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Toxicology > Accidental Drug Ingestion & Overdose: Approach to Treatment > Flashcards

Accidental Drug Ingestion & Overdose: Approach to Treatment Flashcards

(62 cards)

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1
Q

What should be the initial approach to pharmacological intoxications?

A

Obtaining an appropriate history
Immediate stabilization and triage
Performing a thorough physical exam
Initiating treatment: decontamination, detoxification, symptomatic and supportive care of the patient

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2
Q

What are the big 6 that should be looked at on presentation?

A 
Temperature
Pulse
Respiration
Blood pressure
Pulse oximetry
ECG
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3
Q

What 5 things should be evaluated on presentation?

A 
Airway
Breathhing
Circulation
Dysfunction of neurologic system
Exam
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4
Q

What diagnostics should be done on presentation?

A

Blood tests
Urine for UA, culture, drug tests
Imaging

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5
Q

What measures might be taken to achieve stabilization?

A 
Oxygen
Intubation
Fluids
Dextrose
Calcium
Temperature support
Anti-seizure medications
Anti-emetics
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6
Q

What is the goal fro decontamination?

A

Inhibit or minimize further toxicant absorption

To promote excretion or elimination of the toxicant from the body

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7
Q

What are the decontamination techniques?

A 
Ocular
Dermal
Inhalation
Injection
Gastrointestinal
Forced diuresis
Surgical removal
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8
Q

How much of the ingested material can early emesis remove?

A

Up to 80%

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9
Q

What does productive emesis require?

A

The presence of food or liquid in the stomach

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10
Q

When should you induce emesis?

A

Most effective within 1 hour of ingestion
Useful up to 2 hours after ingestion
Unknown time of ingestion in an asymptomatic patient
When ingestion of a product known to stay in the stomach for a long time occurs

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11
Q

True of False: apomorphine is not recommended in cats, but it can be used in dogs

A

True

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12
Q

Why can apo be used in dogs?

A

CRTZ is largely controlled by dopamine receptors, so apo typically induces emesis

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13
Q

What should be used in cats to induce emesis and why?

A

Xylazine or dexmedetomadine because the CRTZ has alpha 2 receptors

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14
Q

When does emesis occur with apo?

A

Within 4-6 minutes

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15
Q

What can apo cause?

A

CNS depression

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16
Q

What is xylazine?

A

Centrally mediated α2-adrenergic agonist

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17
Q

What does xylazine use often result in?

A

Profound CNS and respiratory depression

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18
Q

What can CNS and respiratory depression be reversed by?

A

Atipamizle or yohimbine

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19
Q

What is used as an at home emetic?

A

3% hydrogen peroxide

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20
Q

True or False: hydrogen peroxide can be used in cats

A

False. It is not recommended because it can result in hypersalivation, hemorrhagic gastritis, protracted hematemesis

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21
Q

When is hydrogen peroxide more effective?

A

When a small amount of food is present in the stomach

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22
Q

When do you not want to induce emesis?

A 
Depressed patients
Decreased consciousness
Seizures or are likely to seizure
In symptomatic patients 
In patients with underlying disease predisposing them to aspiration pneumonia or complications associated with emesis induction
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23
Q

What are contraindicated toxins to using emesis?

A

Corrosive and caustic material
With hydrocarbon toxicant ingestion
Petroleum distillates
Other volatile materials that may result in aspiration pneumonia

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24
Q

What is multidose administration of activated charcoal indicated in?

