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Pharm II: Exam 1 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

What are some drug classes that may cause Mydriasis (dilated pupils)?

A
  • Adrenergic agonists
  • Anticholinergics
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2
Q

What are some drug classes that may cause Miosis (constricted pupils)?

A

Sympatholytics Cholinergics

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3
Q

What information is pertinent for history?

A
  • Substance ingested
  • Amount ingested
  • Time since ingestion
  • Symptoms
  • Prior therapies
  • Prior medical conditions
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4
Q

Would you prefer quantitative or qualitative labs for patients with possible toxic conditions? Why?

A

Quantitative; Want to assess poison concentration in tissues (useful for poisons with antidotes or need for dialysis)

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5
Q

What are some helpful labs to order for a patient with possible toxic conditions?

A

Chem 7 Arterial Blood Gases

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6
Q

What are NORMAL Arterial Blood Gases levels?

A

pH: 7.35-7.45 PO2 90-100 PCO2: 35-45 HCO3: 18-24

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7
Q

What are ABG levels for Metabolic Acidosis?

A

pH: BELOW NML PO2: NML PCO2: NML HCO3: BELOW NML

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8
Q

What are ABG levels for Respiratory Acidosis?

A
  • pH: BELOW NML
  • PO2: BELOW NML
  • PCO2: ABOVE NML
  • HCO3: NML
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9
Q

What are ABG levels for Metabolic Alkalosis?

A
  • pH: ABOVE NML
  • PO2: NML
  • PCO2: NML
  • HCO3: ABOVE NML
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10
Q

What are ABG levels for Respiratory Alkalosis?

A

pH: ABOVE NML

PO2: ABOVE NML

PCO2: BELOW NML

HCO3: NML

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11
Q

Why are qualitative labs important for patients with possible toxicity? What labs/imaging are involved?

A

Provide confirmation if toxin is present; Urinary Toxicology Screen, Radiograph (radioopaque compounds)

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12
Q

What are management strategies for patients with known toxins?

A
  • Supportive Care
  • Prevent Further Absorption
  • Enhance Elimination
  • Provide Antidote (if available)
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13
Q

What might supportive care entail for a patient with known toxin?

A
  • ABC’s
  • Monitor complications
  • Assess and treat for shock
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14
Q

T or F: Patients with known toxin and altered mental status should be provided with supportive care.

A

F

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15
Q

What are characteristics of HYPOVOLEMIC shock? How should this condition be pharmacologically treated?

A

Loss of fluid, DEC CO due to DEC’d preload; Fluids, inotropes/vasopressors

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16
Q

What are characteristics of CARDIOGENIC shock? How should this condition be pharmacologically treated?

A

DEC’d CO due to DEC’d SV (typically due to DEC in myocardial contractility); Iron, calcium channel blocker, beta-blockers, cyclic anti-depressants

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17
Q

What are characteristics of DISTRIBUTIVE shock?

A

Redistribution of blood from central compartment to peripheral vasculature

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18
Q

What are considerations in prevention of further absorption?

A
  • Route of Exposure (Inhalation, Dermal, Ocular, Ingestion)
  • Benefits of gasterointestinal decontamination
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19
Q

What could be interventional in preventing further absorption of toxin from INHALATION?

A
  • Fresh air
  • Oxygen
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20
Q

What could be instrumental in preventing further absorption of toxin from DERMAL exposure?

A
  • Irrigation with water
  • Removal of contaminated clothing
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21
Q

What could be instrumental in preventing further absorption of toxin from OCULAR exposure?

A
  • Eye irrigation
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22
Q

What could be interventional in preventing further absorption of toxin from INGESTION?

A
  • Emetic
  • Lavage
  • Activated Charcoal
  • Whole Bowel Irrigation
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23
Q

What is clinically benefical about GI decontamination?

A

Can REDUCE poison bioavailabilty, HOWEVER no improvement in morbidity or mortality (Likely patients with greatest risk will recieve most benefit)

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24
Q

What are general INDICATIONS for GI Decontamination?

A
  • Substantial risk of serious toxicity
  • Recent ingestion
  • Can be performed safely and will work
  • No alternative
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25
Q

What are general CONTRAINDICATIONS for GI Decontamination?

A
  • Rapid onset of Seizures
  • Rapid onset of CNS depression
  • Alkaline corrosives (acids controversial)
  • Loss of Gag reflex
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26
Q

T or F: Emesis has similiar general indication and contraindications as GI Decontamination.

A

T; Additional contraindications: ingested sharp objects, hemorrhagic DX

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27
Q

When is Emesis typically used?

A

Rural settings with >1 hour delay to Emergency Department

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28
Q

What medications are used for emesis?

A

Syrup of Ipecac

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29
Q

What onset time for Syrup of Ipecac?

A

15-20 min (95% vomit in 20 minutes with 30% reduction in toxin bioavailabilty within 1 hour)

30
Q

What is Lavage?

A

Orogastric retrieval of substance

31
Q

T or F: Lavage can DEC the bioavailabilty by 30%, similiar to Emesis, within 1 hour

32
Q

How do you know Lavage fluid is at end point?

A

Saline returns clear

33
Q

Though similiar indications and contraindications to GI Decontamination and Emesis, what are some exceptions to the previous contradindications listed for lavage intervention?

A

Can be used on patients:

  • If intubated and cuffed with endotrachial tray with CNS depression
  • If seizures are controlled and patient is intubated
34
Q

T or F: Can lavage patients with underlying esophageal/stomach pathologies.

