Toxicology Flashcards
Alcohol
Oxycodone
Most common substance abuse
Most licit abused is oxycodone
Posion
Substance that is toxic by nature no matter how it gets into the body or how much is taken
Drug
A substance that has some therapeutic effect when given in appropiate circumstance and dose
Overdose
When a drug, licit, or illicit, is taken in excess
Bioavailixbility
Describe the extent to which any drug is present in sufficient amounts to produce the desired effect
Toxicological emergencies
Fall into two categories,
Intentional and unintentional
Toddlers
Will put anything in their mouth, including dangerous medications
Chloral Hydrate
Also known as “knock out drops” are used to commit assault for decades
Rohypnol
Date Rape drug
Flunitrazepam
A powerful benzodiazepine that has both antegrade and retrograde amnesiac properties to erase memory for next 4-5 hours
Posion Center Number
18002221222
Four Methods of Absoprtion
Ingestion
Inhalation
Injection
Absorption
Ingested Posions
Immediate damage to tissues, or may be delayed for several hours
- Look for stained fingers, lips, or tounge a
- Sudden report of cramps, nausea, vomiting, and diarrhea
- look for empty pill bottles
- ingestion is usually a more forgiving time frame for identification and treatment
- Goal: remove or neutralize the posion before it gains access to intestines
Inhaled Posions
First, the person will remained poisoned as long as they are exposed, as well as the paramedic
Second, atmosphere poisoning, you are likely to encounter more than one patient
-Home agents such as Clorox or Bleach are responsible for most inhalation Emergencies
-CO poisoning is a painless suicide
-CO can be caused by old furnaces as well
Inhaled substances reach the alveoli instantly gaining almost instant access to the circulatory system
Carbon Monoxide
Binds to hemoglobin 250x more readily than oxygen
Injection Poisioning
Sting, bites from insects and animals
IV drugs such as meth, heroin, cocaine
Absorption Posioning
When substance is absorbed through skin
E.g organophosphate
Toxidrome
The Syndrome-like symptoms of a class or group of similar posionous agents Are useful for remembering and management of different substances that fall under same clinical umbrella
Toxidrome Categories
Stimulants Narcotics Cholinergics Anticholinergics Sympathomimetics Sedative/Hypnotics
Stimulant Examples
Amphetamine Methamphetamine Cocaine Diet Aids Nasal Decongestants Bath Salts
Stimulants Signs and Symptoms
Restlessness, agitation, incessant talking
Insomnia, anorexia, dilated pupils, tachycardia, tachypnea, paranoia, seizure
Narcotic Examples
Heroin Opium Morphine Dilaudid (hydromorphine) Fentanyl Oxycodone Ambien Secobarbital
Narcotic Signs and Symptoms
Constricted pupils, respiratory depression,
Needle tracks, drowsiness, coma
Sympathomimetic Examples
Pseudoephedrine, amphetamine, methamphetamine
Sympathomimetic Signs and Symptoms
Hypertension, tachycardia, dilated pupils, hyperthermia, seizures
Sedative/Hypnotic Examples
Phenobarbital, diazepam, midazolam, lorazepam
Sedative/Hypnotic Signs and Symptoms
Drowsiness, ataxia, slurred speech, ams, CNS depression, hypotension
Cholinergic Examples
Acephate Diazinon Celthion Cythion Sarin Parathion
Cholinergic Signs and Symptoms
Increased salivation, lacrimation, diarrhea. Respiratory depression, apnea, seizures
Anticholinergic Examples
Atropine
Antihistamines
Antipsychotics
Anticholinergic Signs and Symtpoms
Dry, flushed skin, hyperthermia, dilated pupils, blurred vision, dramatic delirium
Odor
Almonds: cyanide
Garlic: arsenic
Acetone: methyl alcohol
Pupils
Constricted: narcotics, organophosphate
Dilated: barbiturates, atropine, amphetamine, cyanide, CO
Mouth
Salivation: organophosphate, arsenic, mercury
Dry: atropine, amphetamines, diphenhydramine
Burns: iodine, plants, pine oil, acids
Skin
Pruritus: Jimson weed
Dry, hot: atropine, CO
Sweating: organophosphate, arsenic, aspirin, amphetamine
Respiratory
Depressed: narcotics, alcohol
Increased: Aspirin, cyanide, nicotine
Pulmonary Edema: CO, narcotics, organophosphates
Drug Abuse
Use of drugs that cause physical, psychological, or social harm
Habituation
Psychological dependence on a drug
Physical Dependence
Physiological state of adaption to a drug, with tolerance and withdrawals to the drug
Psychological Dependence
Emotion state of craving a drug to maintain a well being
Tolerance
Physiological adaptation to the effects of a drug in which larger doses are required
Potentiation
Enhancement of the effect of one drug by taking it with another
Synergism
Two substances in which total effects are greater than the sum of the independent effects 2+2=5
Alcohol
Mot widely abused drug in America
Alcoholism
Drinking early in day
Drinking alone or in secret
Periodic Binges
Loss of Memory
Delirium Termens
