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23 spring: pharm > Test 4: 47-48 > Flashcards

Test 4: 47-48 Flashcards

1
Q

what are some non toxic exposure examples

A
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2
Q

what are some things that are toxic in small doses

A
  • Campho
  • Hydrofluoric acid
  • Gun blue (selenious acid)
  • Benzocaine
  • Acetaminophen (cats)
  • Toxic alcohols (methanol, ethylene glycol)
  • Aspirin and related products (cats)
  • Lomotil®
  • Calcium channel blockers
  • Oil of wintergreen
  • Calcipotriene
  • 5-fluorouracil
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3
Q

camphor is found in

A

Vicks Vaporub®, Vicks Vaposteam® and Camphophenique®. Rarely found in moth repellants today.

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4
Q

camphor toxicity presents with

A

rapid-acting neurotoxin (seizures occur without warning)

Range of toxicity: death in a small child may occur with ingestion of as little as 5 mL of camphorated oil (1 gram of camphor).

vicks vaporrub

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5
Q

treatment for camphor

A

supportive care

vicks vapor rub → rapid acting neurotoxin (seizures)

narrow range of toxicity

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6
Q

source of hydrofluoric acid

A

automotive wheel cleaners, glass
etching solution

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7
Q

hydrofluoric acid toxicity causes

A

burns, electrolyte disturbances,
death. Dilute solutions (< 12%) can cause delayed injury

Toxic via all routes of exposure (even intact dermal)

source: automotive wheel cleaners, glass
etching solution

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8
Q

treatment for hydrofluoric acid

A

calcium (topical, local infusions)

Sources: automotive wheel cleaners, glass etching solution

Toxicity: burns, electrolyte disturbances, death. Dilute solutions (< 12%) can cause delayed injury.

Toxic via all routes of exposure (even intact dermal)

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9
Q

source of gun blue

A

selenious acid

Sources: gun blueing solutions (pH 1)

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10
Q

toxicity of gun blue

A

Toxicity: inorganic selenium. Serious burns, systemic toxicity (shock, seizures, severe hypotension, cardiorespiratory arrest)

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11
Q

gun blue toxic dose and treatment

A

Ingestion of a few drops of gun blue can cause illness and 15 mL or more can be fatal

Toxic via dermal route: only if denuded areas

Treatment: supportive care

Sources: gun blueing solutions (pH 1)

Toxicity: inorganic selenium. Serious burns,
systemic toxicity (shock, seizures, severe
hypotension, cardiorespiratory arrest)

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12
Q

benzocaine sources

A

Sources: oral and topical anesthetics (exs:
Orajel®, Anbesol®)

Toxicity: methemoglobinemia

Causes methemoglobinemia in cats without Heinz body formation.

Onset is usually within 20 to 60 minutes

Treatment: treat methemoglobinemia as
indicated (methylene blue)

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13
Q

benzocaine causes — and treatment

A

Sources: oral and topical anesthetics (exs:
Orajel®, Anbesol®)

Toxicity: methemoglobinemia

Causes methemoglobinemia in cats without Heinz body formation.

Onset is usually within 20 to 60 minutes

Treatment: treat methemoglobinemia as
indicated (methylene blue)

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14
Q

goals of gastric decontamination

A

to decrease the blood concentration of the toxin, to decrease the amount of toxin absorbed, and to reduce the severity of the poisoning

  • any technique that prevents absorption of a drug or chemical
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15
Q

how to make dog and cat vomit

A

Dogs: 3% hydrogen peroxide, apomorphine

Cats: 3% hydrogen peroxide, xylazine, (less accepted: apomorphine)

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16
Q

contraindications to induce vomiting

A

Those species that cannot readily vomit (rodents, rabbits, horses, ruminants)

Evidence or risk of CNS depression or seizures

Caustic substances (causes burns)

Batteries or sharp foreign bodies

Substances with risk of aspiration (eg, petroleum distillates: kerosene, gasoline, motor oil, naptha )

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17
Q

complications of emesis

A
  • Persistent vomiting
  • Aspiration
  • Vagal-induced bradycardia during vomiting
  • Esophageal injury (rare)
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18
Q

apomorphine hydrochloride will cause

A

vomiting in dogs

MOA: stimulates chemoreceptor trigger zone (CTZ) then depresses emetic center.

Do not use in cats: can cause excitement

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19
Q

how to give apomorphone hydrochloride

A

conjunctival (unreliable onset of action –2-10 minutes)
Subcutaneous (SC) (2-10 minutes)
Intramuscular (IM) (5 minutes)
intravenous (IV) (immediately)

cause vomiting in dogs

20
Q

what % strength of hydrogen peroxide to induce vomiting

A

3%

21
Q

how to give hydrogen peroxide to induce vomiting

A

3%

give PO
onset: 10 mins
can repeat x1 if no vomiting

As with other emetics, food in stomach encourages emesis

dogs and cats

22
Q

how does xylazine hydrochloride work

A

Alpha-2 adrenergic agonist given IM or SC

MOA: stimulates CRTZ

use in cats, not dogs

AEs: risk of hypotension, especially if cat is dehydrated

23
Q

gastric lavage

A

emptying stomach of animal under sedation

ET tube will protect airway

allows for gastric emptying when emesis is not recommended

24
Q

when to not gastric lavage

A

Hydrocarbons (exs: petroleum distillates, pine oil) (big concern is aspiration)