35
Q

What are some ADRs for using Lavage?

A
  • Aspiration
  • Esophagea/gastric bruising
  • Fluid/electrolyte imbalance
  • EKG changes
  • Hypoxia
  • Esophageal rupture
36
Q

What will Activated Charcoal (AC) not bind to?

A
  • Low molecular weight
  • Charged compounds
  • Highly concentrated solutions
37
Q

What is the efficacy of Activated Charcoal (AC)? (within 1 hour)

A

40% reduction in bioavailability within 1 hour

38
Q

What are the purpose of cathartics?

A

Promote movement of AC bound drug through GI tract (May cause hypovolemia and electrolyte imbalance)

39
Q

What are ADRs of Activated Charcoal?

A
  • Vomiting
  • Constipation
  • Aspiration
  • GI obstruction
  • Charcoal empyema (collection of charcoal in a cavity)
  • GI perforation
40
Q

What is Whole Bowel Irrigation reserved for?

A
  • Substances not absorbed to AC
  • Very large ingestions
  • Significant GI hemorrhage
  • Intestinal obstruction
  • Unprotected airway
  • Hemodynamic instability
41
Q

What solutions are used for Whole Bowel Irrigation?

42
Q

What are INDICATIONS for enhancing elimination?

A
  • Impaired nml route of elimination
  • Severe presentation
  • Progressive deterioration despite full supportive care
  • Significant toxicity expected
43
Q

What are method to enhancing elimination?

A
  • Muliple dose AC
  • Ion trapping
  • Hemodialysis
  • Forced diuresis
  • Exchange transfusions
44
Q

What are INDICATIONS for Multiple Dose AC? (Think different drug ODs)

A
  • Phenobarbital OD
  • Carbamazepine OD
  • Theophylline OD
45
Q

What are CONTRAINDICATIONS for Multiple Dose AC?

A
  • Ileus obstruction
  • Intestinal obstruction
  • Unprotected airway
46
Q

What are ADRs for Multiple Dose AC?

A
  • Pulmonary aspiration
  • Constipation Fluid
  • Electrolyte imbalance
47
Q

What happens during ion trapping?

A

Change in pH of urine to ionize poison preventing reabsorption (Administer Sodium Bicarb to INC pH >7)

48
Q

What are properties of a GOOD antidote?

A
  • Completely reverses or neutralizes the effects of the poison
  • No action of its own
  • Easy to administer
  • No unpleasant side effects
49
Q

What are Chelators?

A
  • Small molecules that bind very tightly to metal ions.
  • Some chelators are simple molecules that are easily manufactured.
50
Q

What chelators could be used in the prescence of As (Arsenic)?

A
  • Dimercaprol
  • Penicillamine
  • DMSA (Succimer)
51
Q

What chelators could be used in the prescence of Pb (Lead)?

A
  • Dimercaprol
  • Penicillamine
  • DMSA (Succimer)
  • EDTA (Edetate Calcium Disodium)
52
Q

What chelators could be used in the prescence of Hg (Mercury)?

A
  • Dimercaprol
  • Penicillamine
  • DMSA (Succimer)
53
Q

What chelators could be used in the prescence of Cd?

A

Dimercaprol

54
Q

What chelators could be used in the prescence of Cu (Copper)?

A
  • Penicillamine
55
Q

What chelators could be used in the prescence of Fe (Iron)?

A
  • Deferoxamine
56
Q

What are possible toxicities/ADRs with Dimercaperol?

A
  • Hypertension
  • Tachycardia
57
Q

What are possible toxicities/ADRs with Penicillamine?

A
  • Allergic reactions
58
Q

What are possivle toxicities/ADRs with DMSA (Succimer)?

A
  • Gas
  • Abdominal pain
59
Q

What are possivle toxicities/ADRs with EDTA?

A
  • Nephrotoxicity
60
Q

What are possible toxicities/ADRs with Deferoxamine?

A
  • Hypotension
  • Anaphlactoid reaction
  • ARDS
61
Q

What agent is used for Rattlesnake envenomation?

A

Crotalidae Antivenim

62
Q

What agent is used for Black Widow spider envenomation?

A

Lactrodectus Antivenim

63
Q

What agent is used for Coral snake envenomation (Eastern, Texas)?

A

Elapidae Antivenim

64
Q

What agent is used for Botulism (Types A, B, E)?

A

Trivalent Botulinum

65
Q

What agent is used for Digoxin and Digitoxin OD?

A

Digoxin immune Fab

66
Q

What pharmacologic antagonist is used for Acetaminophen OD? What is the mechanism?

A

N-acetylcysteine; Prevents NAPQI binding at hepatocyte

67
Q

What pharmacologic antagonist is used for Opiod OD? What is the mechanism?

A

Naloxone; Opoid receptor antagonist

68
Q

What pharmacologic antagonist is used for Benzodiazepine OD? What is the mechanism?

A

Flumazenil; Benzondiazepine receptor antagonist

69
Q

What pharmacologic antagonist is used for Organophosphate and pesticide OD? What is the mechanism?

A

Atropine; Muscarinic receptor antagonist

70
Q

What pharmacologic antagonist is used for Methanol and ethylene glycol OD? What is the mechanism?

A

Fomepizole; Blocks metabolite formation

Pharm II: Exam 1 (7 decks)

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