tocivology ppt Flashcards
– An unusual response to a
substance or an altered reaction
of the body.
Allergy
Drug Allergy
– occurs when the
body forms antibodies to a
particular drug, causing an
immune response when the
person is re-exposed to the
drug.
– is the study of
poisons, including their actions,
adverse effects, and treatment
of
the conditions that they
produce.
This poison includes
household,
environmental,
industrial, or
pharmacologic
substances.
Toxicology
– the ability of a chemical
to cause injury or interfere
adversely with the normal
processes of an individual.
Toxicity
– any substance applied to
the body, ingested, inhaled, or
developed within the body which
causes damage or disturbance of
function.
Poison
Abstinence –
avoidance of substance
use
– a compulsive,
uncontrollable craving for and
dependence on a substance to
such
a degree that cessation causes severe emotional, mental
or physiological reactions.
Addiction
– reliance on
substance that has reached the
level that its absence will cause
an
impairment in function
Dependence
– over indulgence in
and dependence on a substance
that has a negative impact on
psychologic, physiologic, and
social functioning of an
individual
Drug Abuse
– indiscriminate use of
a drug for purposes other than
those for which it is intended
Drug Misuse
– is a state of being
poisoned by a drug or other toxic
substance
Intoxication
– involves treating an
intoxicated client to diminish or
remove drugs or their effects from
the body
Detoxification
– a group of
signs and symptoms that occurs
in physically dependent persons
when drug use is stopped
Withdrawal syndrome
TYPES OF ADVERSE DRUG EFFECTS
a) Primary action –
the
development of adverse effect
from simple over dosage or
merely an extension of the
desired effects. The effect is
caused by individual response
to
the drug, high or low weight,
age, or underlying pathology
that alter the effects of the
drug.
TYPES OF ADVERSE DRUG EFFECTS
Secondary action –
refers to the
effects produced by a drug in
addition to the desired
pharmacologic effects. The
drug dose can be adjusted so
that the desired effect can be
achieved without producing
undesired secondary reaction.
Hypersensitivity –
an
excessively response either
the primary or secondary
effects of the drug, and it may
result from a pathological or
underlying condition.
- TYPES OF DRUG ALLERGIES
Anaphylactic reaction
Involves an antibody that
reacts with specific sites in the
body to cause the release of
chemicals, including
histamine, that produce
immediate reaction (mucous
membrane swelling and
constricting bronchi that can
lead to respiratory distress
and even respiratory arrest.
Anaphylactic reaction
Assessment :
Hives, rash,
difficulty breathing, increased
BP, dilated pupils, diaphore-
sis, “panic” feeling, increased
heart rate, respiratory arrest
Cytotoxic reaction
Involves
antibodies that circulate in the
blood an attack antigens (the
drug) on cell site, causing
death of that cell. This reaction
is not immediate but may be
seen over a few days.
Cytotoxic reaction
Assessment :
CBC showing
damage to blood-forming cells
(decreased Hct, decreased
WBC, decreased platelets),
liver function tests showing
elevated liver enzymes, renal
function test showing
decreased renal function.
Serum-sickness reaction
Involves antibodies that
circulate in the blood and cause
damage to various tissues by
depositing in blood vessels.
This reaction may occur up to
a
week or more after exposure
to the drug.
Serum-sickness reaction
Assessment
Itchy rash, high fever, swollen lymph nodes, swollen and painful joints, edema of the face and limbs.
Dermatologic reactions
an adverse reactions involving the skin. These can range from a simple rash to a fatal exfoliative dermatitis.
Dermatologic reactions E.g. :
Procainamide (Pronestyl), a drug used to treat cardiac arrhythmias, causes a characteristic skin rash in many patient using the drug
Stomatitis
“mouth sores”, inflammation of the mucous membranes caused by a direct toxic reaction to the drug or because drug deposit in the end capillaries of the mucous membrane.
Assessment
Swollen gums, inflamed gums (gingivitis)
Swollen and red tongue (glossitis)
Difficulty swallowing, bad breath, pain in the mouth and throat
Superinfection
several kinds of drugs (especially antibiotics) destroy the normal flora which leads to the development of superinfections.
