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Spring 15 - Pharm Unit IV > Toxicology > Flashcards

Toxicology Flashcards

1
Q

What is a toxin?

A
  • a poisonous substance

- anything can be a toxin (based on route, dose, duration of exposure)

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2
Q

What is a toxidrome?

A

-constellation of physical findings (syndrome) that supports the clinical diagnosis of poisoning (exposure to a toxin)

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3
Q

Toxidrome with Decreased PNS

A

anti-cholinergic

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4
Q

Toxidrome with Increased PNS

A

cholinergic

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5
Q

Toxidrome with Decreased CNS

A

opiate/sedative

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6
Q

Toxidrome with Increased CNS

A

sympathomimetic

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7
Q

Toxidrome with Altered PNS and CNS

A

serotonin syndrome

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8
Q

What are some cholinergic agents that might cause poisoning?

A
  • organophosphates (pesticides and commercial/industrial products)
  • carbamates (home cleaning products)
  • some mushrooms
  • nerve agents (Sarin)
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9
Q

Symptoms of Cholinergic Toxidrome

A
  • SLUDGE: salivation, lacrimation, urination, diarrhea, GI complaint, emesis
  • miosis
  • bronchorrhea
  • bradycardia or tachycardia
  • mydriasis
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10
Q

What muscarinic symptoms are present in cholinergic toxidrome?

A
  • diarrhea, urination
  • miosis
  • bronchorrhea
  • bradycardia
  • emesis
  • lacrimation, salivation
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11
Q

What nicotinic symptoms are present in cholinergic toxidrome?

A
  • mydriasis
  • tachycardia
  • weakness
  • HTN
  • fasciculations
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12
Q

What central effects are present in cholinergic toxidrome?

A
  • agitation, anxiety
  • coma
  • confusion
  • seizure
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13
Q

Symptoms of Anti-Cholinergic Toxidrome

A
  • hot as a hare (hyperthermia)
  • blind as a bat (blurred vision, mydriasis)
  • dry as a bone (impaired sweating)
  • red as a beet (flushing)
  • mad as a hatter (agitation, psychosis, delirium, coma)
  • bloated as a bladder (urinary retention)
  • also tachycardia, HTN, muscle fasciculations, seizure, ileus
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14
Q

What are some anti-cholinergic agents that might cause a toxidrome?

A
  • anti-cholinergics (scopolamine, atropine)
  • anti-histamines
  • anti-psychotics (Haldol)
  • anti-emetics (compazine, phenergan)
  • antidepressants (TCA, SSRI)
  • plants (Jimson weed, deadly nightshade)
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15
Q

What are some anti-cholinergic agents that might cause a toxidrome?

A
  • anti-cholinergics (scopolamine, atropine)
  • anti-histamines
  • anti-psychotics (Haldol)
  • anti-emetics (compazine, phenergan)
  • antidepressants (TCA, SSRI)
  • plants (Jimson weed, deadly nightshade)
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16
Q

What are some opiate/sedatives that might cause a toxidrome?

A
  • morphine, heroin, oxycodone, codeine, methadone
  • barbiturates
  • benzodiazepines
  • ethanol
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17
Q

Symptoms of Opiate/Sedative Toxidrome

A
  • everything is turned down (turns OFF flight/fight)
  • miosis
  • bradycardia, HoTN
  • decreased LOC, coma
  • decrease RR/effort
  • hypotonia, hyporeflexia
  • decreased bowel sounds
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18
Q

What are some sympathomimetic agents that might cause a toxidrome?

A
  • cocaine, amphetamine, MDMA (ecstasy), PCP
  • ephedrine, pseudoephedrine
  • theophylline
  • caffeine
  • withdrawal from EtOH or benzodiazepines
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19
Q

Symptoms of Sympathomimetic Toxidrome

A
  • everything turned up (exaggerates fight/flight)
  • hyperthermia
  • HTN, tachycardia
  • mydriasis
  • urinary retention
  • psychosis, seizure
  • diaphoresis
  • hyperactive bowel sounds
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20
Q

How can you distinguish anti-cholinergic and sympathomimetic toxidromes?

A
  • sympathomimetic will have sweating and hyperactive bowel sounds
  • anti-chol CAN’T sweat and might develop paralytic ileus
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21
Q

How can you distinguish anti-cholinergic and sympathomimetic toxidromes?

A
  • sympathomimetic will have sweating and hyperactive bowel sounds
  • anti-chol CAN’T sweat and might develop paralytic ileus
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22
Q

What might cause serotonin syndrome?

A
  • MAOIs, linezolid
  • SSRIs, cocaine, dextromethorphan, TCAs, trazodone, meperidine, tramadol
  • LSD, buspirone
  • lithium, amphetamines, MDMA
23
Q

Symptoms of Serotonin Syndrome

A
  • cognitive/behavioral: confusion, agitation, coma, anxiety, hypomania, lethargy, seizures
  • neuromuscular: hyperreflexia, muscle rigidity, tremor, ataxia, shivering, nystagmus
  • autonomic: hyperthermia, diaphoresis, sinus tachycardia, HTN, tachypnea, non-reactive pupils
24
Q

What are the first 2 steps in treating a poisoned patient?