A

Enterohepatic recirculation
Drugs with a long half-life
Delayed release products

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25
True or False: additional doses of activated charcoal should contain cathartic.
False
26
What is activated charcoal relatively ineffective against?
``` Ethanol Methanol Isopropyl alcohol Acetone Petroleum distillates Pine oil Ammonia Xylitol Cyanide ```
27
What is activated charcoal dependent on?
Timing of administration
28
What is the benefit of multidose activated charcoal?
It has been found to significantly decrease the serum half-life of certain drugs
29
Why should cathatics no be used in additional doses of activated charcoal?
Increased risks for dehydration and secondary hypernatremia via fluid losses from the GI tract
30
What are contraindications for administration of activated charcoal?
``` Shock Dehydration Electrolyte disturbances Those with excessive free water loss Uncontrolled vomiting Caustic substance ingestion Compromised airway Neurologic deficits ```
31
What are cathartics designed to do?
Increase the speed and transit time of the GI tract | Promote fecal excretion of the toxin
32
What is the most commonly used cathartic? Why?
Sorbitol | Aids in the expulsion of the poison from the GIT
33
What are the side effects of sorbitol?
``` Vomiting Dehydration Secondary hypernatremia Abdominal cramping or pain Possible hypotension ```
34
What is cholestyramine?
Chloride salt of basic anion exchange resin that binds with bile acids in the intestines to prevent them from being reabsorbed
35
What should cholestyramine be used with?
Toxicants that undergo enterohepatic recirculation or biliary elimination
36
What are the indications for gastric lavage?
Toxicants that stay in the stomach for a long time or that form bezoars Indications when emesis is contraindicated Toxicants that have a very narrow margin of safety, result in severe clinical signs. approach 50% of the LD50
37
Where should the patient's head be placed for gastric lavage?
Lower than the chest
38
What are indications for fluid therapy?
``` Excretion of the drug Aid in perfusion Prevent dehydration Encourage diuresis or nephrotoxins Treat underlying azotemia or electrolyte abnormalities Vasodilate renal vessels ```
39
What type of fluid is used for fluid therapy with toxicities that cause hypercalcemia?
Balanced crystalloid at 1.5 to 4 times the normal maintenance rate
40
What are colloid fluid therapies indicated in?
Low colloid oncotic pressure Profound hyponatremia Blood loss or acute hepatic insult
41
Whar are blood product therapies indicated in?
Anemia | Coagulopathy to anticoagulants or hepatoprotectants
42
What are examples of GI support?
Routine use of antiemetic therapy after emesis induction Anti-emetics H2 blocker Proton pump inhibitors
43
What are toxicants that often result in CNS stimulation?
``` Amphetamines SSRI antidepressants Sleep aids Tremorgenic mycotoxins Rodenticides Methylxanthines 5-fluorouracil Insecticides ```
44
What are examples of neurologic support?
Sedatives to treat CNS stimulatory signs Parenteral muscle relaxants Phenobarnital
45
When tpxocants can have effects like CNS depression or sedation?
``` Muscle relaxants Sedatives Sleep aids Illicit drugs Marcocylic lactones ```
46
What is cerebral edema due to?
Primary toxicant | Secondary to uncontrolled, untreated seizures
47
What is used to treat increased intracranial pressure?
Mannitol | Hypertonic saline
48
What are examples of anxiolytics or sedatives?
Acepromazine | Butorphanol
49
What can be used as a reversal with opioid toxicity?
Naloxone | Butorphanol
50
What should be used with sleep aid toxicosis?
Flumazenil
51
What can alpha-agonist toxicity be reversed with?
Alpha-adrenergic antagonists (Yohimbine, Atipamezole)
52
What toxicities is S-adenosyl-methionine (SAM-e) used in?
``` Xylitol Blue-green algae NSAIDs Amanita mushrooms Acetaminophen Sago palm ```
53
What is N-acetylcysteine used for?
To limit the formation of NAPQI by providing alternate glutathione substrate with acetaminophen toxicosis Has been anecdotally used for severe hepatotoxicity with sago palm and xylitol
54
What are beta blockers given for?
Severe tachycardia
55
What are beta blockers associated with?
SSRI, amphetamine, chocolate toxicosis
56
What is Vitamin K therapy used for?
Anticoagulant rodenticide toxicity
57
What is intravenous lipid emulsion therapy used for?
As an antidote for lipophilic drug toxicosis
58
How does IV lipid emulsion therapy work?
Lipid sink Providing myocytes with energy substrates Increasing the overall fatty acid pool
59
When is ILE advocated for use?
Macrocyclic lactones Lidocaine Pyrethrins Calcium channel blockers
60
What does ILE have anecdotal success with?
Baclofen Cholecalciferol Beta blockers Marijuana
61
What are the guidelines for ILE administration?
20% ILE bolus Followed by CRI rate of 0.25 ml/kg/min IV over 30-60 minutes Additional doses can be administered after 6-8 hours if signs have not resolved and serum is not lipemic
62
What are the possible complications with ILE therapy?
``` Fat embolism Fat overload syndrome Pancreatitis Worsening of acute respiratory distress syndrome Coagulopathy ```

Toxicology (4 decks)

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