Superinfection
Assessment:
Fever, diarrhea, black-hairy tongue, inflamed swollen tongue, mucous membrane lesions, vaginal discharge and/or itching
Blood Dyscrasia
– Bone marrow suppression caused by drug effects. This occurs when drugs that can cause cell death (antineoplastic, antibiotics) are used.
Blood Dyscrasia
Assessment:
Fever, chills, sore throat, weakness, back pain, dark urine, decreased Hct (anemia), low platelet count (thrombocytopenia), low WBC count (Leukopenia), a reduction of all cellular elements of the CBC (pancytopenia).
Liver injury Assessment:
Fever, malaise, nausea, vomiting, jaundice, change in the color of urine or stools, abdominal pain or colic, elevated liver enzymes (AST [SGOT], ALT [SGPT]); alterations in bilirubin levels changes in clotting factors (PTT changes).
Renal Injury
– some drug
molecules are get plugged
into the capillary networks
in the glomerulus of the
kidney causing acute
inflammation and severe
renal problems. Other
drugs are excreted
unchanged from the kidney may directly irritate the renal tubule.
Renal Injury Example:
Gentamicin (Garamycin), a potent antibiotic is frequently associated with renal toxicity.
Renal Injury Assessment:
Elevated BUN, elevated creatinine levels, decreased Hct, electrolyte imbalances, fatigue, rash.
Poisoning –
occurs when an overdose of a drug damages multiple body system leading to fatal reactions.
) Hypoglycemia
“low serum blood glucose level”. Some drugs affect metabolism and the use of glucose, causing hypoglycemia.
) Hypoglycemia Example:
Glipizide (Glucotrol) and glyburide (Diabeta) are anti diabetic agents whose desired action is a lower blood glucose, but which can lower blood glucose too far causing hypoglycemia.
Hypoglycemia Example:
Assessment:
Fatigue, drowsiness, hunger, anxiety, headache, cold/ clammy skin, shaking and lack of coordination, increased heart rate, increased blood pressure, numbness and tingling of mouth, tongue and/or lips, confusion, rapid and shallow respirations
Hyperglycemia –
“high serum
blood glucose level”. Some
drugs stimulate the
breakdown of stored
glycogen or alter metabolism,
causing hyperglycemia
Hyperglycemia – Example:
Ephedrine, a drug used as a bronchodilator and anti-asthma can breakdown stored glycogen and cause hyperglycemia by its effect on the sympathetic nervous system.
Hyperglycemia
Assessment:
Assessment:
Fatigue
increased urination (polyuria)
increased thirst(polydipsia),
deep rapid respiration
Restlessness
increased hunger(polyphagia)
nausea, hot or flushed skin
fruity odor to breath.
- Electrolyte Imbalance
Hypokalemia
some drugs (loop diuretics) alter renal exchange system causing potassium loss.
- Electrolyte Imbalance
Hypokalemia
Assessment:
Serum potassium less than 3.5 mEq/L, weakness, numbness and tingling in the extremities, muscle cramps, nausea, vomiting, diarrhea, decreased bowel sounds, irregular pulse, weak pulse, orthostatic hypotension, disorientation
- Sensory Effects
Ocular toxicity
– some drugs are deposited into the tiny arteries of the retina causing inflammation and tissue damage.
- Sensory Effects
Ocular toxicity
example
Example: Chloroquine (Aralen), a drug used to treat some rheumatoid diseases can cause retinal damage and even blindness.
Auditory Damage
some drugs irritates and damage the tiny vessels and nerves in the eighth cranial nerves.
Auditory Damage
Example
Macrolides antibiotics can cause severe auditory nerve damage. Aspirin, most commonly used drug often link to auditory ringing and eighth cranial nerve effects
Neurological Effects
General CNS effects :
– some drugs affect neurological functioning, either directly or by altering electrolyte or glucose levels.
Neurological Effects
General CNS effects :
Example:
Beta blockers used to treat hypertension can cause feeling of anxiety insomnia and nightmares.
Atropine-like (Cholinergic antagonist) Effects
– some drugs mimic the effects of sympathetic nervous system
Atropine-like (Cholinergic antagonist) Effects
eg
Example: Many cold remedies and antihista- mine also cause anticho- linergic effects
Parkinson-like Syndrome
drugs that directly or indirectly affects dopamine levels in the brain can cause a syndrome that resembles Parkinson’s disease.
