(SYNOPTIC) Poisoning & Antidotes

Question 1

Define poisoning.

Answer 1

Exposure to drug/ chemical/ pollutant in sufficient quantity to produce an adverse effect

Can be acute OR chronic

Question 2

What is the most common type of poisoning?

Answer 2

Accidental

47%

Question 3

What are some of the least common types of poisoning?

Answer 3

Drugs of misuse - 2.6%

Question 4

What are the types of poisoning?

Answer 4

(1) Accidental
(2) Therapeutic error
(3) Deliberate
(4) Drugs of misuse

Question 5

What are some types of accidental poisoning?

Answer 5

• Duplication of therapy
• Household chemicals (children)
• Prescribing/ dispensing errors
• Counterfeit drugs

Question 6

What is the main motive for deliberate poisoning?

Answer 6

To cause others harm

Question 7

What is a medicine that is commonly overtaken deliberately, leading to poisoning?

Answer 7

Thyroxine for weightloss

Or paracetamol

Question 8

What is environmental poisoning?

Answer 8

Air/ water/ soil pollution

e.g. carbon monoxide

Question 9

What is the lowest amount of nicotine that can be fatal in an adult?

Answer 9

40mg

Question 10

What is occupational poisoning?

Answer 10

Overexposure to chemicals in the place of work

e.g. x-rays/ pesticides

Question 11

What is the EU Tobacco Product Directive (2014)?

Answer 11

• No advertising on TV/ radio/ newspapers
• Only advertising at point of sale
• Max. 20mg of nicotine

Question 12

What is the most common drug taken in overdose?

Answer 12

Paracetamol

Question 13

What are the top 5 most common drugs taken in overdose?

Answer 13

(1) Paracetamol
(2) Ibuprofen
(3) Codeine
(4) Sertraline
(5) Diazepam

Question 14

What are some of the most common household poisons?

Answer 14

(1) Fabric tablets
(2) Reed diffusers
(3) Bleach
(4) Air fresheners
(5) Dishwasher tablets

Question 15

What is the pharmacist’s role in prevention of self-poisoning?

Answer 15

• Limit stock piling of medicines
• Review home medicine’s cupboard
• Safe storage of medicines and caustic substances
• Dispose of expired/ unused medicines

Question 16

What is the pharmacist’s role in treatment of poisoning?

Answer 16

• Recognition of poisoning
• Establish drug history
• ID the agents involved
• Give advice on antidote use
• Ensure availability of appropriate antidotes
• Provide patient information

Question 17

What is the general treatment of poisoning?

Answer 17

• Symptomatic and supportive care

- Check for infection/ trauma/ metabolic derangements

Question 18

What is toxidrome?

Answer 18

Disorientations/ hallucinations

Question 19

What is gut decontamination?

Answer 19

(1) Activated charcoal
- Absorbs ingested substances
- Must be fully conscious + have a protected airway

(2) Whole bowel irrigation
- e.g. polyethylene glycol
- High doses of iron

Question 20

What are some therapeutic methods of enhanced elimination, with regard to patients with renal failure?

Answer 20

(1) Urinary alkalisation
- e.g. NaHCO3
- Increases elimination of weak acids

(2) Haemodialysis/ Haemoperfusion
- Limited subset of drugs/ chemicals

Question 21

How do antidotes function?

Answer 21

• Inert complex with poison
• Accelerated detoxification of poison
• Reduced rate of conversion to more toxic compound
• Compete with poison at essential target sites
• Bypass effect of poison

Question 22

What is N-acetylcysteine?

Answer 22

Antidote

Accelerates detoxification of paracetamol

Question 23

What website would you use to find guidance on poisoning regarding a drug?

Answer 23

Toxbase

Question 24

What is DigiFab?

Answer 24

Antidote for digoxin

Question 25

How does DigiFab work?

Answer 25

Forms an inert complex with digoxin

Question 26

What is naloxone used for?

Answer 26

Reversal of respiratory depression in opioid overdose

Specifically, heroine/ oxycodone

Question 27

What is phytomenadione used for?

Answer 27

Competes with warfarin at essential receptor sites

Warfarin antidote