Toxicology Flashcards
Risks of Exposure
- To what agents are children exposed to at home?
- What are safe levels and durations of exposure, if they exist?
- Accidental versus intentional?
Environmental Exposure
- Methyl Mercury
- Ethyl Alcohol
- Lead
Anticholinergics Overdose side effects (7) and mnemonic
- Increased BP
- Increased HR
- Increased temperature
- Delirium
- Increased pupils
- Decreased peristalsis
- Decreased diaphoresis
– Blind as a bat – Mad as a hatter – Red as a beet – Hot as a hare – Dry as a bone
Cholinergics overdose side effect (4) and SLUDGE mnemonic
- Increased RR
- Increased peristalsis
- Increased diaphoresis
- Decreased pupils
– S Salivation – L Lacrimation – U Urination – D Diarrhea – G Gastrointestinal Distress – E Emesis
Cholinergics
DUMBBELLS
– D Diarrhea – U Urination – M Miosis – B Bradycardia – B Bronchospasms – E Emesis – L Lacrimation – L Lethargy – S Salivation and Seizures
Ethanol overdose side effects (6) and mnemonic
SAMS GIN
- Decreased BP
- Decreased HR
- Decreased RR
- Decreased temp
- Depressed
- Decreased peristalsis
– S Slurred speech
– A Attention impairment
– M Memory impairment
– S Stupor or coma
– G Gait unsteady
– I Incoordination
– N Nystagmus
Opioid overdose side effects (7) and SAD mnemonic
- Decreased BP
- Decreased HR
- Decreased RR
- Decreased temp
- Decreased pupils
- Decreased peristalsis
- Depressed
– S Slurred speech
– A Attention impairment
– D Drowsiness
Ethanol Withdrawal symptoms (8) and PAST NITE mnemonic
- Increased BP
- Increased RR
- Increased HR
- Increased Temp
- Agitated
- Increased pupils
- Increased peristalsis
- Increased diaphoresis
– P Psychomotor agitation
– A Anxiety
– S Seizures
– T Transient hallucinations
– N Nausea or vomiting
– I Insomnia
– T Tremor
– E Excitability
Opioid Withdrawal symptoms (6) and ARMY FINDS mnemonic
- Increased BP
- Increased HR
- Agitated
- Increased pupils
- Increased peristalsis
- Increased diaphoresis
– A Aches
– R Rhinorrhea
– M Mood disorders
– Y Yawning
– F Fever – I Insomnia – N Nausea or vomiting – D Diarrhea – S Sweating
Anion Gap Acidosis Mneumonic for causes
MUD PILES – M Methanol – U Uremia – D Diabetic ketoacidosis – P Propylene glycol – I Isoniazid – L Lactic acidosis – E Ethylene glycol – S Salicylates
GI Decontamination
NOT the standard of care for all patients; don’t do it without poison center or toxicology consult
Considerations
- Type of ingestion
- Quantity and amount of ingestion
- Patient age/weight
- Other precluding medication conditions
Available Agents
- Ipecac syrup
- Activated charcoal –> used more often
Antidotes (4)
Should be used judiciously
– Agent/agents ingested confirmed
– Highly suspected and consistent with toxidrome
– High potential for morbidity or mortality without administration of antidote
– Reversal benefits outweigh the risks
Naloxone (Narcan)
USE
MOA
Use: opioid toxicity & opioid induced itching at low cont. infusions
Mechanism of Action
- Opioid antagonist, directly inhibits opioids from binding to mu-receptor
Naloxone (Narcan)
Dosage forms
PK
Caution
Dosage forms available
- IV/IM
- Nasal spray (4 mg dose)
PK:
- Quick onset and duration
Caution with rapid reversal especially if someone is truly in pain
N-acetylcysteine (NAC, Mucomyst®)
Use
MOA
Dosage forms
Beneficial if…
Use: acetaminophen toxicity
Mechanism of Action
- Free radical scavenger
- Repletes the glutathione
Dosage forms:
- IV
Most beneficial if used within 8 hours of ingestion
Physostigmine Antidote for what? MOA Dosage Monitor...
Anticholinergic antidote
MOA
- Acetylcholinesterase inhibitor
Dosage form: IV
Must monitor heart rate, respiratory rate, and ECG
Fomepizole Antidote (2)
MOA (2)
Antidote for ethylene Glycol and Methanol
MOA
- Competitive alcohol dehydrogenase inhibitor
- Allows for elimination of alcohol
*Alcohol dehydrogenase inhibitor; It can treat accidental poisoning caused by anti-freeze (ethylene glycol) or methanol.
Flumazenil
Antidote
MOA
Give in what kind of settings?
Antidote for benzodiazepines
MOA
- Competitive benzo/GABA receptor antagonist
Give in controlled setting
- Seizures may be precipitated
- *Good for significant respiratory depression but also lowers seizure threshold
What is a REMS program? (include 4 types)
Definition:
Risk Evaluation and Mitigation Strategies (REMS); strategy used to minimze risks
Types
1. Medication guide –> all patients must have the medication guide if it is required
- Communication Plan –> discuses drug wtih patient
- Elements to Assure Safe Use –> drug company comes up with a plan to do this
- Implementation –> how the drug company oversees drug risks and safe usage
Teratogens Birth Defect (3)
- Physical/structural, function, or metabolic abnormality in an embryo or fetus
- Results in physical or mental disability
- Or is fatal
Teratogens
Deformation (2)
- Structural or functional developmental abnormality
- Resulting from physical forces acting on the fetus
Teratogens Developmental Hazard (2)
- Chemical, biological, or physical agent that produces developmental disease
- Happens when exposure occurs prior to conception or following conception
Teratogen
- Chemical, physical, or biological agent
- Capable of producing a disruption in an embryo or fetus
Birth Defects (5)
Death Structural abnormalities Functional abnormalities Alteration of growth Premature birth
Structural Malformation
At least 75 chemicals and medications implicated
May result in:
- Loss of limbs
- Addition of limbs
- Abnormal shape of body and/or appendages
Functional Abnormalities (2)
- Increased recognition that agents may produce functional abnormalities in addition to structural abnormalities
- Behavior, intelligence, performance may be involved
Alteration of Growth (3)
- Includes birth weight and rate of weight gain after birth
- Sensitive indicator of insults during pregnancy and early postnatal development
- Not specific to chemical exposure
Anticonvulsants
Major defects (3) Implicated AEDs (4)
Risk of defects varies with number and kind of
AED used
Major defects
- Spina bifida
- Oral clefts
- Cardiovascular defects
Implicated AEDS:
- Phenytoin/fosphenytoin
- Valproic acid
- Phenobarbital
- Rufinamdie (Banzel®)
ACE Inhibitors (2)
- Reduced renal blood flow and inhibition of renal development
- Risk of toxicity LOWER in the first trimester
Warfarin (Coumadin®) risks for (3)
Risk for:
- Nasal hypoplasia
- Limb hypoplasia (first trimester)
- Ventral/dorsal midline dysplasia (2nd/3rd trimester)