A
  • stabilize the patient (BLS, ALS)

- ABCs

25
Q

What labs should you consider for poisoned patient?

A
  • CBC, coags, LFTs, CPK, ABG/VBG
  • UA, urine tox
  • serum levels: salicylate, APAP, digoxin
26
Q

Treatment of Cholinergic Overdose

A
  • atropine: indicated in all cholinergic crisis pts; repeat every 5 minutes until secretions clear
  • pralidoxime (2 PAM): for organophosphate poisoning and other cholinergic crisis with severe weakness and respiratory compromise
27
Q

Treatment of Anti-Cholinergic Overdose

A
  • diazepam
  • repeat PRN
  • manage anxiety/agitation
  • hyperthermia: cool mist, ice, cooling blanket, fans
28
Q

Treatment of Opiate/Sedative Overdose

A
  • naloxone: may need to repeat often, higher doses needed for methadone OD
  • flumazenil: usually reserved for pts WE overdose; will induce seizures in abusers and those who use it therapeutically
29
Q

Treatment of Sympathomimetic Overdose

A
  • diazepam

- cooling

30
Q

Treatment of Serotonin Syndrome

A
  • diazepam
  • cooling
  • antipyretics
  • cyproheptadine: serotonin antagonist; does not decrease duration, but can reduce severity of sxs
31
Q

What are the options for GI decontamination? (list them)

A
  • activated charcoal
  • gastric lavage
  • whole bowel irrigation
32
Q

Activated Charcoal:
When is it effective?
What is it not effective for?
When is it contraindicated?

A
  • most effective within first hour
  • not effective for iron, lead, lithium, alcohols, corrosives
  • contraindicated in pts who are high risk for aspiration
33
Q

What is Gastric Lavage?

A

-2-4 liters of warmed saline into stomach

34
Q

Risks of Gastric Lavage

A

-risks: hypothermia, electrolyte imbalance, mechanical damage to esophagus, aspiration)

35
Q

CIs of Gastric Lavage

A

-CI unless pt has a protected airway; CI for hydrocarbons and corrosives

36
Q

What is whole bowel irrigation?

A

-polyethylene glycol passed through GI track

37
Q

Indications for WBI

A

-for extended release meds and those that do not bind charcoal

38
Q

CIs for WBI

A
  • GI bleeding
  • ileus
  • obstruction
  • perforation
39
Q

CIs for WBI

A
  • GI bleeding
  • ileus
  • obstruction
  • perforation
40
Q

APAP Toxicity

A
  • primary cause of acute liver failure in US
  • pts may be asymptomatic at first
  • progresses to liver damage with hypoglycemia, jaundice, scleral icterus, hepatomegaly
41
Q

Tx of APAP Toxicity

A

N-acetylcysteine

42
Q

Initial Management of Anticholinesterase Insecticides

A
  • decontaminate first! (these products can absorb through skin)
  • ABCs
  • protect the airway (high risk of decreased resp drive)
43
Q

Treatment of Anticholinesterase Insecticides

A
  • atropine: for all symptomatic pts; not a reversal agent

- pralidoxime: for pts with severe toxicity

44
Q

Calcium Channel Blocker Overdose Symptoms

A
  • vasodilation
  • decreased cardiac contractility
  • decreased conduction velocity
  • impaired insulin release leads to hyperglycemia and impaired cellular metabolism
45
Q

Interventions for CCB Overdose

A
  • IV calcium chloride for pts with persistent HoTN, arrhythmias
  • infusion of insulin and dextrose can correct metabolic disturbance
  • close monitoring of blood glucose, serum K+, calcium, acid/base balance
  • glucagon
  • intralipid
46
Q

Iron Toxicity Sxs

A
  • intense GI distress: N/V/D
  • period of relative improvement or absence of sxs
  • progression w/ continued GI symptoms, poor perfusion and decreased urine output
  • also hepatic injury, hypoglycemia, acidosis, seizure, coma, ARDS
47
Q

Treatment of Iron Toxicity

A
  • ABCs, supportive care, airway, fluid resuscitation

- IV deferoxamine

48
Q

What is deferoxamine?

A
  • highly selective iron chelator

- removes excess iron from circulation

49
Q

What are AEs of IV deferoxamine administration?

A
  • HoTN
  • tachycardia
  • shock
  • exacerbate ARDS
50
Q

What are AEs of IV deferoxamine administration?

A
  • HoTN
  • tachycardia
  • shock
  • exacerbate ARDS
51
Q

TCA Toxicity Sxs

A
  • QRS widening, AV block, ventricular tachy, decreased contractility
  • vasodilation, HoTN
  • urinary retention, ileus, dry mucus membranes, hyperthermia
  • agitation, delirium, lethargy, coma, seizure
52
Q

TCA Toxicity Sxs

A
  • QRS widening, AV block, ventricular tachy, decreased contractility
  • vasodilation, HoTN
  • urinary retention, ileus, dry mucus membranes, hyperthermia
  • agitation, delirium, lethargy, coma, seizure
53
Q

Treatment of TCA Overdose

A
  • ABCs, supportive care

- BICARB BICARB BICARB

Spring 15 - Pharm Unit IV (11 decks)

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