Salicylates

Question 1

how do peak levels change in OD

Answer 1

normally peaks in 30ming in OD peaks 4-6hrs after very delayed

Question 2

effervescent effect on absorption

Answer 2

pushes the agent into the small intestine where drug is always absorbed the most

Question 3

effect of Vd in OD

Answer 3

normally small, increased

Question 4

effect on protein binding in OD

Answer 4

normally high, decreases

Question 5

how are salicylates eliminated

Answer 5

first order kinetics
5 pathways of metabolism
liver metabolism
renal elimination depends on urine pH

Question 6

effect on half life in OD

Answer 6

increased from 2 to 18-26

bc changes to zero order kinetics - michealis menton

Question 7

why does OD lead to decreased protein bindin and increased tissue binding

Answer 7

michalis menten

metabolism pathways become saturated

Question 8

toxic doses

Answer 8

150-200 mg/kg = mild intoxication
300-500mg/kg = severe
500 = lethal
>100mg/kg/d for > 2d = chronic intoxication

Question 9

severe toxicity in acut serum levels

Answer 9

> 90-100mg/dL

or >60 with acidosis and altered mental status?

Question 10

chronic therapeutic values

Answer 10

10-30mg/dL

Question 11

central stimulation of respiratory center causes

Answer 11

hyperventilation
respiratory alkalosis
dehydration

Question 12

intracellular effects

Answer 12

interference with krebs cycle and uncoupling of oxidative phosphorylation - lactic acid accumulation
increased fatty acid metabolism
metabolic acidosis
hyper and then hypoglycemia

Question 13

explain why hyper and hypo glycemia occur

Answer 13

first mobolizationof glycogen stores causes hyper then theres glycogen depletion and inhibition of gluconeogenesis

Question 14

GI effects

Answer 14

hemorragic gastritis

Question 15

renal effects

Answer 15

tubular damage

proteinuria

Question 16

hepatic effect

Answer 16

salicylate induced hepatitis

Question 17

ototoxicity

Answer 17

tinnitus

hearing loss

Question 18

acute toxicity signs and symptoms

Answer 18

vomitng 
hyperpnea
tinnitus
lethargy
mixed respiratory alkalosis and metabolic acidosis 
coma
seizure
hypoglycemia
hyperthermia
cerebral and pulmonary edema

Question 19

characteristics of chronic toxicity

Answer 19

100mg/kg/d for 2 days
elderly
slow onset
less severe appearance
often misdiagnosed

Question 20

chronic toxicity presentation

Answer 20

hearing loss and tinnitus
NV
dyspnea, hyperventialtion
hyperthermia
neurologic
cerebral and pulmonary edema more common

Question 21

acute vs chronic poisoning

Answer 21

acute is generally younger, intentional, easily recognized, suicidal, marke serum elevation, mortality uncommon, not many disease states
chronic opposite

Question 22

lab tests for management

Answer 22

salicylate
ABG
electrolytes

Question 23

possible interventions

Answer 23

gastric emptying
activated charcoal
sodium bicarb
urinary alkalinization
hemodialysis 
hemoperfusion 
MDAC
continuous venovenous hemofiltration

Question 24

can we use emesis

Answer 24

no cause cna have a coma or seizure

Question 25

how to use sodium bicarb

Answer 25

correct metabolic acidemia bringing ph to 7.4
continuous titration over 4-8hrs
treat hypokalemia

Question 26

indications for hemodialysis

Answer 26

acute ingestion serum levels higher than 100mg/dL with severe acidosis or other manifestations of toxicity
chronic intoxication serum levels >60mg/dL
renal failure
deterioration