Parkinson-like Syndrome
eg
Antipsychotic or neuroleptic drugs can cause Parkinson-like syndrome, but in most cases the effect will go away when the drug is withdrawn
Parkinson-like Syndrome
assesmnet
Lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or “jitters” (Akathisia), spasms (dyskinesia)
Neuroleptic Malignant Syndrome (NMS)
general anesthetics and other drugs that have direct CNS effects can cause a generalize syndrome that includes high fever.
Neuroleptic Malignant Syndrome (NMS)
asssesmnt
Extrapyramidal symptoms, hyperthermia, autonomic disturbances, fever
Teratogenicity
– Many drugs that reach the developing fetus or embryo can cause death or congenital defects. The exact effect of a drug on the fetus may not be known. All pregnant women should be advised not to self medicate during pregnancy
DRUGS OF ABUSE
A. Stimulant
1. Nicotine
Physiologic and psychologic effects:
Increased arousal and alertness;
* Performance enhancement;
* Increased heart rate, cardiac output, and blood pressure;
Nicotine replacement therapy (NRT)
Bupropion - reduces the urge to smoke and reduces symptoms of nicotine withdrawal
➛ Varenicline (Chantix) - reduces cravings for nicotine and decreases the pleasurable effects of cigarettes
Cocaine / Amphetamines
➥ Amphetamine (Benzedrine);
➥ Benzphetamine (Didrex);
➥ Dextroamphetamine (Dexedrine);
➥ Methamphetamine (Desoxyn);
➥ Methylphenidate (Ritalin);
➥ Pemoline (Cylert);
➥ Phenmetrazine (Preludin);
. Caffeine
Mood elevation, increased alertness, nervousness, jitterness, irritability, insomnia, increased respirations, increased heart rate, and force of myocardial contraction, relaxation of smooth muscle, diuresis
. Caffeine Toxicity
Nervousness, confusion,psychomotor agitation, anxiety, dizziness, tinnitus, muscle twitching, elevated blood pressure, tachycardia, extra- systoles, increased respiratory rate
Opioids
Heroin, morphine, opium, codeine, fentanyl
Meperidine, hydromor- phone, propoxyphene, oxycodone, methadone
Opioids
Physiologic and psychologic effects
Analgesia, euphoria, drowsiness, detachment from environment, relaxation, constricted pupils, decreased respiratory rate, slurred speech, impaired judgment, decreased sexual drives
Opioids|
Toxicity
➛ Slow, shallow respirations; clammy skin; constricted pupils, coma; possible death
Opioids|
Withdrawal Syndrome
- Watery eyes, dilated pupil, runny nose, yawning, tremors, pain, chills, fever, diaphoresis, nausea, vomiting, diarrhea, abdominal cramps
Treatment
Opioid antagonist
▸ Naloxone (Narcan )
Opioid substitution: use to prevent withdrawal syndrome
Methadone (Dolophine), buprenorphine
Opioids|
Centrally acting alpha2- adrenergic agonist
▸ Clonidine (catapres )- effective in decreasing GI hyperactivity
Cannabis; Marijuana; Hashish
Physiologic and psychologic effects
Relaxation, euphoria, amotivation, slowed time sensation, sexual arousal, abrupt mood changes, impaired memory and attention, impaired judgment, reddened eye, dry mouth, lack of coordination, tachycardia, increased appetite
Cannabis; Marijuana; Hashish
➢ Toxicity
Fatigue, paranoia, panic reactions, hallucinogen-like psychotic states
Cannabis; Marijuana; Hashish
➢ Withdrawal Syndrome
With heavy use: insomnia, restlessness, irritability, tremors, weight loss, hyperthermia, chills
Psychedelics drugs
Lysergic acid diethylamide (LSD )
Psilocybin (mushrooms )
Dimethyltryptamine (DMT)
3,4-methylendioxy- amphetamine (Ecstasy)
Mescaline (peyote)
Phencyclidine (PCP)
Psychedelics
Physiologic and psychologic effects
Perceptual distortions, hallucinations, delusions (PCP), depersonalization, heightened sensory perception, euphoria, mood swings, suspiciousness, panic, impaired judgment, increased body temperature, hypertension, flushed face, tremor, dilated pupils (PCP), nystagmus (PCP), violence (PCP)
Psychedelics
➢ Treatment
Diazepam- to treat panic attack
. Inhalants
Euphoria, decreased inhibitions, giddiness, slurred speech, illusions, drowsiness, clouded sensorium, tinnetus, nystagmus, dysrhyth- mias, cough, nausea, vomiting, diarrhea, irritation to eyes, nose, mouth
–Amedicationor subs- tancegiventoinducevomiting.
