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