Toxicology Flashcards
What is the number for the poison control center?
1-800-222-1222
What are the important aspects when determining toxicity?
- what was ingested
- when and how much was ingested
- other non-drug ingestions
What are the general treatments for all toxicology?
- crystalloid fluids
- activated charcoal (1-2h of ingestion)
- HD
What are s/s of anticholinergic toxicity?
- confusion
- tachycardia
- decreased urine output
- dry mouth
- flushed skin
- dilated pupils
What agents cause anticholinergic toxicity?
- antihistamines
- TCAs
- SSRIs
- antipsychotics
- muscle relaxants
- H2RAs
What are the common causes of cholinergic toxicity?
- organophaoshates
- pyridostigmine
What are s/s of sympathomimetic toxicity?
- agitation
- mydriasis
- tachycardia, HTN
- hyperthermia, diaphoresis
What doses of Tylenol are considered toxic?
- > 7.5 g in adults
- > 150mg/kg in children
What are the outcomes of congestion of ethanol with Tylenol?
can be protective and or harmful, ethanol inhibits CYP2E1
What is the toxic metabolite of Tylenol?
NAPQI
What must be true of Tylenol ingestion to use Rumack Matthew Nomogram?
- must be IR product
- acute, single-dose ingestion
- between 4 and 24 hours after ingestion
How is Tylenol ingestion treated if Rumack Matthew Nomogram cannot be used?
treat if signs of liver damage (AST, ALT. T.bili, INR)
What is the dosing of IV NAC for tylenol toxicity?
150 mg/kg over 1 h
50 mg/kg over 4 hours
100 mg/kg over the next 16h
What is the dosing of PO NAC for tylenol toxicity?
140 mg/kg loading dose
70 mg/kg orally every 4 h
Total of 18 doses in 72 h
What are s/s of aspirin toxicity?
Triad of hyperventilation, tinnitus, GI irritation
What are treatments for aspirin toxicity?
- activated charcoal
- sodium bicarbonatee
- HD
What is the MOA of Warfarrin?
inhibits synthesis of vitamin K-dependent clotting factors (2,7,9,10)
How is Warfarin toxicity reversed?
1st give: 4 factor prothrombin concentrate complex (KCENTRA, BALFAXAR)
then give: IV Phytonadione (vit K) diluted over 30 min
What is the MOA of Andexxa?
Andexxa- binds and sequesters Xa inhibitors (Rivaroxaban, Apixaban, Edoxaban)
What agents are used to treat anti Xa toxicity?
- PCC factors- KCNETRA
- factor 8 inhibitor bypass activator FEIBA
How is Dabigitran (thrombin inhibitor) toxicity reversed?
Idarucizumab PRAXBIND
How is unfractionated heparin toxicity reversed?
Protamine
How is LMWH toxicity reversed?
- protamine
- Andexxa?
How is CCB toxicity reversed?
- activated charcol (1-2h)
- Vasopressors (DA and NE/E)
- Calcium
- lipids (diltiazem, verapamil)
- High Dose Insulin Euglycemia Therapy
- ECMO
How is beta blocker toxicity reversed?
- activated charcol (1-2h)
- Vasopressors (DA and NE/E)
- Calcium
- lipids (diltiazem, verapamil)
- High Dose Insulin Euglycemia Therapy
- ECMO
- Glucagon
How is sulfonylurea toxicity reversed?
- octreotide
How is methanol and ethylene gycol toxicity reversed?
Fomepizole +/- folic acid
How is digoxin toxicity reversed?
Dogoxin Specific Antibody Fragment (DigiFab, DigiBind)
How is benzo toxicity reversed?
Flumazenil
How is cyanide toxicity reversed?
Hydroxocobalamin (CyanoKit)
AND
sodium thiosulfate
How is serotonin syndrome toxicity reversed?
Cyproheptadine
How is TCA toxicity reversed?
sodium bicarbonate
How is bupropion toxicity reversed?
IR: charcoal
ER: bowel irrigation
AND symptom based treatment