Caustics

25
Q

possible complications of gastric lavage

A

Aspiration pneumonia

Esophageal perforation

Fluid and electrolyte imbalances:

  • Hyponatremia, water intoxication (when water is used
  • Hypernatremia (with large volumes of normal saline)
26
Q

activated charcoal is not effective for

A

– alcohols
– hydrocarbons
– metals
– inorganic minerals
– caustics

27
Q

how to give activated charcoal

A

powdered activated charcoal mixed with water

can give with cathartic (sorbitol). Not mineral oil (may interfere with charcoal adsorption)

28
Q

when to use activated charcoal

A

drugs that are enterohepatically
recirculated, large amount of substance still in GI tract

can give with cathartic (sorbitol) to remove from GI tract quickly

29
Q

when not to use activated charcoal

A

Caustics

Agents with high risk of aspiration (eg, hydrocarbons/petroleum products).

30
Q

how to give whole bowel irrigation

A

Large volumes of polyethylene glycol (PEG) solution via nasogastric tube until clear rectal effluent

used for sustained-release medications, agents not adsorbed by activated charcol (metals: Li, Fe, K)

31
Q

NAC (mucomyst, acetadote) antidote is used for —

A

acetaminophen poisoning. For best prognosis, treat ASAP. Best if still have 30% of glutathione stores (approx. 8 hrs post ingestion)

Other uses: xylitol, phenol, some mushrooms

Mechanism of action: acts intracellularly as a glutathione substitute, directly binds to NAPQI, precursor for glutathione synthesis

32
Q

how does NAC (mucomyst, acetadote) antidote work

A

Mechanism of action: acts intracellularly as a glutathione substitute, directly binds to NAPQI, precursor for glutathione synthesis

antidote for acetaminophen, xylitol, phenol, some mushrooms

33
Q

adverse reactions of acetadote

A

bronchospasm (NAC antidote for acetaminophen)

34
Q

fomepizole (antizol) is used for

A

antidote for ethylene glycol (EG) or methanol toxicity in dogs

35
Q

how does fomepizole (antizol) work

A

Competitively inhibits alcohol
dehydrogenase – this is the enzyme that breaks down ethylene glycol. Most effective if given within 3-6 hours of ingestion,
before metabolism and significant renal damage occurs.

antidote for ethylene glycol or methanol toxicity

36
Q

adverse reactions of fomepizole (antizol)

A

Not expected with therapeutic doses. Excess doses can cause CNS depression.

antidote for ethylene glycol (EG) or methanol toxicity in dogs

37
Q

how to treat ethylene glycol toxicity in cats

A

fomepizole(antizol) is not efficacious in cats at the doses used in dogs. Much higher doses are needed to inhibit feline alcohol dehydrogenase so use 20% ethanol in cats.

38
Q

how does ethanol prevent ethylene glycol toxicity

A

Blocks conversion of toxic alcohols via alcohol dehydrogenase. ETOH has 100x more of an affinity for this enzyme than does EG or methanol.

Adverse reactions: CNS depression, hypoglycemia

Special considerations: 2 protocols: bolus dosing or continuous infusion.

use ethanol in cats and dogs. Use fomepizole in dogs

39
Q

when to use vit K antidote

A

for symptomatic (bleeding animals)- give PO or SQ. NOT IV

Do not give as prophylaxis- makes it hard to know when to discontinue treatment

Mechanism of action: reverses the inhibitory effects of coumarin and indanedione derivatives on the synthesis of coagulation factors II, VII, IX and X.

40
Q

deferoxamine

A

antidote for iron and aluminum toxicosis

Mechanism of action: Binds iron to form ferrioxamine – this chelate is then excreted through the kidneys

41
Q

adverse reactions of deferoxamine

A
  • Hypotension (especially if renal impairment) or an anaphylactoid-type reaction (from very rapid iv infusion)
  • Yersinia sepsis (deferoxamine promotes the growth of yersinia enterocolitica)
  • Pulmonary complications (acute respiratory distress syndrome) with infusions > 24 hrs

Special considerations
– Dosage information not available for cats.
– Do not infuse > 24 hours (reports of severe or fatal pulmonary toxicity when used > 24 hours)

antidote for iron and aluminum toxicosi

42
Q

where to get antivenins for snake bites

A

will have North American Pit Vipers and Eastern coral snake (Micrurus fulvis)

can call zoo for more exotic places

43
Q

mechanism of action for antivenins for snake bite

A

blocks the venom’s ability to bind to the targeted tissues (binds circulating venom components but also accumulates at the bite site to inactivate locally deposited venom)

44
Q

— are very sensitive to black widow spider venom (howling, tremor, paralysis).

A

cats

Dogs are more resistant than cats although they can still develop severe clinical signs.

45
Q

when to use antivenins for black widow

A

due to possibility of anaphylaxis, use only in pts with significant neurotoxicity, hemodynamic instability, uncontrolled pain, or prolonged symptomatology

cats are very sensitive

46
Q

naloxone is used for

A

for opioid toxicity and the return of adequate, spontaneous ventilation

works as opioid receptor antagonist

Monitor patient for relapse since the narcotic may have a longer duration of action than the naloxone.

47
Q

bulldog ingests cocaine

Increased salivation, tachycardia (HR 200), febrile (105°) ↑risk for seizures

What method would you use for
decontamination?

A

depends

prob would not induce vomiting cause of risk of seizure

give activated charcol and diazepam to sedate pt

23 spring: pharm (46 decks)

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