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Y3R2 - Toxicology ☠️ > L5: Paracetamol > Flashcards

L5: Paracetamol Flashcards

1
Q

Origin of Paracetamol

A
  • Synthetic non opiate derivative of p-amino phenol (N-acetyl-p-amino phenol NAPAP) or (Acetaminophen)
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2
Q

uses of Paracetamol

A
  • Analgesic & anti pyretic properties but with no or weak anti-inflammatory criteria.
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3
Q

what is a major metabollite for acetanilide & Phenacetin?

A

Paracetamol?

(causes Met HB)

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4
Q

Preparations of Paracetamol

A
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5
Q

Toxic action of Paracetamol in therapeutic doses

A
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6
Q

Toxic action of Paracetamol in toxic overdoses

A
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7
Q

Manner of poisoning by Paracetamol

A
  • Accidental in children
  • Suicidal (very common)
  • Never homicidal
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8
Q

what are substances that delay gastric emptying?

A
  • anticholinergics
  • Antihistamines
  • Anti depressants
  • Antipsychotics
  • Antiparkinsonian
  • Anticonvulsants
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9
Q

Absorbtion of Paracetamol

A
  • Rapidly absorbed,
  • But may delay in cases of SR Proparation, by Other drugs and high carbohydrate foods
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10
Q

Distribution of Paracetamol

A
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10
Q

Metabolism of Paracetamol

A

95% metabolized by the liver.

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11
Q

excretion of Paracetamol

A

5% excreted unchanged in the kidney.

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12
Q

what is the toxic dose of Paracetamol?

A
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13
Q

CP of Paracetamol toxicity

A
  • Stage I (0-24 hours): “GIT upset stage”
  • Stage Il: (1-2 Days): “Asymptomatic Stage”
  • Stage III: (3-5 days): “Hepatic Stage”
  • Stage IV: (5 days - 2 weeks): “Recovery Stage”
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14
Q

Stage II of Paracetamol toxicity

A
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14
Q

Stage 1 of Paracetamol toxicity

A
  • Anorexia, nausea, vomiting, pallor & malaise.
  • Symptoms subside and the patient may appear normal
15
Q

Stage III of Paracetamol toxicity

A
16
Q

Stage IV of Paracetamol toxicity

A
  • Normalization of the liver function tests begins about 8 days post-ingestion
  • Hepatic architecture returns to normal within 3 months.
17
Q

Investigations for Paracetamol toxicity

A
  • Plasma Acetaminophen Level
  • Liver function tests
  • Renal Functions Tests
18
Q

plasma acetaminophen level in Paracetamol toxicity

A
19
Q

Liver Function tests in Paracetamol toxicity

A
20
Q

Renal Function Tests in Paracetamol toxicity

A

In cases of Evidence of renal damage “Proteinuria, Phosphaturia”.

21
Q

TTT aspects of Paracetamol toxicity

A
  • Emergency and supportive measures
  • Decontamination
  • Antidote
  • Enhanced Elimination
22
Q

Emergency & Supportive TTT of Paracetamol toxicity

A
  • Treatment of Shock, Hypotension & Arrhythmia.
23
Q

Decontamination of Paracetamol toxicity

A
  • Gastric Lavage
  • Activated Charcoal
24
Q

Gastric Lavage in Paracetamol toxicity

A
  • If large ingestion of paracetamol & presented within 1 hour
  • Or in concomitant ingestion of drugs which delay Gl absorption.
25
Q

Activated Charcoal in Paracetamol toxicity

A

If <4 hours from ingestion:

  • Administer as a single dose 1g/kg orally or nasogastric tube.
  • Does not advorsely affoct oral N-acetylcystein (NAC) efficacy.
26
Q

Antidote in Paracetamol toxicity

A

N-Acetylcystein 20%

27
Q

Indications of N-Acetylcystein 20% in Paracetamol toxicity

A
  • The first choice, it is best given within 8 hours.
  • Indicated for toxic levels of paracetamol.
  • Do not delay antidote therapy for lack of a paracetamol level.
28
Q

Mechanism of NAC

A
  • Increase synthesis of glutathione.
  • Increase conversion to sulfate metabolite.
  • Decrease conversion to toxic intermediates.
28
Q

oral doses of N-Acetylcystein in Paracetamol toxicity

A
29
Q

IV infusion of N-Acetylcystein in Paracetamol toxicity

A
30
Q

SE of oral antidote in Paracetamol toxicity

A
  • Nausea, vomiting &diarrhea.
  • Extremely offensive sulfur odor.
31
Q

SE of IV infusion of antidote in Paracetamol toxicity

A
  • Infravenous anaphylactoid reaction (treaf with
    ontihistamines, epinephrine).
  • Isolated effects include
    1. Flushing
    2. Pruritus
    3. Angioedema
    4. Bronchospasm
    5. Tachycardia
    6. Hypotension.
32
Q

Enhanced Elimination in Paracetamol toxicity

A

Hemedialysis & Hemoperlusion

Iodicated in selested patisot with:
* Plasma level > 1000 microgram/ml
* Hypersensitivity to NAC
* Renal failure > 48 h

33
Q

Supportive therapy for liver in Paracetamol toxicity

A
34
Q

what are groups at high risk of Paracetamol toxicity?

A

Y3R2 - Toxicology ☠️ (15 decks)

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