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Spring Pharm Block 1 > Tox General > Flashcards

Tox General Flashcards

1
Q

Where are poison control centers generally located?

A

One in every state –> KY’s is in Louisville

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2
Q

What is the average time to presentation for a toxicology ingestion in adults and in children?

A

Adults: 3.5 hours
Pediatrics: 1.5 hours

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3
Q

What patient population accounts for the most toxic ingestions?

A

Children under 17 account for the most ingestions but only 10% of the fatalities

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4
Q

T/F: Most pediatric fatalities from toxic ingestions occur under the age of 4.

A

False: Fatalities in children under the age of 6 are uncommon

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5
Q

T/F: Toxic ingestions in children have been increasing recently.

A

False: ingestions have been declining since the 1960s

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6
Q

Differentiate generally pediatric ingestions from adult ingestions

A

Peds: ingestions are single, known, and promptly recognized
Adults: ingestions are multiple, intentional, unknown, and with a delayed presentation

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7
Q

What are the four most commonly ingested products in children?

A

Plants
Cleaning products
Cough/cold preps
Perfumes/colognes

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8
Q

What accounts for most toxic ingestions in geriatric patients?

A

Chronic overmedication (polypharmacy)

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9
Q

What route of administration accounts for the most toxic exposures

A

Ingestion

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10
Q

What is the basic approach to determining how best to treat a tox patient?

A

Identify the substance, amount, and route of exposure –> assume the worst case scenario

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11
Q

If a toxin is unknown, how might a provider identify the toxin?

A

Using toxidromes –> constellation of S/S associated with what a drug does in toxicity

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12
Q

Differentiate between a quantitative and qualitative tox screen.

A

Quantitative: tells you how much is present
Qualitative: tells you whether or not substance is present

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13
Q

When would one use a qualitative screen instead of a quantitative screen?

A

Qualitative screens may be faster in reporting results

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14
Q

What drugs can a tox screen usually look for?

A

Any drug, but you must specify what you want the lab to look for

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15
Q

What are five general treatment principles for managing toxic exposures.

A 
Provide supportive care
Prevent absorption
Enhance elimination
Interrupt or alter metabolism
Provide specific antidotes
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16
Q

When would you want to interrupt or alter metabolism?

A

When the drug is not toxic but it’s metabolite is

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17
Q

What drugs are included in the standard toxicology treatment cocktail?

A

Thiamine, 100mg IV
D5W, 50ml IV
Naloxone, 2-8 mg IV
Flumazenil, 0.2mg IV

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18
Q

Why is the standard toxicology management cocktail no longer hot?

A

Because flumazenil decreases seizure threshold and many toxins can cause seizures

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19
Q

What is the mechanism of action of syrup of ipecac?

A

Plant derivative containing emetine and cephalin which irritate the stomach and stimulate the vomit control center in the brain –> induces vomiting.

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20
Q

Why is syrup of ipecac not hot anymore? (2 reasons)

A

It is not effective if substance is post pyloric

Risk of aspiration since most toxins cause decreased level of consciousness or seizures

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21
Q

What are 5 relative contraindications to ipecac?

A
  1. Seizure inducing drugs
  2. Rapid coma inducing drugs
  3. Pregnancy –> vomiting causes bradycardia and may decrease blood flow to the fetus
  4. Hydrocarbons –> substance is generally only toxic if they are aspirated
  5. Severe bradycardia
22
Q

What are 3 absolute contraindications to ipecac?

A

Children < 6 months
Seizing or comatose patients
Corrosive substances

23
Q

What is another term for gastric lavage?

A

Pumping the stomach

24
Q

Differentiate the gastric lavage procedure in children from adults?

A

In adults you may use free water. In kids, you must use saline so as not to cause hyponatremia and decrease seizure threshold.

25
Q

T/F: Use of activated charcoal requires a prescription.

A

False –> available OTC

26
Q

Describe the mechanism of action of activated charcoal.

A

Absorbs toxic substances, thus, preventing absorption of the substance through the GI tract.

27
Q

T/F: Activated charcoal is only effective if the toxin is pre-pyloric.

A

False –> charcoal prevents absorptions beyond the pyloric valve

28
Q

List 3 substances activated charcoal will not be effective for.

A

Heavy Metals
Hydrocarbons
Alcohols

29
Q

List four alcohols we worry about in toxic ingestions and state which is most toxic.

A

Ethanol
Isopropyl
Methanol
Ethylene Glycol –> most toxic

30
Q

What is an AE of activated charcoal?

A

Turns the stool black –> charcoal and toxin end up in the poop

31
Q

How is activated charcoal administered and what is a contraindication in its use?

A

It must be administered through the gut and it must be able to pass. If someone has no GI motility or an ileus, charcoal is contraindicated. The patient must have bowel sounds to use activated charcoal.

32
Q

Define a cathartic and state what type of toxic ingestion they are used for.

A

Cathartics are things that make you poop. They are most effective in ingestion of sustained release products

33
Q

What is the mechanism of action of cathartics in toxic ingestions?

A

SR products ingested in large quantities tend to from bezors, big clumps of the drug. Cathartics move the bezors out through the poop.

34
Q

Differentiate polyethylene glycol from propylene glycol from ethylene glycol.

A

Polyethylene Glycol: a cathartic (aka Go Lightly)
Propylene Glycol: a drug diluent
Ethylene Glycol: anti-freeze

35
Q

Will hemofiltration (dialysis) help with ingestion of drugs not eliminated by the kidneys?

A

No –> dialysis removes same products as the kidneys

36
Q

In general, what types of substances are not eliminated by the kidneys?

A

Lipophilic
Large molecules
Protein bound substances
Heavy Metals

37
Q

What ingested substance is the one most commonly removed via dialysis?

A

Alcohol

38
Q

What is the antidote for narcotics?

A

Naloxone

39
Q

What is the antidote for a dystonic reaction to an anti-psychotic medication?

A

Diphenhydramine

40
Q

What is the mechanism of action of diphenhydramine in a dystonic reaction?

A

Dopamine balances with Ach in the brain. Anti-psychotics decrease dopamine and thus increase Ach, which can cause a dystonic reaction. Diphenhydramine is an anti-cholinergic.

41
Q

What is the antidote for iron?

A

Desferroxamine

42
Q

What is the antidote for heavy metals?

A

Dimercaprol (BAL) and CaNa2EDTA

43
Q

What is the antidote for acetaminophen (Tylenol/APAP)?

A

N-acetylcysteine (NAC)

44
Q

What is the antidote for an insulin overdose?

A

Glucagon

45
Q

What is the antidote for calcium channel blocker or beta blocker overdoses?

A

Glucagon –> glucagon is a potent inotrope

46
Q

What is the antidote for nitrates?

A

Methylene Blue

47
Q

What is the antidote for organophosphates (pesticides or nerve gas)?

A

Pralidoxime

48
Q

What is the antidote for cyanide?

A

Sodium Thiosulfate

49
Q

What is the antidote for ethylene glycol?

A

Ethanol

50
Q

What is the antidote for Isoniazid (treatment for TB)

A

Pyridoxine

51
Q

What is the antidote for pseudoephedrine?

A

Phentolamine –> potent alpha-1 agonist

Spring Pharm Block 1 (9 decks)

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