Specific Drug Induced Toxicities Flashcards
Acetaminophen symptoms
overdose when higher than 4 gm in 24 hr
early tox: anorexia, nausea, vomiting
24-48 hrs- elevated PT, increased transaminase levels
48 hr to 7 days- inc intracranial pressure, hepatic encephalopathy, coma, multiorgan failure
hepatic necrosis
Acetaminophen tx
gastric lavage with charcoal
give metoclopramide to prevent vomiting
acetylcystein (NAC) within 8-12 hrs of exposure to increase glutathione - adjust dose based on normogram
IV glucose for hypoglycemia
salicylates symptoms
phase 1: respiratory alkalosis- hyperapnea, inc O2 consumption and CO2 production
metabolic acidosis (later stages)- accumulation of salicylic acid, impariment of renal excretion of acids, depletion of bicarbonate reserve
hyperpyrexia
tinnitis and dizziness
salicylates tx
perform gastric lavage
blood sample for salicylate levels and acid-base studies
correct hyperthermia by external cooling
mechanical ventilation for resp depression
fluids containing glucose and electrolytes
sodium bicarb to alkalize urine and promote excretionn
treat coma with osmotic diuretics
dialysis if renal fxn is impaired
Cocaine, amphetamines, phencyclidine symptoms
sympathomimetics
CNS stimulation, muscle rigidity, seizures (with MDMA, methamphetamine, ecstasy) vtach or vfib severe htn coma death
sympathomimetics tx
cocaine, amphetamines, phencyclidine
maintain airway and resp
convulsions controled by diazepam
activated charcoal and remove contents of stomach by lavage or emesis
succinylcholine if convulsions interfere with resp
maintain bp with fluids (not vasopressors because may be hazardous)
no beta blockers!!
opioids symptoms
toxic triad:
unconscious
pinpoint pupils
slow, shallow respiration
cyanosis, hypotension, spasms of GI tract, spasticity and twitch of muscles, death from resp depression within 2-4 may occur
opioid tx
maintain vital signs
naloxone is opioid antagonist- repeat doses bc of short duration of action
anticholinergics symptoms
dry as a bone red as a beet blind as a bat hot as a hare mad as a hater bowel and bladder lose tone loss vagal break- arrythmias, tachycardia
tx of anticholinergics
physostigmine
atropine if physostigmine becomes poisonous
1st gen antihistamines symptoms
CNS excitation may precede eventual CNS depression
drowsiness, tremors, disorientation, excitement, hallucinations, hyperthermia, tachy, convulsions, coma, difficult to treat
(symptoms similar to anticholinergics, don’t use physostigmine to treat though!)
tx of antihistamines 1st gen
maintain vital signs
activated charcoal
control convulsions with diazepam
TCA symptoms
anticholinergic effects
CV toxicit- arrhythmias, hypotension, abnormal cardiac conduction- torsades de pointe
seizures
Tx of TCA
sodium bicarbonate- maintain pH to reverse cardiac depressant
tx seizures with diazepam, pancuronium
supportive tx
beta blocker symptoms
overextension of pharmaceutical action- hypotension, bradycardia, cardiogenic shock, heart block,
Normal QRS (widening in high overdose sometimes)
bronchospasms in pts with preexisting asthma
hypoglycemia, hyperkalemia
convulsions, coma,resp arrest
