Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
59 Cards in this Set
- Front
- Back
|
what is the definition of a birth defect?
|
physical/structural, functional or metabolic abnormality in an embryo or fetus that results in physical or mental disability or is fatal
|
|
|
what is a deformation?
|
structural or functional developmental abnormality that results from physical forces acting on the fetus
|
|
|
what is a developmental hazard?
|
chemical, biological or physical agent that produces developmental disease when exposure occurs prior to conception, following conception or the child (prior to conception exposure included father)
|
|
|
what is a chemical, physical or biological agent capable of producing a disruption in an embryo or fetus?
|
tetraotogen
|
|
|
what are the characteristics of alterations of growth that can occur as a result of birth defects?
|
-birth weight and rate of gain after growth
-sensitive indicator of insults during pregnancy and early postnatal development -not specific to chemical exposures -ex: exposure to tobacco or alcohol |
|
|
what drug has been known to cause structural malformations in the fetus?
|
DES
|
|
|
what is an example of a substance known to cause functional abnormalities in neonates and children exposed?
|
lead
|
|
|
what can ACEIs do if taken while pregnant?
|
cause death of the fetus
|
|
|
what is the second leading cause of death in the first year of life?
|
premature birth
|
|
|
What are the infectious agents?
|
-CMV
-Rubella -toxoplasmosis -varicella |
|
|
what are the medications that have been found to be tetratogens in pregnancy?
|
-anticonvulsants
-antihypertensives -warfarin derivatives -DES |
|
|
what are the major defects that can occur with anticonvulsant use during pregnancy?
|
-spina bifida
-oral clefts -CV defects |
|
|
Describe the role of antihypertensives in birth defects.
|
-reduce renal blood flow and inhibition of renal development
-CV and CNS systems most commonly affected -risk of toxicity is lower in FIRST trimester -Mostly ACEIs |
|
|
What can warfarin do if given during pregnancy?
|
risk of nasal hypoplasia and or stippled epiphyses, limb hypoplasia (first trimester exposure) and ventral and dorsal midline dysplasia (second and third trimester exposure)
|
|
|
Describe DES
|
-synthetic nonsteroidal estrogen used in 1938 to 71 to prevent miscarraige
-increased the risk for abnormal development of genitalia and increased risk of cancer |
|
|
what are the typical environmental exposures that can cause birth defects in neonates?
|
-Methyl mercury
-hypoxia -ethyl alcohol |
|
|
what are the characteristics of pediatric ingestions in toddlers?
|
-withOUT suicidal intent
-usually only 1 xenobiotic involved -usually non-toxic in nature -quantity is usually small -presentation is usually within 1 hour of event or discovery of event |
|
|
what is the peak "unintentional" poisoning age?
|
1-3 years
|
|
|
what are the reasons for exposure to ingested poisons for children ages 5-9?
|
psychosocial stressors or suicidal intent emerges
|
|
|
what are the top 3 substances that are involved in pediatric poisoning under the age of 5?
|
1. cosmetics/personal care
2. cleaning substances 3. analgesics |
|
|
what is a xenobiotic?
|
chemical or substance found in an organism, but not usually expected to be there
|
|
|
what is considered a minor exposure to a xenobiotic?
|
minimal SxS often not requiring intervention or monitoring
|
|
|
ToF: moderate xenobiotic exposures in children do not require intervention and/or observatino
|
false
|
|
|
what is the initial priority after an unknown overdose?
|
stabilization
airway breathing circulation neurologic disability |
|
|
what must be considered before conducting GI decontamination from a xenobiotic exposure?
|
-Not the standard of care
Do not want to bring an erosive substance up the esophagus -type of ingestion -quantity and amount of ingestion -patient age and weight -other precluding medical conditions |
|
|
what is syrup of ipecac?
|
it induces vomiting and its use has diminished over the years.
has been associated with undesirable effects must be given quickly after exposure |
|
|
what are the pros to the indication for orogastric lavage?
|
-ingestion presents within 1 hour of event
-contents to be removed are ideal -preferred for serious pediatric ingestions |
|
|
what are the reasons not to use orogastric lavage after poisoning?
|
-aspiration risks, consider airway protection
-inefficient removal of stomach contents -substance ingested is unknown or poor timeline history |
|
|
what position should the patient be in for an orogastric lavage?
|
left lateral decubitus
|
|
|
What is administered in an orogastric lavage?
