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Pharmacology and Drugs / Poisons 9.14 > Poisons > Flashcards

Poisons Flashcards

1
Q

Name 6 methods of poisoning decontamination

A
  1. Forced emesis, 2. Gastric lavage, 3. Adsorption (charcoal), 4. Whole bowel irrigation, 5. Catharsis (shortening gut transit time using sorbitol & charcoal). 6. ENHANCED ELIMINATION
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2
Q

Complications of forced emesis

A

Aspiration and further damage eg from corrosives

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3
Q

Complications of gastric lavage

A

Risk of flushing into bowel & incr absorption. Perforation.

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4
Q

Most effective time from ingestion for activated charcoal

A

1 hr

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5
Q

Why does activated charcoal not work with metals (lithium, iron etc.)?

A

They do not bind to it.

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6
Q

Why does activated charcoal not work with hydrocarbons, (ethanol, methanol etc.)?

A

They are absorbed too rapidly .

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7
Q

Contraindications for charcoal

A

Caustic substances - danger of charcoal induced vomiting.

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8
Q

Methionine is strongly or weakly adsorbed by charcoal?

A

Strongly adsorbed

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9
Q

What are 3 methods of enhanced elimination?

A
  1. Urine alkalinisation, 2. Forced diuresis, 3. Heamodialysis / haemoperfusion
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10
Q

Briefly outline Urine alkalinisation

A

Keeping urine at ph7-8. Prevents weak acids e.g. aspirin becoming lipid soluble so they flush out in urine not into cells.

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11
Q

Briefly outline Forced diuresis

A

Giving diuretic eg furosemide (often in combin with urine alkalinisation)

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12
Q

Briefly outline heamoperfusion

A

Passing blood through charcoal - but oral charcoal simpler and can be as effective

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13
Q

What 6 effects common to these drugs in overdose:

TCAs, Antihisthamines, Orphenadrine (Parkinson’s med.), Thioridazine (antpsychotic)

A

Coma, hypertonia, extensor plantar reflexes, myoclonus (twitching), mydriasis (dilated pupils), sinus tachycardia (prol. QT - TCAs and antipsych.))

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14
Q

What might cause: coma, miosis (constrict. pupils) and red. resp rate?

A

Opiates

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15
Q

Antidote for opiates?

A

Naloxone

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16
Q

Nausea & vom.
Tinnitus, Metabolic acidosis
Deafness, Vasodilation
Sweating, Hyperventilation

A

Salicylates (e.g. aspirin)

17
Q

What 3 drugs might cause:
Coma, hypotonia & hyporeflexia
Hypotension
Extensor or absent plantar response.

A

Benzodiazepines +-alcohol
Barbituates (eg Sodium thiopental)
Severe TCAs

18
Q

Hyperthermia, Tachycardia, delirium, mydriasis, agitation

A

MDMA (ecstasy - amphetamine)

19
Q

Paracetamol antidote

A

N-acetyl cysteine

20
Q

Benzodiazepine antid.

A

Flumazenil

21
Q

Beta blocker antid.

A

Glucagon

22
Q

Iron antid.

A

Desferrioxamine

23
Q

Paraquat antid.

A

Fullers earth

24
Q

Methanol antid.

A

Ethanol

25
Q

Digoxin antid.

A

Digoxin specific antibiodies

26
Q

TCA od treatment

A

Supportive and activated charcoal

27
Q

What dose of paracetamol may be toxic?

A

10-15g within 24 hrs can kill

28
Q

Outline pathophsyiology of paracetamol poisoning

A

5-10% forms toxic metabolite - NAPQI.
Normally this conjugated with Glutathione & excr by kidneys.
In OD glutathione stores empty - NAPQI binds to liver cells - necrosis.

29
Q

Paracetamol OD treatment regime?

A 
Charcoal within 1 hr
Serum levels measure at 4 hrs.
Start N acetyl cisteine btwn 4 - 8 hrs
Reduced effectiveness >8hrs
Methionine also a glutathione precursor
30
Q

Features of paracetamol OD (6)

A 
Vomiting
Abd pain
Hyper / hypo glycaemia
Metabolic acidosis
Jaundice / encephalopathy
Renal failure
31
Q

Carbon monoxide poisoning features? (6)

A 
Headache
Nausea & vom
Weakness
Altered LOC
Cherry red lips
Tachycardia
CNS abnormalities
32
Q

Carbon monoxide treatment?

A

Oxygen (hyperbaric O2 for severe and pregnancy)

33
Q 
What might cause: Anxiety
Dizziness
Dyspnoea
Reduced LOC
Tachycardia or bradycardia
"Bitter almonds" smell
Acidodic - no signs of hypoxia
A

Cyanide (industrial uses, burning wool, plastics)

34
Q 
What is treated with:
100% oxygen
Dicobalt edetate (Kelocyanor)
Vit B12
Nitrites & sodium thiosulphate
A

Cyanide

35
Q

Digoxin toxicity SE

A

Xanthopsia - things look yellow
Dysryhthmias
Nasea & vomiting

Pharmacology and Drugs / Poisons 9.14 (7 decks)

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