Toxicology Flashcards
Opioids addiction is treated with:
Methadone & buprenorphine: suppress withdrawal symptoms and relieve cravings.
naltrexone (Vivitrol®):Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified
Early symptoms of aspirin poisoning are:
Ringing in the ear and blurred vision
Antidote for warfarin:
vit k (the other name of it phytomenadion)
Alternative names of Vit. K (Phylloquinone; K1;) (Menaquinone; K2;) (Menadione; K3)
……………….. causes mydriasis while …………….. & …………….. causes miosis aka pin point pupil
…cocaine…. causes mydriasis while …..Heroin… & …morphine …. causes miosis aka pin point pupil
For a 4 year old child, the maximum daily dose of paracetamol is:
1.2g
while adults: 4 g
is extracted from the leaves of the coca plant (Erythroxylum coca)
Cocaine
MOA of Cocaine
- indirect sympathomimetic agent, blocks the presynaptic re-uptake of serotonin and catecholamines (ie, dopamine, norepinephrine, and epinephrine) from their adrenergic receptors.
- “Negative inotropy”***. Sodium (Na+) channel blockade – Cocaine slows or blocks nerve conduction and acts as a local anesthetic by altering the recovery of the neuronal Na+ channels. During overdose: it manifest in ECG as prolongation of QRS complex.
- Increases the concentration of the excitatory amino acids glutamate and aspartate in the brain. Glutamate is the main excitatory neurotransmitter of the CNS.
**Negative inotropes weaken the heart’s contractions and slow the heart rate.
The euphoric properties of cocaine derive from the inhibition of neuronal ……………………………. reuptake in the central nervous system, while addiction has been linked to effects on ………………………………..
The euphoric properties of cocaine derive from the inhibition of neuronal serotonin reuptake in the central nervous system, while addiction has been linked to effects on dopamine reuptake
Heroin & Morphine
act at one of the 3 main opioid receptor systems (mu, kappa, delta).
Heroin is a derivative of morphine.
Opium – Opium, extracted from the opium poppy, and containing morphine and codeine.
Miosis, constipation
False-positive opiate drug screens have been reported in patients taking rifampin and quinolones:
True
False
True
The chemical name for heroin is
diacetylmorphine
Synthetic opioids include
fentanyl, tramadol, and methadone.
semi-synthetic opioids
Oxycodone and hydrocodone
approach to digoxin toxicity:
Serum levels:
The therapeutic range is 0.8 to 2 ng/mL (1 to 2.6 nmol/L). The serum digoxin concentration does not necessarily correlate with toxicity.
IV: 4 hours after the last dose
Oral: 6 hours after the last oral dose
**For an acute overdose, obtain a serum concentration measurement on presentation and approximately six hours after the ingestion
Treatment:
1.Antidote: Digibind (One vial binds approximately 0.5 mg of digoxin) Empiric treatment consists of:
10 vials of digoxin Fab fragments for adults or
5 vials for children.
Several electrolyte abnormalities increase patient susceptibility to the toxic effects of digoxin such as:
hypokalemia, hypomagnesemia, and hypercalcemia,
Theophylline
narrow clinical therapeutic index.
phosphodiesterase inhibitor
used as bronchodilator in asthmatic and treat bradycardia in newborns
acute toxicity (eg, vomiting) may occur with ingested or administered doses as low as 7.5 mg/kg
Mechanism of Theophylline toxicity:
Phosphodiesterase inhibition increases levels of cyclic adenosine monophosphate which augments beta-adrenergic effects. Adrenergic hyperstimulation results in the metabolic abnormalities frequently seen with theophylline intoxication Excess catecholamines may also predispose to arrhythmias as well as contribute to hypotension through beta-adrenergic mediated vasodilatation.
Signs of Theophylline toxicity:
Seizures
Hypokalemia
hyperglycemia
metabolic acidosis
the following change color of the urine to red:
Rifampin
Nitrofurantoin
Iron antidote
Defroxamine
TCA (amitripy) antidote
NAHCO3
ASA antodite
N-acetyl cysteine
Nerve gases and organophospohorus antodote
Atropine followed by Pralidoxime
OPOID antidote (morphine, Codeine, Heroin and Fentanyl)
NAloxone, Nalmefene