- Emetic
Gastric lavage
Atechniquefor washingpoisonoutofthe stomachbyinstilling wateror salinesolutionthroughatube, removingthestomachcontents bysuction,andrepeatingthe processuntilthewashingsare freeofpoison.Itisalsocalled stomachpumping
Othertypesofpoisons :
1) Bacterialtoxinsthatcause food poisoning
suchas Escherichia coli;
Othertypesofpoisons
-Heavymetals
such as the lead found in the paint
Commonoutdoorplantsthat containsomepoisonouspart include:
- Birdofparadiseflower
- Buttercup
- Castorbean
* Daffodil
- Lily-of-the-valley
* Morningglory
* Potato
* Tomato
* Englishivy
* Eucalyptus
* Foxglove
* Holly
* Horsechestnut
* Iris
TREATMENT :
A. General Antidote: (Universal Antidote)
for poison
TREATMENT :
A. General Antidote: (Universal Antidote)
This should be given after the ingestion of the poison :
2 parts activated charcoal or burned toast (Absorbent)
1 part tannin (tannic acid) or strong tea (General precipitant)
1 part magnesium oxide or milk of magnesia (Antacid)
Note : Although few poisons have specific antidotes, the most common substance that is effective and generally available in the household is
MILK
. Induction of vomiting
➥ Syrup of ipecac is the preferred emetic for inducing vomiting
. Alternative to emesis
Gastric lavage – is especially useful in treating poisoning by aromatic substances such as perfume, or when some contraindication for emesis exist
Activated charcoal – absorbs the poison or toxin and delays gastrointestinal absorption.
) Cathartics – are used to hasten the removal of a toxic substance and are useful for ingestion of hydro carbons and enteric-coated tablets. Sodium sulfate is frequently used cathartic.
) Dialysis – is most effective if the poison has a small volume of distribution and has low protein binding.
TYPES OF POISON
. LEAD (Pd)
➥ Properties ➥ Classification ➥ Toxic Action
➥ Properties : Soft bluish white metal, very heavy. The salt that are mostly used with toxic properties are : lead acetate, lead carbonate, lead sulfate.
➥ Classification – Metallic poisons ➥ Toxic Action – Lead salt combine with protein producing astringent effect.
TYPES OF POISON
. LEAD (Pd)
➥ Symptoms:
1) Acute poisoning
Chronic poisoning
➥ Symptoms:
1) Acute poisoning
Sweet metallic taste; thirst
Nausea and vomiting that persist
Paralysis in the stomach, abdominal pain
Diarrhea or constipation. The stool are black due to lead sulfate
Pain and cramps in the limbs, numbness, palsi
Blue line on the gums
Fatal cases pass into comma with or without convulsions
2) Chronic poisoning
Gastrointestinal disturban- ces, anorexia
Anemia
Blue line on the gums
Bloody urine
Nervous symptoms
TYPES OF POISON
. MERCURY (Hg)
➥ Properties ➥ Classification ➥ Toxic Action
➥ Properties : Mercury is liquid, heavy metals which is very toxic and cumulative
➥ Sources : Use in antiseptics, manufacture of thermo- meter, paints, electric and physical apparatus
➥ Lethal Dose : 1 gm to 4 gm
CARBON MONOXIDE (CO)
➛ Produced whenever there is incomplete combustion of organic material
ACIDS
➥ Synonyms
➥ Lethal dose
➥ Uses
➥ Symptoms
Hydrochloric acid (HCl)
➥ Synonyms : Muriatic acid
➥ Lethal dose : 1 ml
➥ Uses : Metal cleaners, flux for soldering in industry, medicinal
➥ Symptoms:
Mouth – severe corrosion without blackening, acid penetrating odor
ACIDS
➥ Synonyms
➥ Lethal dose
➥ Uses
➥ Symptoms
Sulfuric Acid (H2SO4)
➥ Synonyms : Oil of vitriol
➥ Lethal dose : 1 ml
➥ Uses : Storage batteries, in industry
➥ Symptoms:
Mouth – severe corrosion with blackening
ACIDS
➥ Synonyms
➥ Lethal dose
➥ Uses
➥ Symptoms
Acetic Acid (CH3COOH)
➥ Synonyms : Glacial acetic acid, vinegar
➥ Lethal Dose : 20 ml.
