Toxicology Flashcards
5 Management Steps
Supportive: ABCs
ID harmful agent
Prevent further absorption; get out of danger area or remove poisonous thing
Removal of poison; hemodialysis/increase excretion
Specific antidotes; counteract or reverse
Activated Charcoal
IND: Acute poison, preferred method to remove ingested toxic agents
MOA: Irreversible adsorbs to toxic substances and prevents GI absorption. Increases excretion
BOX: n/a
CON: GI obstruction or perforation, unprotected airway.
Binds to antidotes too, administer 30-60min after
ADR: Black stool/discoloration of mucosa and vomit. Constipation, abdominal distension
Gastric Lavage and Aspiration
Flush stomach with fluid and aspirating the fluid back out with a tube. ONLY done for life threatening cases and under 1 hour of ingestion
Whole Bowel Irrigation
Large doses of polyethylene glycol solution. Useful for sustained release products, iron, lithium, and lead
Surface Decontamination
Minimizes injury from topical agents with soap, water, alcohol based agents. Also wash hair and remove clothes
Sodium Bicarbonate
Alkalinizes the urine and promotes organic acids (aspirin/phenobarbital) to be excreted via kidneys
Hemodialysis/Hemoperfusion/Exchange Transfusion
Limited value, can be life saving
Deferoximine
IND: Acute Fe poisoning or Fe overload from blood transfusion
MOA: Chelating agent; binds to ion and eliminated by kidney
BOX: n/a
CON: Renal disease or anuria
ADR: Infusion related reactions; similar to IV Fe products.
Deferasirox and Deferiprone are oral options for chronic Fe overload d/t chronic blood transfusions
Dimercaprol
IND: Antidote for gold, arsenic, mercury, and lead poisoning
MOA: Chelation with ions, eliminated by kidneys. Early administration is crucial, as this agent is better at preventing the binding than it is reversing
BOX: n/a
CON: Hepatic insufficiency (except in arsenic cases)
ADR: Transient tachycardia and hypertension
Edetate Calcium Disodium
IND: Lead poisoning
MOA: Chelates with lead to form a stable bond and eliminate thru kidneys
BOX: Cerebral edema. Pts with lead encephalopathy and cerebral edema can experience a lethal increase in ICP. IM route preferred.
CON: Active renal dz or anuria, hepatitis
ADR: Renal tubular necrosis, monitor for hematuria or proteinuria; d/c immediately if these effects develop
Fomepizole
IND: Ethylene Glycol (antifreeze) and methanol toxicity. Metabolic acidosis is the killer.
MOA: Competitively inhibits alcohol dehydrogenase.
BOX: n/a
CON:
ADR: HA, nausea
Acetylcysteine
IND: Acetaminophen OD, mucolytic
MOA: Restores hepatic glutathione, enhancing the nontoxic sulfate conjugation of acetaminophen. Hepatoprotective.
BOX: n/a
CON:
ADR: Infusion related reactions
Idarucizumab
IND: Dabigatran Reversal, to stop bleeding
MOA: Monoclonal Antibody that binds specifically to dabigatran. Neutralizes the anticoagulant within minutes with full hemostasis restoration around 11 hours
BOX: n/a
CON: n/a
ADR:n/a
Andexanet Alfa
IND: Life threatening bleed associated with apixaban or rivaroxaban. Very expensive.
MOA: Binds and sequesters Xa inhibitors
BOX: Increased risk of thromboembolic disorder, ischemic risk, cardiac arrest, and death
CON: n/a
ADR: Infusion related rxn. Antibody development
Prothrombin Complex Concentrate
IND: Bleeding, treatment and prophylaxis from vitamin K antagonist. Off label: other anticoagulants
MOA: Human blood product that contains clotting factors 2, 7, 9, and 10, as well as protein C and S; components related to Vit K dependent coagulation factors
BOX: Increased risk of VTE
CON: Disseminated Intravascular Clotting (DIC)
ADR: n/a