|
several Liters of Normal saline until no particulate matter returns
|
|
|
what is the primary decontamination modality used in EDs?
|
activated charcoal
|
|
|
what does activated charcoal do? what is it used for?
|
prevents ongoing absorption and distrupts enteropathic reciruclation of xenobiotic
-used in tx of serious intoxications with phenobarb, theophyilline, carbamezapine, dapson and quinine -may also be used for salicylate, colchicine, and amatoxin (mushroom) tox |
|
|
what are the indications for whole bowel irrigation?
|
-known ingestion of sustained-release medication or substance
-alternative when activate charcoal will not absorb or alternatives are not possible or effective |
|
|
what are the reasons to not use whole bowel irrigation?
|
-questionable efficacy
-interferes with activated charcoal efficacy -aspiration and GI risks -any conditions diminishing peristalsis |
|
|
what is the solution used for whole bowel irrigation? what can help make it taste better?
|
PEG-ELS
polyethlyene glycol electrolye lavage solution with tap water -chilling it can help it taste better |
|
|
what are cathartics?
|
laxatives
|
|
|
ToF: laxatives have a proven role in routine use to enhance elimination with xenobiotic ingestion
|
false
|
|
|
when are antidotes used for xenobiotics?
|
-when they are confirmed as the agent/agents ingested
-is highly suspected and consistent with its toxidrome -has high potential for morbidity or mortality without administration of antidote -reversal benefits outweigh risks |
|
|
what is the antidote for opioid toxicity?
|
naloxone
|
|
|
what is the antidote for acetaminophen toxicity?
|
N-acetylcysteine
|
|
|
when can acetaminophen levels be monitored?
|
no sooner than 4 hours after ingestion of immediate release formulations
-or two hours after liquid formulations -do liver functions tests |
|
|
what is the antidote for anticholingeric toxicity? what should you monitor while giving it?
|
physostigmine
monitor HR, Resp rate and ECG |
|
|
What is fomepizole?
|
antidote for ethylene glycol and methanol toxicity
|
|
|
what do you give to treat organophosphate or carbamate overdose?
|
Atropine: it dries out the secretions. acteylcholine inhibitor
comes IV or IM |
|
|
what color atropen is used for infants?
|
blue: 0.5mg
|
|
|
what antidote is given for acetylcholinesterase toxicity?
|
pralidoxine
|
|
|
what is the action of pralidoxine?
|
reverse muscle paralysis associated with toxic exposure to organophosphate anticholinesterase pesticides and chemicals.
use in conjunction with atropine can be given IV or IM |
|
|
what do you give for a coumadin toxicity?
|
phytonadione (vit K)
|
|
|
what is vit K?
|
cofactor in liver synthesis of clotting factors II, VII, IX, and X
|
|
|
what are the sympathomimetic illicit drugs?
|
meth, MDMA, cocaine
|
|
|
what is the antidote for sympathomimetic toxicity?
|
benzodiazepines: diazepam
|
|
|
How does diazepam work for sympathomimetic overdose?
|
Competitive for benzo/GABA/chloride receptor antagonist
|
|
|
what is the antidote if a child comes in with a lsyergamide, phencyclidine, mescaline, psilocybin, cannabinoids, or belladonna alkaloids toxicity? what is the adjunctive therapy?
|
LSD, PCP etc
give benzodiazepines (cornerstone) adjunctive therapy is antispychotics (haldol) |
|
|
what could haldol do in acute psyhotropic intoxications?
|
exacerbate panic and visual symptoms in acute intoxication
|
|
|
what is the drug of choice to reverse the effects of a benzo overdose? what is a possible side effect?
|
flumazenil; seizures
|
|
|
what is the management of serotonin syndrome? what symptoms does this help?
|
benzodiazepines
-aids in agitation, hyperthermia, possess CNS dpressant and anti-convulsant properties |
|
|
what are the xenobiotics to cause serotonin syndrome?
|
MAOIs, TCAs, SSRIs, mixed reuptake inhibitorss, St. John's wort, meperidine, dextromethorphan
|
|
|
what are the adjunctive therapies for serotonin syndrome?
|
cyproheptadine and dantrolene
cyp: potent antihistamine and serotinin antag dan: skeletal muscle relaxant which decreases calcium ion release |
|
|
what is the drug of choice to treat extrapyramidal symptoms? when is it used and why?
|
Benztropine
only used in peds under 3 in life threatening emergencies can cause cardiac arrhythmias |
