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Pharm II exam 1 > Tox I > Flashcards

Tox I Flashcards

1
Q

What are the most commonly ingested products in children?

A

Plants
Cleaning products
Cough/cold preps
perfumes

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2
Q

What is the difference between children, adolescent/adult and elderly toxic ingestions?

A

Children - single, known, promptly
A/A - multiple, intentional, unknown, delayed regocnition
Elderly - med overuse

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3
Q

What are the 3 things that you should identify when approaching a patient who has ingested something toxic?

A

Substance
Amount
Route of ingestion

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4
Q

5 things to check on physical exam

A
  1. VS
  2. Coma grade/level of consciousness
  3. Neurological findings
  4. Cardiac dysrhythmias
  5. Odors
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5
Q

What is a toxidrome?

A

constellation of S/S referable to a single drug overdose

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6
Q

What labs should you order?

A 
ELectrolytes
Anion Gap
ABG
Serum osmolality 
EKG
Toxic screen - common available drugs
Coags
LFTs
UA
Serum myoglobin 
KUB
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7
Q

What are the 5 treatment principals?

A
  • Provide supportive care
  • Prevent absorption
  • Enhance elimination
  • Interrupt or alter metabolism (Anti-freeze)
  • Provide specific antidotes
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8
Q

What is the old tox drug cocktail?

A
  • Thiamine 100mg (IV) – Vit B - alcoholics that are vitamin deficient can develop Wernicke’s encephalopathy
  • D5W – 50ml (IV) In case they are hypoglycemic
  • Naloxone – 2-8mg IV narcotic antidote
  • Flumazenil – 0.2mg IV Benzo antidote
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9
Q

How does Ipecac work? What is the key to deciding whether or not Ipecac is appropriate?

A

Local gastric irritant and stimulator of the CTZ

Key - When the ingestion occured - Whether the toxin is before or after the pyloric valve

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10
Q

What is the time limit when using Ipecac?

A

Beyond 4-6 hours of time 0 is ineffective unless the toxin itself delays the absorption time

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11
Q

Children younger than ______ are not given Ipecac.

A

6 months

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12
Q

What are the 5 relative contraindications to giving Ipecac?

A
  • Seizure-inducing drugs – seizing + vomiting = aspiration, asphyxiation
  • Rapid coma inducing drugs – same thing
  • Pregnancy process of vomiting causes bradycardia (ACh), which decreases blood flow to the fetus
  • Hydrocarbons (gasoline, oils) - #1 risk is that they can cause aspiration, so do not bring them back up closer to chest
  • Severe bradycardia – patient will pass out
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13
Q

What are the 3 absolute contraindications to using Ipecac

A
  • Children
  • Corrosive
  • Seizing/coma
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14
Q

What is gastric lavage?

A

Passage of a large bore orogastric tube and the administration/aspiration of small volumes of liquid (200-300cc of warm water or saline) for removal of gastric contents.
“Stomach pumping”

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15
Q

Avoid using ______ in children when performing gastric lavage for risk of _________. Only use _____.

A

avoid water for risk of hyponatremia

only use saline

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16
Q

Follow up gastric lavage with _______.

A

activated charcoal

17
Q

Only use gastric lavage in cases where the ingestion occured ____________ prior.

A

1 hour

18
Q

Name a absolute contraindication of gastric lavage.
Name a relative contraindication.
Name the 2 most common AEs.

A

absolute NO - unprotected airway
relative NO - hydrocarbons and corrosive
AEs - aspiration PNA and bradycardia

19
Q

Activated charcoal is emerging as the _____ decontamination produced. It is available _____. It is okay/not to give it when substance is post-pyloric

A

Sole
OTC
okay

20
Q

You need to do WHAT before giving someone activated charcoal (AC). Why?

A

Check for bowel sounds. If patient has ileus, it can lead to toxic megacolon

21
Q

How does AC work? What is the most common AE?

A

Absorbs toxic substances and prevents their absorption in the GI tract.
Constipation

22
Q

What is AC not effective for? MUST KNOW.

A

Heavy metals - irons, lithium, minerals
Alchohols - ethanol, methanol
Hydrocarbons - cyanide, organic solvents

23
Q

Which should you use first…ipecac or charcaol?

A

Ipecac because charcoal will absorb ipecac.

24
Q

When is whole bowel irrigation used?

A
  • In the massive ingestions of of toxic substances in patients presenting late (>4h post-exposure)
  • ingestion of SR drug products
  • ingestion of drug packets by body stuffers
  • ingestion of small foreign bodies (disk batteries)
  • ingestion of substances not removed by activated charcoal.
25
Q

What do you use for whole bowel irrigation?

A

Polyethylene glycol PEG - GoLytely.

26
Q

Is peritoneal dialysis used often for the treatment of toxic ingestions?

A

No - only small, unbound, hydrophilic things can be filtered.

27
Q

What is the advantage of hemofiltration over hemodialysis?

A

Hemofiltration can filter larger things - aminoglycosides, metals, highly PPB toxins.

28
Q

What is the antidote for narcotics?

A

Naloxone

29
Q

What is the antidote for ACh?

A

Diphenhydramine

30
Q

What is the antidote for iron?

A

Desferroxamine

31
Q

What is the antidote for heavy metals?

A

Dimercaprol (BAL)

32
Q

What is the antidote for APAP?

A

N-acetylcysteine

33
Q

What is the antidote for nitrates?

A

Methylene blue

34
Q

What is the antidote for insecticides (nerve gas)?

A

Pralidoxime

35
Q

What is the antidote for cyanide?

A

Sodium thiosulfate

36
Q

What is the antidote for anti-freeze (ethylene glycol)?

A

Ethanol

37
Q

What is the antidote for benzos?

A

Flumazonil

Pharm II exam 1 (4 decks)

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