toxicology: classwork drugs + drugs of abuse Flashcards
Methotrexate
antineoplastic drug/antimetabolite (stops cell growth)
tx indications:
- Rheumatoid Arthritis,
- Psoriasis
- Neoplastic conditions (Leukemias/lymphomas)
- Ectopic Pregnancy
- Abortion
monitor:
- can cause bone marrow suppression
- liver toxicity: LFTs
- CBCs
reversal agent: leucovorin, glucarpidase (folinic acid)
commonly monitored drugs: cyclosporin
immunosuppresant + prophylaxis for organ transpant
- treats autoimmune ds if methotrexate doesn’t work
monitor:
- LFTs, RFTs, bone marrow suppression (increased infections)
- nephrotoxicity
no reversal agent
commonly monitored drugs: aminoglycoside
bactericidal antibiotic:
Gentamicin
Tobramycin
Amikacin
Streptomycin
Neomycin
Tx for severe bacterial infections: gram negative (pseudomonas)
- endocarditis, sepsis
monitor:**
- Nephrotoxicity
- ototoxicity
- neuromuscular blockade
Reversal: IV calcium for neuromuscular blockade
commonly monitored drugs: vancomycin
Glycopeptide antibiotic
- gram positive infections (MRSA)
- C. diff: by mouth only**
- can cause RED MAN SYNDROME/vancomycin flushing syndrome when infusion is too rapid
monitor:
- ototoxicity
- nephrotoxicity
- infusion reactions (RED MAN)**
- to avoid bacterial resistance**
reversal: Hyaluronidase (?)
commonly monitored drugs: dilantin/phenytoin
anticonvulsant: seizure tx
SE:
- irregular eye movement (nystagmus)
- SJS rash
monitor:
- narrow TI + dose related toxicity
- LFTs
reversal agent : activated charcoal
what can be reversed with activated charcoal? naloxone?
Activated charcoal:
- aspirin
- phenytoin
- TCAs
- carbamazepine
Naloxone:
- methadone
- valproic acid
- any opiod
commonly monitored drugs: tegretol/carbamazepine
carbamazepine (anticonvulsant)
- tx for seizures, trigeminal neuralgias, bipolar disorders
monitor:
- LFTs
- CBCs
- opthalmologic exams
- avoid grapefruit:
- category D
reversal: activated charcoal
commonly monitored drugs: valproic acid
anticonvulsant:
- tx for bipolar ds, seizures, migraines
monitor:
- LFTs: hepatoxicity and PANCREATITIS**
- category X: blackbox warning
reversal
- meropenem: intentional overdose
- naloxone: mild- mod overdose
commonly monitored drugs: TCAs
antidepressants
- tx for depression, migraines, neuropathic pain
monitor:
- cardiotoxic: prolongs QT
- LFTs: hepatotoxcity
- renal function
- narrow TI: can be fatal in overdose
reversal:
- sodium bicarb: helps with severe toxicity
- benzodiazepines: helps with TCA associated convulsions
- activated charcoal
commonly monitored drugs: lithium
Mood stabilizer
- tx for bipolar ds, depression, mania
monitor:
- narrow TI
- kidney function: nephrogenic DI
- TFTs: hypothyroidism
- metallic taste
- slurred speech, tremors
reversal: none
commonly monitored drugs: prozac
SSRI/antidepressant:
- tx for depression, panic ds, bulimia, OCD
monitor:
- LFTs
- can cause prolonged QT interval
- suicidal thoughts**
no reversal agents
commonly monitored drugs: digoxin
cardiac glcyoside
- tx for afib, HF, SVTs
monitor:
- narrow TI
- renal ds: adjust dose
- GI issues
- “green halos”
- cardiac arrhythmias
- electrolyte abnormalities: hypokalemia, hypomagnesemia
reversal:
- digoxin immune fab
- Digibind/DigiFab**
commonly monitored drugs: acetaminophen
antipyretic analgesics
- pain relief and fever reduction
monitor:
- blood drug levels
- AST/ALT for hepatotoxicity
reversal: n-acetylcysteine (NAC)**
commonly monitored drugs: aspirin
NSAID/salicylate
- pain relief
- blood thinner
monitor:
- REYE syndrome in children
- TXB2
- bleeding risk
- ABG: metabolic acidosis/ resp alkalosis
reversal: activated charcoal, desmopressin (?)