➥ Uses : In industry for synthesis and dyes, toilet bowl cleaners, as automobile battery acid and metal cleaners
Some examples of antidotes that nurses should know include:
Acetylcysteine for
Acetylcysteine for Tylenol, Acetaminophen and Paracetamol poisoning
Some examples of antidotes that nurses should know include:
Activated charcoal
for most poisons; Non-specific poisons except cyanide, iron, lithium, caustics and alcohol.
Some examples of antidotes that nurses should know include:
Albuterolinhaler,Insulin & glucose, NaHCO3, Kayexalate
for Potassium
Some examples of antidotes that nurses should know include:
Anticholinesterase agents
for
Neuromuscular blockade (paralytics)
Some examples of antidotes that nurses should know include:
Atropine
for organophos- phates and carbamates insecticide
Some examples of antidotes that nurses should know include:
Benzylpenicillin
for Amanita phalloides (Death cap mushroom)
Some examples of antidotes that nurses should know include:
Calciumsalts
for Fluoride ingestion
Some examples of antidotes that nurses should know include:
Deferoxamine mesylate
for Iron poisoning
Some examples of antidotes that nurses should know include:
◈ Digoxin immune fab/ Digibind
for digoxin toxicity
Some examples of antidotes that nurses should know include:
◈ Dimercaprol, Edetatecalcium, Disodium
for lead, arsenic, gold, or inorganic mercury poisoning
Some examples of antidotes that nurses should know include:
Flumazenil
for benzodiazepine overdose
Some examples of antidotes that nurses should know include:
Fomepizole
for Ethylene glycol and Methanol poisoning
Some examples of antidotes that nurses should know include:
Insulin with Glucagon
for Beta blockers and Calcium channel blockers poisoning
Some examples of antidotes that nurses should know include:
Glucose(Dextrose 50%)
for Insulin reaction
Some examples of antidotes that nurses should know include:
Heparin
for Ergotamine
Some examples of antidotes that nurses should know include:
Hydroxocobalamin
for Cyanide
Some examples of antidotes that nurses should know include:
Leucovorincalcium
for Methotrexate and Trimethoprim
Some examples of antidotes that nurses should know include:
Magnesiumsulfate
for Calcium gluconate
Some examples of antidotes that nurses should know include:
◈ Mesna
for Cyclophosphamide
Some examples of antidotes that nurses should know include:
Methylene blue
for drug- induced methemoglobinemia
Some examples of antidotes that nurses should know include:
Naloxone / Nalmefene
for opioid analgesic overdose
Some examples of antidotes that nurses should know include:
Naloxone (Narcan)
for Narcotic overdosage
Some examples of antidotes that nurses should know include:
Neostigmine
for anticholener- gics
Some examples of antidotes that nurses should know include:
Octreotide
for Oral Hypogly- cemic Agents (OHA)
Some examples of antidotes that nurses should know include:
Nitrite,sodiumand glycery- trinitrate
for cyanide
Some examples of antidotes that nurses should know include:
Penicillamine
for Copper, Gold, Lead, Mercury, Zinc, Arsenic
Some examples of antidotes that nurses should know include:
Phentolamine(Regitine)
for Dopamine
Some examples of antidotes that nurses should know include:
Phyostigmine or NaHCO3
Tricyclic antidepressant (TCA)
Some examples of antidotes that nurses should know include:
Phytomenadione (Vitamin K)
for Coumadin/Warfarin
Some examples of antidotes that nurses should know include:
Pralidoxime
for poisoning by anti-cholinesterase nerve agents.
Some examples of antidotes that nurses should know include:
Protamine sulfate
for Heparin
Some examples of antidotes that nurses should know include
Pyridoxine
for Isoniazid, theophylline, monomethyl hydrazine. Adjunctive therapy in ethylene glycol poisoning.
Some examples of antidotes that nurses should know include
Sodiumthiosulphate
for Cyanide
