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80 Cards in this Set
- Front
- Back
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what are the most frequent substances involved in intoxications?
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1. analgesics, 2. cosmetic/personal care, 3. household cleaners, 4. sedative/hypnotics/anti-psychotics, 5. foreign bodies
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what are the most frequent substances associated with fatalities?
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1. sedative/hypnotics/anti-psychotics, 2. opioid, 3. antidepressants, 4. acetaminophen in combo, 5. cardiovascular drugs
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what does benzo-a pyrine do?
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reacts with DNA after chemical changs and is a carcinogen
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when is dilution used to decrease toxicity?
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for topica toxicants, for orally ingested poisons; don't try to neutralize
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what does activated charcoal do?
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non-toxic absorbs organic toxins, given orally to prevent absorption
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what substances are NOT absorbed by activated charcoal?
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PHAILS: pesticides, halocarbones, alcohols, acids and alkalis, iron, lithium and solvents
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when is whole bowel irritation used?
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for enteric coated tablets "concretion"
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what are the symptoms of opioid OD
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miosis, CNS/respiratory depression, constipation
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how do you treat opioid OD?
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IV naloxone; avoid emetics; check acetaminophen and salicyalte levels
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how do you treat acetaminophen OD?
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N-acetylcysteine - provides cystine needed for glutathione and direclty conjugates NAPQI
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how do you assess risk in acute acetaminphen doses?
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Rumack-Mathew nomogram
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what are the symptoms of salicylate OD?
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tinnitus, hyperthermia, hyperglycemia then hypoglycemia, respiratory alkalosis then metabolic acidosis
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how do you treat salicylate OD?
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emesis or activated charcoal if early enough; bicarb; hemodialysis if levels are > 100 mg/dL
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what are the symptoms of digoxin OD?
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halo of yellow or purple; increased automaticity, fatigue, CNS depression, hyperkalemia
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how do you treat digoxin OD?
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gastric decontamination if early; digibind; atrophine for bradycardia, insulin, dextrose and bicarb if hyperkaemia isn't fixed by digiband
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how do you treat beta blocker OD?
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activated charcoal with lavage; IV glucagon to reverse cardiac effects; atropine for bradycardia, insulin/dextrose: HIE
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how do you treat calcium channel blocker OD?
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IV calcium chloride; fluids, insulin/dextrose for hyperglycemia; glucagon if everything else fails
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what are the symptoms of stimulant OD?
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HTN, arrhytmias, hyperthermia, mydriasis
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how do you treat stimulant OD?
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maintain airway, IV for supportive care, BZD for agitation or seizures, control hyperthermia
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what are the symptoms of TCA OD?
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antichoinergic effects
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how do you treat TCA OD?
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activated charcoal; sodium bicarb for dysrrythmias; maintain airway and BP
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what are the symptoms of SSRI OD?
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N&V, lethargy, sedation , clonue, agitation, weating, tremor/hyperreflexia, hyperthermia
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how do you treat SSRI OD?
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cyproheptadine - has anti-serotonin effects; activated charcoal if early enough, BZD for sedation
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how do you treat ethanol OD?
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supprotive - protect bleeding, correct hypothermia and hypoglycemia, thiamine
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what are the symptoms of isopropanol OD?
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like ethanol - actetone odor on breath
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how do you treat isopropranol OD?
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hemdialysis if levels are high; gastric lavage if early enough
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what are the symptoms of methanol OD?
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less intoxicating than ethanol but toxic metabolites can cause severe metabolic acidosis and blindness
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how do you treat methanol OD?
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1. give ethanol or fomepizole (AD inhibitor), 2. sodium bicarb, 3. folic/folinic acid to increase excretion
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why is methanol so toxic?
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it is metabolized by AD to formic acid
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what are the symptoms of ethylene glycol OD?
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severe metabolic acidosis, lowers blood calcium levels, forms urinary calcium oxalate crystals = renal toxicity
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how do you treat ethylene glycol OD?
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1. ethanol or fomepizole, 2. sodium bicarb, 3. thaimine an dpyridoxine (shift glyoxylic acid conversion away from oxalic acid
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why is ethylene glycol so toxic?
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metabolzied to glycolic acid and then to oxalic acid
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what are the symptoms of carbon monoxide OD?
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redding color to skin; hypoxia; 4-5 hr half life
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how do you treat carbon monoxide OD?
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remove exposure, give 100% oxygen (reduce CO half life to 80 minutes) or a hyperbaric oxygen (reduce half life to 23 minutes
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why is carbon monoxide so toxic?
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binds hemoglobin with higher affinty than oxygen fomring carboxyhemoglobin = decreased oxygen delivery to tissue
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what are the symptoms of cyanide OD?
