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43 Cards in this Set

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What are the symptoms of Acetaminophen?
Early: none other than anorexia, nausea, or vomiting

24-48 hrs:
-elevated Prothrombin Time (PT)
-increased Transaminase levels

Hepatic Necrosis
What is the treatment strategy for Acetaminophen overdose?
1. Gastric lavage with Charcoal
2. give Metoclopramide to prevent vomiting = dopamine receptor antagonist
3. give N-ACETYLCYSTEINE (NAC)
Within how long does N-Acetylcysteine need to be given for it to be effective? What is it effective against?
Within 8 hrs of exposure to Acetaminophen
What drugs can act synergistically with Acetaminophen in causing Liver toxicity? Why do they do this?
Ethanol & Isoniazid

They induce CYP2E1, which converts Acetaminophen into its Toxic Intermediate
What are the symptoms of Salicylate overdose?
1. Tinnitus (rining of ears) & dizziness

2. Respiratory Alkalosis (early stages)

3. Metabolic Acidosis (later stages)

4. Hyperpyrexia = elevation of temperature

5. Coma, convulsions, & respiratory failure with increasing dose
What causes Respiratory Alkalosis in the Early stages of Salicylate overdose?
1. Hyperpnea due to increased sensitivity of respiratory centers in the brain to pO2 & pCO2
-increased O2 consumption
-increased CO2 production
What causes Metaolic Acidosis in the Later Stages of Salicylate toxicity?
1. Accumulation of salicylic acid (obviously an acid)
2. Uncoupling of oxidative phosphorylation
3. accumulation of keto acids
4. Impairment of renal excretion of acids
5. depletion of Bicarbonate reserve
List the treatment strategies of Salicylate in chronological order (8)
1. induce vomiting or perform gastric lavage
2. draw blood sample for collection of Salicylate levels & for acid-base & electrolyte studies
3. correct Hyperthermia by external cooling
4. treat respiratory depression using mechanical ventilation with O2
5. Administer oral or IV fluids containing Glucose & Electrolytes
6. give SODIUM BICARBONATE to alkalinize the urine to promote excretion & help counteract acidosis
7. treat persisting coma with OSMOTIC DIURETICS
8. if renal function is impaired, dialysis must be used to remove salicylates
What are the symptoms of Cocain, Amphetamine, & Phencyclidine toxicity? (Sympathomimetics)
1. CNS stimulation & muscle rigitidy or hyperactivity
2. Seizures
3. Ventricular Tachycardia or Fibrillation
4. Severe HTN
5. Circulatory failure
6. Coma
7. Death
What is the treatment strategy for Cocaine, Amphetamine, & Phencyclidine toxicity?
1. Maintain airway & respiration
2. control convulsions by giving DIAZEPAM IV
3. if oral intoxication, delay absorption by giving activated Charcoal & then remove from the stomach by lavage or emesis (treat convulsions first though)
4. SUCCINYLCHOLINE may be necessary if convulsions interfere with respiration
5. maintain blood pressure with fluids since vasopressors may be hazardous
What are the symptoms of toxicity from Sedative-Hypnotics & Anticonvulsants?
1. Sedative-hypnotics cause progressive depression of the CNS in descending order from Cortex to Medulla

2. Early symptoms: sleepiness & mental confusion followed rapidly by Coma % slow, shallow respiration

3. Respiratory depression

4. elevation of blood CO2

5. Death often due to Pneumonia, Pulmonary Edema or Refractory Hypotension
What is Benzodiazepine overdose treated with?
Flumazenil
What is the treatment strategy for Sedative-Hypnotic & Anticonsulsants toxicity?
1. Maintain airway
2. Gastric Lavage (with CNS depression or Coma, only after Endotracheal tube)
3. Artificial respiration as required ***air is preferred (CO2 increases respiration)
4. Alkalinization of urine = only works for Phenobarbital
5. Maintain circulation = volume expanders & plasma expanders, followed by Vasopressors if needed
6. Hemodialysis
For what Sedative is Alkalinizing the urine of only value to increase excretion?
Phenobarbital = weak organic acid
What is the Triad of Symptoms associated with Opioid toxicity?
1. Unconsciousness
2. Pin-point pupils (dilated with anoxia)
3. Slow, shallow respiration

-Cyanosis
-Hypotension
-Spasms of GI tract
-Spasticity & twitching of muscles
-Death from Respiratory Depression may occur within 2-4 hours
What is the treatment strategy for Opioid toxicity?
1. maintain vital signs
2. if victim is conscious, perform gastric lavage or induce emesis if the narcotic was ingested orally
3. Antidote = Naloxone = opioid antagonist
-must give repeated doses due to short duration of action
4. Maintain body warmth & adequate fluid intake
What are the symptoms of Anticholinergics? (Atropine)
Dry as a bone
Red as a beet = Atropine flush
Blind as a bat
Hot as a hare
"Mad as a Hatter"
The bowel & bladder lose their tone
The heart goes on along = lose vagal brake

Blocks SLUD = no salivation, lacrimation, urination, defecation
What is the treatment for Atropine or other Anticholinergics poisonings?
Physostigmine = only for pure Anticholinergics
-Atropine
-Scopolamine

*not for Antihistamines, TCA's or Phenothiazines
What are the symptoms of toxicity of 1st Generation Antihistamines (Diphenhydramine, etc)?
CNS excitation may precede eventual CNS depression