commonly monitored drugs: methadone
synthetic opiod
- chronic pain, tx for opiod dependency
monitor:
- drug levels in blood: overdose
- for abuse/addiction/withdrawal
- Respiratory depression
- bleeding of gums
- grapefruit juice
reversal: naloxone***
drugs of abuse: methamphetamines sx
Stimulant!! - Sympathomimetic
- Pupil dilation
- agitation
- euphoria
- tactile hallucinations
- alertness/wakefulness
- meth mouth: bruxism (jaw clenching) and dental carries and vasconstriction = less saliva
methamphetamines withdrawal sx
- Sleepiness
- Hunger
- Depression
cocaine withdrawal sx
- Sleepiness
- Hunger
- Depression
- profound hypotension
drugs of abuse: cocaine sx
Pupil dilation
Agitation
Euphoria
Tactile hallucination
-> “bugs crawling on the skin” **
Alertness
arousal
cocaine association
“bugs crawling on the skin” **
drugs of abuse: cocaine associations
- Nasal septum perforation (vasoconstriction)
- Cocaine Induced Cardiomyopathy
- Paranoia Drug induced depression
- Renal tubular necrosis
- Rhabdomyolysis
drugs of abuse: phencyclidine (PCP) sx
-Initial euphoria
-> Violent/aggressive with superhuman strength****
- NMDA receptor antagonist
- psychotic + cant feel pain (analgesia)
- rotary/torsional nystagmus**
PCP withdrawal sx
Insomnia
mood disturbance
drugs of abuse: MDMA/ectasy sx
- Hallucination
- Euphoria
- Disinhibition
- Bruxism
- Altered sense of time *
- Altered sensation *
- Super charged SSRI Anti-depression
-> increase dopamine and serotonin*
withdrawal:
- Anxiety, concentration difficulties, depression*
drugs of abuse: MDMA/ectasy associations
- Serotonin syndrome
- Bruxism
- Hyponatremia/thirst
-> seizures - Hallucinogen persisting perception disorder
drugs of abuse: Marijuana sx
- Calm: less anxiety
- Altered judgement
- Slowed reaction time
- Munchies *
- Conjunctival injection (red eyes) ***
drugs of abuse: Marijuana associations
- Psychosis
paranoia = bad trip - Cannabinoid Hyperemesis Syndrome: Tx- with heat, hot showers
drugs of abuse: benzodiazepines sx
sedative!!!
- Ataxia: loss of coordinated muscle movement
- mild respiratory depression
- somnolence: drowsiness
benzodiazepines association
increases frequency of chloride channel opening “ben wants it more often/frequent”
drugs of abuse: opiods sx + withdrawal sx
- Euphoria
- CNS/respiratory depression (COD)
- Pinpoint pupils *****
- Decreased gag reflex **
withdrawl:
- YAWN ** (OOOOpoids = yawn)
- sweating
- dilated pupils
- lacrimation
drugs of abuse: opiods associations
Abscesses *
RT-sided endocarditis *
Hepatitis
HIV/AIDS
Overdose
drugs of abuse: ETOH withdrawl sx timeline
Hr 0-36:
- GI upset
- tremors
- agitation,
- insomnia
HR 12-48: Alcoholic hallucinosis (still aware of orientation)
HR 6-48: withdrawal seizures
HR 48+: delirium tremens
- massive SNS overdrive: CV overdrive = death
- lose orientation (time, place)
Why is this happening?
- low gaba
- high glutamate: BOTH SNS EXCITATION
ETOH intoxication sx
Slurred speech
ataxia
emotional lability
disinhibition
drugs of abuse: ETOH association
Cirrhosis LABS
- LFTs, GGT, platelets, clotting factors
Wernicke Korsakoff Syndrome LABS
- thiamine, mamillary bodies
Pancreatitis LABS
- hypocalcemia, high amylase, high lipase
Beriberi LABS
- thiamine, volume overload (wet), noninflammatory demyelination (dry)
Dilated cardiomyopathy LABS
- dilated ventricles, heart ballooning, BBB
Cerebellar degeneration LABS
- dysdiadochokinesia, FNT, Stewart-Holmes sign (rebound elbows), cerebellar drift
Gastritis LABS
- endoscopy, H pylori (stool antigen or urease breath tests)
Marchiafava-Gibnami Disease LABS
- corpus callosum degeneration, vitamin B levels Testicular atrophy