“Alcohol withdrawal syndrome” results in fever, disorientation, confusion, and seizures
Effects of Alcohol
Have chronic malnutrition causing them to fall a lot
Decreases life span 10-20 years
Alcohol Suscepitble Medical Problems
Subdural Hematoma GI bleeding Pancreatitis Hypoglycemia Pneumonia Burns Hypothermia Seizures Dysrhythmia Cancer Esophageal Varices
Acute Alcohol Intoxication
Give thiamine
Delirium Termens
Usually 48-72 hours after last intake
Mortality as high as 15%
Stimulants
Only takes days to become addicted and abuse drugs
Commonly recognized as wide eyed and thin as a rail
Cocaine
Natural occurring alkaloid
“Blow, flake, lady, nose, candy, snow, toot”
-Local anasthetic and CNS stimulant and creates a euphoria
-Causes widened QRS and QT intervals
Amphetamine-like Drugs
Include ecstasy, meth, and amphetamine
-most nasal decongestants and diet pills are members of this family
Meth: ingredients to make are available locally
Compared to cocaine very similar, however, meth last much longer, up to 12 hours
Bath Salts
Contain active ingredient such as “Sudafed”
Can snort, smoke or ingest drug
Management of Stimulant Abuse
Maintain maximum oxygen saturation levels, present seizures with adequate sedation and monitor vitals
- Excessive pulse rates, preload can drop drastically
- Consider beta blocker to lower pulse rate
- Apply ice packs or mist patients skin for hyperthermia
Marijuana and Canabis Compounds
- Does not produce true hallucinogens
- Results in bronchodilator and slight tachycardia
Spice
Can produce deliriums and produce psychotic long term and short term effects
Hallucinogens
Causes distortion of perception
LSD
Non habit forming drug
- primarily affects senses rather than altering physiologic functions
- “I was watching music play”
- Effects are mostly sympathomimetic in nature
PCP
"Phencyclidine" -Also called angel dust or dust -Classified as a dissociative anesthetic -slurred speech, staggering gait, hypertension -experience a mind-body separation Can cause patients to be ver violent ! Haldol IM for sedative
Ketamine
Physically and psychologically addicting
Used as an elephant tranquilizer
Peyote and Mescaline
Native tribes use for religious purposes
- experience hallucinations of outer experiences
- support abc’s
Psilocybin Mushrooms
Cause hallucination effects
-nausea, vomiting, tachycardia, hypertension
*Sedative Hypnotic
Reduce anxiety and calm agitated patients, used as sleep aids, in either cases, they function primarily as CNS depressants
Barbituates
Long Hx use as sleep aids, anti anxiety and seizure control medications
“Barbitals”
-management: oxygen, 12 lead, IV
IF SHOCK present, rapidly infuse 1-2 L of fluid.
For LONG ACTING such as Phenobarbital, administer BiCarb 1meq/kg to help alkaline the urine and traps the drug in its ionized form.
Lasix can also be used to deplete body of urine and bring closer to an alkalytic state
Activated Charcoal can also be used
Benzodiazepines
Used to treat anxiety, seizures, d alcohol withdrawal (ambien) easy to buy
- CNS depressant
- management: oxygen, 12 lead, IV romazicon, contraindicated for head injury and increased ICP
Narcotics, Opiates, Opiods
Is a drug that produces sleep, or AMS
Opiate
Natural drugs derived from opium
Opiod
Refers to non-opium derived synthetics
Produces effects on CNS by binding with receptor sites in the brain and other tissues
Management: abc! Bag and ventilate in necessary. Administer Narcan .4-2mg
Narcs example
Oxycodone, morphine, fentanyl, codeine. Heroin, hydrocodone, Demerol, robitussin
Cardiac Medications
Types of Antidysrhythmics
Type 1
Lidocaine
Na Channel Blocker affecting depolarization and impulse conduction
In certain cases, BiCarb may be used for QT prolongation, bradycardia and hypotension by reversing the inhibition of fast Sodium channels within cardiac cells
Type 2
Beta-adrenergic and Beta-Blocker medications
Control pulse rate and BP
Hypotension, AMS, bradycardia
HYPOGLYCEMIA AND HYPERKALEMIA occur with beta overdoses
Management: IV Glucagon, Epinephrine infusion, pacing
Type 3
Block cell potassium channels causing prolongation of cardiac action potential
E.g Amiodarone
Hypotension, bradycardia
Type 4
Ca channel blocker medications
Verapimil or Cardizem (ca channel blockers)
Slow calcium influx into present cells in the heart, blood vessels and other types of smooth muscles.
OD treatment is calcium
Organophosphates
Insecticides used in agriculture and nerve gases in the military
Except effects at neuromuscular junctions of Nerves and release acetylcholine.
Management: oxygen, IV, 12 lead, atropine 1mg up to 3mg
Carbon Monoxide
Odorless, tasteless gas and is 250x more affinity to bind with hemoglobin than oxygen
Assessment: cherry red skin color, pressure in the head, unable to think clearly
Management: highest concentration oxygen available. Hyperbaric chamber.