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bright red skin, bitter almond breath (cyanide is released from burning plastic)
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how do you treat cyanide OD?
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amyl nitrate by inhalation and sodium nitrate by IV - converst iron in Hb to ferric state to bind up as much cyanide as possible, induces mehemoglobinemia; 2. sodium thiosulfate - to convert cyanide to metaboite thiocyanate, 3. hydrocobalamin - to bind cyanide
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why is cyanide so toxic?
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it is a potent inhibitor of cytochrome oxidase
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how do you treat hydrogen sulfide OD?
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no antidote, stop exposure, supportive care - toxic when exposed to sewer gas in confined space - inhibits cytochrome oxidase
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what are the symptoms of pesticide OD (organophophates: parathion and malathion)?
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muscarinic - sweating, miosis, urination, BMs, nicotinic - muscle fatigue, tachycardia, hypotension; CNS - respiratory depression, covulsions, anxiety
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how do you treat pesticie (organophosphates: parathion and malathion) OD?
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give atropine and parlidoxime (helps regenerate AChE), emesisi or charcoal; give oxygen
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why are pesticides so toxic?
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irreversible inhibitors of AChE
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what are the symptoms of carbamate (sevin - a pestacide)?
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resembles parathion and malathion but more transient
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how do you treat carbamate (sevin) OD?
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ABCs, atropine - DO NOT give pralidoxime
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why is carbamate (sevin) so toxic?
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reversible inhibitor of AChE
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what are the symptoms of organochloride (DDT) OD?
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weak neurtoxins - convulsions
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how do you treat organochloride (DDT) OD?
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BZDs
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what metals are most commonly seen in heavy metal poisoning?
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iron, lead and mercury
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what type of damage do lead and mercury cause?
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they interact with electron rich amino acids
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what type of damage do irona nd copper cause?
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free radial formation - oxidative stress
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what is the therapy for heavy metal poisoning?
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chelating agents - contain electron rick domains that bind ionic forms of the metals (little effect on uncharged alkyalted metals)
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what is dimercaprol?
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invented as a antidote to war gas (BAL) it chelates with most metaollic poisons, must be given by IM
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what is edentate?
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chelator that is very effective for lead, can cause mild kidney damage, IM preferred administration
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what is penicillamine?
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degraded penicillin used in Wilson's disaese to chelate copper; ORALLY effective; can develop an allergy
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what is trientine?
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orally effective copper chelater used in wilson's disease for those who are intolerate of penicillamine - can develop iron deficiency anemia
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what is succimer?
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chelating agent indicated for lead poisoning in children (also effective for mercury and arsenic)
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what is deferoxamine?
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specific iron chelation agent, given orally or by injection if poisoning is systemic; can be used for aluminum overload
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what is the most comon heavy metal poisoning?
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iron - kids are most frequent victim
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what are the symptoms of iron poisoning?
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early - GI problems followed by recover; a few days later - shock, acidosis, cyanosisi and liver injury
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how do you treat iron poisoning?
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deferoxamine by continuous IV infusion
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when does lead distribute in the body?
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soft tissues then in the bone
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what are the symptoms of lead poisoning?
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hyperchromic microcytic anemia, renal toxicity, foot drop and wrist drop - caused by demyelination; encephalopathy in kids
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how do you treat lead poisoning?
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combo of edentate, dimrcaprol and penicillamine (succcimer in kids!)
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what state of mercury is most toxic?
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mercuric from (oxidized form)
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what are the symptoms of mercury poisoning?
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acute - direct toxic reactions along route of ingestion; chronic - neurological and psychiatric symptoms and renal toxicity
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how do you treat mercury poisoning?
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dimercaprol and penicillamine or its N-acetyl derivateive; orally administered polythiol resins interfere with the enterheaptic circulation of mercury
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what is the antidote for acetaminophen?
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acetylcysteine
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what is the antidote for cholinergis
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atropine
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what is the antidote for anticholinergics
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physostigmine
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what is the antidote for anticholinesterases?
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pralidoxime
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what is the antidote for BZDs?
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flumazenil
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what is the antidote for digoxin?
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digibind - digoxin immune fab
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what is the antidote for doxorubicin?
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dexrazoxane
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what is the antidote for folate antagonists (methotrexate)?
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leucovorin
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what is the antidote for heparin?
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protamine sulfate
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what is the antidote for ifosfamide?
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mesna
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what is the antidote for insulin?
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glucagon
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what is the antidote for non-depolarizing muscle relaxants?
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pyridostigmine, neostigmine or edrophonium
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what is the antidote for opioids?
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naloxone, naltrexone and nalmefene
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what is the antidote for oral anticoagulants (warfarin)?
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vitamin K
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