toxicology: classwork drugs + drugs of abuse

Question 1

Methotrexate

Answer 1

antineoplastic drug/antimetabolite (stops cell growth)

tx indications:
- Rheumatoid Arthritis,
- Psoriasis
- Neoplastic conditions (Leukemias/lymphomas)
- Ectopic Pregnancy
- Abortion

monitor:
- can cause bone marrow suppression
- liver toxicity: LFTs
- CBCs

reversal agent: leucovorin, glucarpidase (folinic acid)

Question 2

commonly monitored drugs: cyclosporin

Answer 2

immunosuppresant + prophylaxis for organ transpant
- treats autoimmune ds if methotrexate doesn’t work

monitor:
- LFTs, RFTs, bone marrow suppression (increased infections)
- nephrotoxicity

no reversal agent

Question 3

commonly monitored drugs: aminoglycoside

Answer 3

bactericidal antibiotic:
Gentamicin
Tobramycin
Amikacin
Streptomycin
Neomycin

Tx for severe bacterial infections: gram negative (pseudomonas)
- endocarditis, sepsis

monitor:**
- Nephrotoxicity
- ototoxicity
- neuromuscular blockade

Reversal: IV calcium for neuromuscular blockade

Question 4

commonly monitored drugs: vancomycin

Answer 4

Glycopeptide antibiotic
- gram positive infections (MRSA)
- C. diff: by mouth only**

• can cause RED MAN SYNDROME/vancomycin flushing syndrome when infusion is too rapid

monitor:
- ototoxicity
- nephrotoxicity
- infusion reactions (RED MAN)**
- to avoid bacterial resistance**

reversal: Hyaluronidase (?)

Question 5

commonly monitored drugs: dilantin/phenytoin

Answer 5

anticonvulsant: seizure tx

SE:
- irregular eye movement (nystagmus)
- SJS rash

monitor:
- narrow TI + dose related toxicity
- LFTs

reversal agent : activated charcoal

Question 6

what can be reversed with activated charcoal? naloxone?

Answer 6

Activated charcoal:
- aspirin
- phenytoin
- TCAs
- carbamazepine

Naloxone:
- methadone
- valproic acid
- any opiod

Question 7

commonly monitored drugs: tegretol/carbamazepine

Answer 7

carbamazepine (anticonvulsant)
- tx for seizures, trigeminal neuralgias, bipolar disorders

monitor:
- LFTs
- CBCs
- opthalmologic exams
- avoid grapefruit:
- category D

reversal: activated charcoal

Question 8

commonly monitored drugs: valproic acid

Answer 8

anticonvulsant:
- tx for bipolar ds, seizures, migraines

monitor:
- LFTs: hepatoxicity and PANCREATITIS**
- category X: blackbox warning

reversal
- meropenem: intentional overdose
- naloxone: mild- mod overdose

Question 9

commonly monitored drugs: TCAs

Answer 9

antidepressants
- tx for depression, migraines, neuropathic pain

monitor:
- cardiotoxic: prolongs QT
- LFTs: hepatotoxcity
- renal function
- narrow TI: can be fatal in overdose

reversal:
- sodium bicarb: helps with severe toxicity
- benzodiazepines: helps with TCA associated convulsions
- activated charcoal

Question 10

commonly monitored drugs: lithium

Answer 10

Mood stabilizer
- tx for bipolar ds, depression, mania

monitor:
- narrow TI
- kidney function: nephrogenic DI
- TFTs: hypothyroidism
- metallic taste
- slurred speech, tremors

reversal: none

Question 11

commonly monitored drugs: prozac

Answer 11

SSRI/antidepressant:
- tx for depression, panic ds, bulimia, OCD

monitor:
- LFTs
- can cause prolonged QT interval
- suicidal thoughts**

no reversal agents

Question 12

commonly monitored drugs: digoxin

Answer 12

cardiac glcyoside
- tx for afib, HF, SVTs

monitor:
- narrow TI
- renal ds: adjust dose
- GI issues
- “green halos”
- cardiac arrhythmias
- electrolyte abnormalities: hypokalemia, hypomagnesemia

reversal:
- digoxin immune fab
- Digibind/DigiFab**

Question 13

commonly monitored drugs: acetaminophen

Answer 13

antipyretic analgesics
- pain relief and fever reduction

monitor:
- blood drug levels
- AST/ALT for hepatotoxicity

reversal: n-acetylcysteine (NAC)**

Question 14

commonly monitored drugs: aspirin

Answer 14

NSAID/salicylate
- pain relief
- blood thinner

monitor:
- REYE syndrome in children
- TXB2
- bleeding risk
- ABG: metabolic acidosis/ resp alkalosis

reversal: activated charcoal, desmopressin (?)

