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60 Cards in this Set
- Front
- Back
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What dose of activated charcoal is usually given?
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1g/kg
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When is activated charcoal most effective?
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Within one hour of ingestion.
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Activated charcoal does not work for what ingestions?
ACEHH |
Alcohol, Corrosives, Electrolytes, Heavy Metals, Hydrocarbons,
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What is used for whole bowel irrigation?
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Polyethylene glycol solution
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What drug toxicities would warrant multi-dose activated charcoal?
CDPQST |
Carbamazepine, Dapsone, Phenobarbital, Salicylates, Theophylline, Quinine
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What are three drug overdoses where urinary alkylinization might be necessary?
PMS |
Phenobarbital, Methotrexate, Salicylate
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What are three drug over doses that might require hemodialysis?
ALS |
Toxic Alcohol
Lithium Salicylate |
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What drugs cause false positives in TCA screens?
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Antihistamines = Ciproheptadine and Diphenhydramine
Cyclobenzaprine, Carbamazapine, Quietiapine Phenothiazines = Chlorpromazine, Perphenizine, Thioridazine, Trimeprazine |
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What drug drug interactions occur with TCAs?
CCK |
Cimetidine, Cipro, Ketoconazole
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What are the clinical presentations of TCA overdose?
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Tremor = Seizures(Acidosis, hypoxia, hyperthermia)
Cardiovascular = (arrhythmias, hyperthermia) Anticholinergic = Tachycardia, HTN, Fever, Delirium, Mydriasis |
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What is the hallmark cardiovascular symptom of TCA overdose?
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QRS widening of more than 0.1 second.
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What is given to treat tremors/seizures if they don't stop?
LPP |
Lorazepam
Phenobarbital Phenytoin = Not Usually |
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What will happen if phenytoin is pushed rapidly to a TCA overdosed patient?
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Blood pressure will drop.
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What is the antidote given for cardiovascular symptoms of QRS widening?
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Na Bicarbonate
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Which anticholinergic is contraindicated in treating the anticholinergic effects of TCA overdose?
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Physostigmine because it causes seizures and asystole.
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What is used to treat rhabdomyolysis?
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IV Fluids and +/- Sodium Bicarb, monitor output.
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What TCA levels are toxic?
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500ng/mL
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What organ has the highest concentration of MAOI?
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Liver
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Which MAOIs are metabolized by acetylation?
HIPP |
Hydrazines, Isocarboxazid, Phenelzine
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What drugs interact with MAOIs causing HTN?
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Amphetamines, Cocaine, Fenfluramine, PPA, Phenteramine, St. John's Wort and Ephedra
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How does MAOI intoxication present?
HDH |
Hypertensive Crisis, Delirium, Hyperthermia
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What drugs can be used to treat catecholamine mediated HTN?
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Labetolol - A blocker, Phentolamine - A and B blocker, and Nitroprusside vascular smooth muscle relaxant.
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What symptoms may develop 24-48 hours after MAOI ingestion?
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Hypotension from COMT breakdown of amines.
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What are symptoms of Paroxetine (Paxil) Withdrawel?
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Nausea, Vomitting, Dizziness, Headache, Lethargy, Paresthesias
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When do these symptoms occur?
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within 1-3 days of last dose and last 48 hours.
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How do you treat paxil withdrawel?
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Gradually taper the drug over a period of weeks = 5-10mg a week.
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Which salicylate is very rapidly absorbed and very toxic?
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Oil of Wintergreen (methyl salicylate)
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How does aspirin metabolism change in overdose?
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It goes from first order metabolism to zero order metabolism.
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How does the half life of aspirin change in overdose?
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It goes from 2-4 hours to 20 hours.
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What levels of aspirin are considered to be severely toxic?
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Anything over 500mg/kg
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How does anion gap metabolic acidosis develop as a symptom of toxicity?
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Increased pyruvic acid and lactic acid, lipid metabolism, and inhibition of aminotransferases.
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Why does tachypnea occur, and what does it cause?
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Direct CNS stimulation, leads to respiratory alkalosis.
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What fluid and electrolyte abnormalities occur?
4 things |
increased water loss, hypokalemia, hypocalcemia, loss of bicarb.
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What symptom of toxicity is more common in children?
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Hyperpyrexia
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What symptoms of toxicity occur with chronic overdose?
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Pulmonary edema, problems with clotting.
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How long can peak levels be delayed in overdose?
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6 hours with tabelts, 12 hours or more with enteric coated pills.
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How are aspirin overdoses treated?
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Activated Charcoal, lavage if soon after ingestion, whole bowel irrigation with large over dose, correct fluid and electrolyte abnormalities.
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How does the half life of tylenol change in overdose?
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Goes from 1-3 hours to greater than 12 hours.
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Inducers of what CYP enzymes increase NAPQI?
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CYP2E1 and CYP1A2
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When would you not give AC for tylenol overdose?
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If 3-4 hours have passed since over dose.
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What is NAC a substitute for?
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Glutathione
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What are the two FDA approved oral NAC protocols?
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72 hour course and a 24 hour course.
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What are the two IV NAC protocols
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21 hour course and a 48 hour course.
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Which protocols are superior if started after 10 hours?
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72 hour PO and the 48 hour IV.
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Where are the nicotinic receptors located? 3 places
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CNS spinal cord, postganglionic autonomic neurons, skeletal neuromuscular junction.
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Where are muscarinic receptors located? 3 places
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CNS brain, end organs innervated by parasympathetic fibers, post ganglionic sympathetic sweat glands.
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What kind of bond to AchE makes organophosphate poisoning so severe?
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Permanent Covalent Bond
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What symptoms does atropine treat in organophosphate poisoning?
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Bronchorrea and excess oral secretions.
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What are the therapeutic levels of pralidoxime?
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over 4ug/ml
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What medical uses do carbamates have?
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Glaucoma - Physostigmine, Neostigmine, Pyridostigmine
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What pesticides are made from carbamates?
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Sevin, Bug b Gone
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What kind of DDI would occur with an organochlorine?
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They are P450 inducers.
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What occurs with organochlorine toxicity?
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Dysrhythmias.
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What occurs with DDT toxicity?
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Repeated action potentials = tremors, increased startle response.
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What occurs with chlordecone toxicity?
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Tremors, increased startle response, ketone shakes, reproductive toxicity
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What anti-seizure drug should be avoided in the Tx. of organochlorine poisoning?
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barbiturates = increased risk of respiratory depression.
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What characteristic of organochlorines cause them to undergo enterohepatic circulation?
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They are lipophilic
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Which GABA antagonists cause seizures?
CLT |
Cyclodienes, Lindane, Toxaphene
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What are synthetic uses of pyrethroids?
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Eliminite, Nix, Scourge, Flea Bombs, Tent Spray
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What symptoms result form pyrethroid poisoning?
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Allergic reactions, seizures, paresthesias.
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