Toxicology Flashcards
When activated charcoal is used correctly to detoxify a patient, how is the toxicity reduced?
the toxin is absorbed on the large surface area of the charcoal and then excreted in the feces
Why is airway protection essential in the use of activated charcoal?
the charcoal can be aspirated in the lungs and result in death
During what time period should activated charcoal be used?
within 1 hr of toxin ingestion
How does syrup of ipecac decontaminate a patient?
it induces emesis within 20 min of administration
During what time period should syrup of ipecac be administered to be effective? Why?
Within 30 min of toxin ingestion because it will only clear gastric contents
What is the consequence of chronic systemization of syrup of ipecac?
cardiotoxicity
How does a gastric lavage work?
Several liters of water are instilled via a large bore tube and then suctioned out with the contents of the stomach.
*not helpful if contents have already moved in to duodenum
What is the result of whole bowel irrigation?
increased speed of elimination, especially of enteric coated or sustained release products that move quickly into the small intestine
What is whole bowel irrigation contraindicated with?
bowel obstruction, hemorrhage, ileus, hemodynamic instability, intractable vomiting
What types of toxins can effectively be treated with hemodialysis?
- water soluble
- low volume of distribution
- molecular wt <500 Da
- low plasma protein binding
What are some examples of drugs that can be effectively removed by hemodialysis?
methanol, ethylene glycol, salicylates, lithium, sotalol
What is hemoperfusion? What drug characteristic it if useful for?
passage of blood through absorbtive-containing cartridge (charcoal) used to remove substances with high degree of plasma protein binding
What are some examples of drugs that can be removed by hemoperfusion?
carbamazepine, phenobarbital, phenytoin, theophylline
What toxins require quantitative levels to diagnose as toxic?
- acetaminophen
- carbon monoxide
- ethanol, ethylene glycol
- heavy metals
- iron
- methanol
- methemoglobin
What toxins require quantitative serial levels to diagnose as a toxin?
aspirin/ salicylates, tegretol, digoxin, penobarbital, phenytoin, valproic acid, theophylline
How are the vitals (RR, HR, BP, temp) changed in adrenergic excess?
rr: increased
hr: increased
bp: increased
temp: increased
How are the vitals (RR, HR, BP, temp) changed in anti-cholinergic excess?
rr: NC
hr: increased
bp: NC/increased
temo: increased
How are the vitals (RR, HR, BP, temp) changed in cholinergic excess?
rr: NC/ increased
hr: decreased
bp: NC/increased
temp: NC
How are the vitals (RR, HR, BP, temp) changed in opioid excess?
rr: decreased
hr: NC/ decreased
bp: NC/decreased
temp: NC/decreased
How are the vitals (RR, HR, BP, temp) changed in sedative/hypnotic excess?
rr: NC/decreased
hr: NC
bp: NC
temp: NC
How are the vitals (RR, HR, BP, temp) changed in serotonergic excess?
rr: increased
hr: increased
bp: increased
temp: increased
What are the result of the physical exam (mental status, pupils, mucus membranes, skin, reflexes, bowel sound, urine output) changes in adrenergic excess?
mental: alert/ agitated
pupils: dilated
mucus mem: wet
skin: diaphroetic
reflex: increased
bowel sound: increased
urine output: increased
**possible seizures
What are the result of the physical exam (mental status, pupils, mucus membranes, skin, reflexes, bowel sound, urine output) changes in anti-cholinergic excess?
mental: depressed/ confused/ hallucinating
pupils: dilated
mucus mem: dry
skin: dry
reflex: normal
bowel sound: decreased
urine output: decreased
**possible seizures
What are the result of the physical exam (mental status, pupils, mucus membranes, skin, reflexes, bowel sound, urine output) changes in cholinergic excess?
mental: depressed/ confused
pupils: constricted
mucus mem: wet
skin: diaphoretic
reflex: normal/ decreased
bowel sound: increased
urine output: increased
**muscle fasciculations/vomiting
