolic acidosis, respiratory alkalosis
late –> metabolic acidosis, respiratory acidosis
electrolyte disturbances
abnormal glucose
-administer glucose regardless of serum glucose levels
mental status changes

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14
Q

What might be an early sign of salicylate toxicity?

A

tinnitus

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15
Q

What might be seen in older adults with chronic salicylate toxicity?

A

slow onset and less severe appearance - often misdiagnosed with dementia, respiratory failure, CHF

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16
Q

What is the antidote for salicylates?

A

no antidote

17
Q

What is the management of salicylate toxicity?

A

ABCs/symptomatic & supportive care
pay attention to hydration, oxygenation, elytes, glucose

18
Q

What is the therapeutic salicylate concentration?

A

5-25 mg/dL (0.4-1.8 mmol/L)

19
Q

What is the Done Nomogram?

A

validated in pediatrics with single ingestions
poorly predictive of toxicity, not widely used

20
Q

What are two lab markers that must be monitored in salicylate poisoning?

A

serum levels
blood pH
-until clinical improvement AND low salicylate [] AND normal-high pH

21
Q

Why is it important to monitor blood pH in salicylate poisoning?

A

low pH favors salicylate entering CSF & tissues
-increased proportion of non-ionized salicylate at low pH

22
Q

What is the role of elimination in salicylate poisoning?

A

alkalinization;
-mainstay of treatment
-salicylate = weak acid
-increased pH = ionized salicylate = ion trapping
hemodialysis:
-very effective since increased fraction of free salicylate following saturation of protein binding
-recommended in severe toxicity

23
Q

What is the MOA of NSAIDs?

A

inhibit COX –> inhibit synthesis of prostaglandins
-prostaglandins = prostacyclins, thromboxane

24
Q

What is the most important prostaglandin in regards to NSAIDs?

A

PGE2

25
Q

What does PGE2 cause?

A

pain
fever

26
Q

What do COX-2 inhibitors end in?

A

-coxib

27
Q

What are the most toxic NSAIDs?

A

phenylbutazone
mefenamic acid

28
Q

What is the life-threatening dose of ibuprofen?

A

> 400 mg/kg

29
Q

True or false: life threatening toxicity is common with NSAIDs

A

false

30
Q

What is the management of NSAID toxicity?

A

supportive and symptomatic care
-milk for children
decontamination:
-avoid ipecac
-if no evidence of GI perforation = SDAC
elimination:
-MDAC: meloxicam, phenylbutazone, piroxicam
-hemodialysis: not beneficial for reducing lvls, maybe acute renal failure

31
Q

What is the antidote for NSAIDs?

A

no antidote

PHAR324 (7 decks)

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