Question 15

commonly monitored drugs: methadone

Answer 15

synthetic opiod
- chronic pain, tx for opiod dependency

monitor:
- drug levels in blood: overdose
- for abuse/addiction/withdrawal
- Respiratory depression
- bleeding of gums
- grapefruit juice

reversal: naloxone***

Question 16

drugs of abuse: methamphetamines sx

Answer 16

Stimulant!! - Sympathomimetic

• Pupil dilation
• agitation
• euphoria
• tactile hallucinations
• alertness/wakefulness
• meth mouth: bruxism (jaw clenching) and dental carries and vasconstriction = less saliva

Question 17

methamphetamines withdrawal sx

Answer 17

• Sleepiness
• Hunger
• Depression

Question 18

cocaine withdrawal sx

Answer 18

• Sleepiness
• Hunger
• Depression
• profound hypotension

Question 19

drugs of abuse: cocaine sx

Answer 19

Pupil dilation
Agitation
Euphoria
Tactile hallucination
-> “bugs crawling on the skin” **
Alertness
arousal

Question 20

cocaine association

Answer 20

“bugs crawling on the skin” **

Question 21

drugs of abuse: cocaine associations

Answer 21

• Nasal septum perforation (vasoconstriction)
• Cocaine Induced Cardiomyopathy
• Paranoia Drug induced depression
• Renal tubular necrosis
• Rhabdomyolysis

Question 22

drugs of abuse: phencyclidine (PCP) sx

Answer 22

-Initial euphoria
-> Violent/aggressive with superhuman strength****
- NMDA receptor antagonist
- psychotic + cant feel pain (analgesia)
- rotary/torsional nystagmus**

Question 23

PCP withdrawal sx

Answer 23

Insomnia
mood disturbance

Question 24

drugs of abuse: MDMA/ectasy sx

Answer 24

• Hallucination
• Euphoria
• Disinhibition
• Bruxism
• Altered sense of time *
• Altered sensation *
• Super charged SSRI Anti-depression
  -> increase dopamine and serotonin*

withdrawal:
- Anxiety, concentration difficulties, depression*

Question 25

drugs of abuse: MDMA/ectasy associations

Answer 25

• Serotonin syndrome
• Bruxism
• Hyponatremia/thirst
  -> seizures
• Hallucinogen persisting perception disorder

Question 26

drugs of abuse: Marijuana sx

Answer 26

• Calm: less anxiety
• Altered judgement
• Slowed reaction time
• Munchies *
• Conjunctival injection (red eyes) ***

Question 27

drugs of abuse: Marijuana associations

Answer 27

• Psychosis
  paranoia = bad trip
• Cannabinoid Hyperemesis Syndrome: Tx- with heat, hot showers

Question 28

drugs of abuse: benzodiazepines sx

Answer 28

sedative!!!
- Ataxia: loss of coordinated muscle movement
- mild respiratory depression
- somnolence: drowsiness

Question 29

benzodiazepines association

Answer 29

increases frequency of chloride channel opening “ben wants it more often/frequent”

Question 30

drugs of abuse: opiods sx + withdrawal sx

Answer 30

• Euphoria
• CNS/respiratory depression (COD)
• Pinpoint pupils *****
• Decreased gag reflex **

withdrawl:
- YAWN ** (OOOOpoids = yawn)
- sweating
- dilated pupils
- lacrimation

Question 31

drugs of abuse: opiods associations

Answer 31

Abscesses *
RT-sided endocarditis *

Hepatitis
HIV/AIDS
Overdose

Question 32

drugs of abuse: ETOH withdrawl sx timeline

Answer 32

Hr 0-36:
- GI upset
- tremors
- agitation,
- insomnia

HR 12-48: Alcoholic hallucinosis (still aware of orientation)

HR 6-48: withdrawal seizures

HR 48+: delirium tremens
- massive SNS overdrive: CV overdrive = death
- lose orientation (time, place)

Why is this happening?
- low gaba
- high glutamate: BOTH SNS EXCITATION

Question 33

ETOH intoxication sx

Answer 33

Slurred speech
ataxia
emotional lability
disinhibition

Question 34

drugs of abuse: ETOH association

Answer 34

Cirrhosis LABS
- LFTs, GGT, platelets, clotting factors

Wernicke Korsakoff Syndrome LABS
- thiamine, mamillary bodies

Pancreatitis LABS
- hypocalcemia, high amylase, high lipase

Beriberi LABS
- thiamine, volume overload (wet), noninflammatory demyelination (dry)

Dilated cardiomyopathy LABS
- dilated ventricles, heart ballooning, BBB

Cerebellar degeneration LABS
- dysdiadochokinesia, FNT, Stewart-Holmes sign (rebound elbows), cerebellar drift

Gastritis LABS
- endoscopy, H pylori (stool antigen or urease breath tests)

Marchiafava-Gibnami Disease LABS
- corpus callosum degeneration, vitamin B levels Testicular atrophy