-drowsiness
-tremors
-disorientation
-excitement
-hallucinations
-hyperthermia
-tachycardia
-convulsions
-coma can occur
What is the treatment strategy for toxicity of 1st Generation Antihistamines?
1. Maintain vital signs
2. delay absorption of ingested drug by giving a Charcoal Slurry & remove by Gastric Lavage while protecting the airway, followed by Catharsis

3. Control convulsions with IV Diazepam

**hard to treat Children due to cycle: Seizures -> Coma
What are the symptoms of toxicity of TCA Antidepressants?
1. Anticholinergic effects = block SLUD
2. CV toxicity manifested as abnormal cardiac conduction, arrhythmias, & hypotension
3. Seizures
4. Death
What is the treatment strategy for TCA overdose?
1. maintain airway & assist ventilation
2. Treat seizures with Diazepam or Pancuronium
3. give SODIUM BICARBONATE (antidote) to maintain artrial pH between 7.45-7.55 in order to reverse cardiac membrane depressant effects
4. Supportive therapy
What is the antidote for TCA overdose?
Sodium Bicarbonate
What are the symptoms of Nicotine overdose?
Complex Symptoms
1.Ganglion Stimulant
-Sympathomimetic effects
-Parasympathomimetic effects

2. Ganglion Depolarizing blockade
-Sympatholytic effects
-Parasympatholytic effects
What is the mechanism of toxicity of Botulinum toxin?
Blocks transfer of nerve impulses at motor end-plate by preventing release of ACh from cholinergic vesicles = paralysis of muscles
What are the symptoms of Botulinum toxin?
Depends on strain (A-F)
-Vomiting
-Double vision
-Muscular paralysis = intercostals & diaphragm among others
What is the treatment for Botulinum toxin?
1. Emesis, lavage, or cathartic depending on the time elapsed since ingestion
2. support vital signs & draw blood for toxin determination in serum
3. give type ABE botulinus antitoxin
Bacteria that causes acute gastroenteritis 12-24 hours after eating contaminated food. Symptoms are severe GI inflammation, mild fever, dehydration, occasionally shock

What is the treatment?
Salmonella

1. Anti-emetic (Prochlorperazine) to control severe vomiting
2. Maintain fluid intake
3. Supportive care
Bacteria that causes acute gastroenteritis 1-6 hours after ingesting unrefrigerated foods. Symptoms are severe nausea, vomiting, & diarrhea

What is the treatment strategy?
S. aureus

1. Fluids
2. bed rest
3. supportive care
4. occasionally antibiotics
What are Bleaches?
normally 3-6% solutions of Sodium Hypochlorite in water; give off chlorine gas
What are the symptoms of Bleach toxicity?
1. Severe irritation
2. Hypotension
3. Delerium
4. Coma

*symptoms occur with increasing dose
What is the treatment strategy for Bleach toxicity?
1. Remove from skin by flooding with water
2. do not use Emesis, Lavage, or Acid antidotes
3. DO give milk, melted ice cream, or beaten eggs; antacids are helpful
4. Support vital signs
What are the Nerve Agent organophosphate Cholinesterase Inhibitors? What symptom do they cause?
Sarin & Soman

Convulsions
What are the Irreversible Cholinesterase Inhibitors?
Organophosphates
-Parathion -> Paraoxon
-Malathion -> Malaoxon
-Sarin
-Soman
-Isoflurophate
-Di-isoflurophate
-Donepezil
-Tacrine
What are the Reversible Cholinesterase Inhibitors?
Carbamates
-Carbaryl
-Aldicarb
-Carbofuran
-Aminocarb
What is contraindicated in Carbamate Cholinesterase Inhibitor poisoning?
2-PAM
What are the symptoms of Cholinesterase Inhibiting insecticides?
DUMBELSS
1. Diarrhea
2. Urination
3. Miosis
4. Bronchospasm
5. Bradycardia
6. Excitation of skeletal muscle & CNS
7. Lacrimation
8. Sweating
9. Salivation
How do people with Cholinesterase-inhibiting insecticide toxicity usually die?
from drowning in secretions
What is the treatment strategy for Cholinesterase-inhibiting insecticide toxicity?
1. remove contaminated clothing & wash skin thoroughly
2. cautiously give a small dose of ATROPINE to block cholinergic effects, then increase dose as needed
3. 2-PAM may also be given to reactivate the AChE enzyme (only for Organophosphates)
4. Gastric Lavage or Emesis if ingestion was recent
5. Support vital signs
What was Strychnine used for back in the day?
Rodenticide
What is Strychnine's mechanism of toxicity?
Competitive antagonist of Glycine
-glycine is an important inhibitory transmitter to motorneurons & interneurons in the SPINAL CORD
-blocks normal inhibition of nerve impulses in the spinal cord causing convulsions & rigidity of skeletal muscles
What are the symptoms of Strychnine poisoning?
1. Convulsions, with the victim being very sensitive to sensory stimuli

2. Death results from respiratory paralysis & failure
What is the treatment for Strychnine poisoning?
1. Support vital signs
2. IV Diazepam or Succinylcholine to control convulsions
3. After convulsions and hyperactivity are controlled, prevent further absorption of Strychnine using Charcoal