Antidotes, toxicities, and side effects Flashcards
(58 cards)
1
Q
Antidote for acetomenaphin poisoning
A
N-Acetyl-cysteine
- Also used to loosen mucus in CF patients
- Centrolobular necrosis from NAPQI toxic metabolite from CYP450. CYP450 inducers can worsen disease.
2
Q
Salicylate poisoning
A
- Initial respiratory alkalosis at breathing center in brain followed by metabolic acidosis
- Tinnitus, dizziness, cerbral edema
- TX: by alkalanizing the urine: NaHCO3
3
Q
Amphetamines
A
- Dilated pupils, tremors, tachychardia
- Acificy urine
- NH4Cl
4
Q
Organophosphate poisoning
A
- Atropine immediately and praladoxime if early in course
- Irreversible acetylcholinesterase inhibitor leads to massive muscarinic stumilation
- Bradychardia, vasodilation, dry skin, mental status changes, miosis, salivation, urination
5
Q
Atropine or muscarinic blockade overdose
A
- Tx with AChE inhibitors. Neostigmine, physostigmine to cross BBB
- Tachychardia, etc
6
Q
Beta Blockers
A
- Treat with glucagon, increase cAMP Gs
- Hypotension, bradychardia
7
Q
Digitalis
A
- digitalis fAb, Lidocaine, normalize K, Lidocaine
- Yellow blurry vision, bradychardia, arrythmias and hyperkalemia
8
Q
Iron
A
- Deferoxamine, deferasirox
- Stomach ulceration, Naseau and Vomitting, metabolic acidosis
9
Q
Lead
A
- Succimer, dimercaperol, EDTA, penicillamine
- Acute: Weakness paresthesia, encephalitis, constipation
- Long term is IQ drop, basophilic stippling, lead lines
10
Q
Mercury, Arsenic, Gold
A
- Dimercaperol, succimer
- Arsenic: Diahrrea, vomitting, confusion, headache, blood urine, convulsions, coma. Long term is night blindness
- Inhibits PDH and can lead to lactic acidosis.
11
Q
Copper Posioning
A
- Penicillamine
- Wilsons disease from defective copper trasnport resulting in low ceruloplasm levels
- Hematemasis, naseu, and hypotension are common in acute poisonings
12
Q
Cyanide Poisoning
A
- Nitrate and Thiosulfate, also hydroxycobalamin
- Amyl Nitrate turns iron in the ferric state which makes them bind cyanide in blood acting like a sink. Hydroxycobaamin directly binds to cyanide gererating cyanocobalamin
- Complexes with cytochromes in ETC leading to defective oxidative phosphorylation and histiotoxic hypoxia
- Acute is siezures, apnea, pulmonary edema, almond smell and red tissues
13
Q
Methemoglobin
A
- Methylene blue
- Fe in hemglobin is in ferric state, not ferrous. Methylene blue non-enzymatically reduces back to ferrous.
- G6PD, Oxidizing drugs (nitrates), congenital, newborn distress
14
Q
Carbon Monoxide
A
- Hyperbaric oxygen
- Binds tightly to hemoglobin than oxygen and prevents delivery to tissue
- Headache, nasseau, reddening of the skin
- Pulse ox does’t pick up elevted carboxyhemoglobin. Must directly measure carboxyhemoglobin levels
15
Q
Methanol
A
- Fomepizole, competitive inhibitor of alcohol dehydrogenase
- Prevents production of toxic metabolites (formic acid)
- Metabolic acidosis
- Blindness, stupor, coma, death at low concentrations
16
Q
Ethylene glycol
A
- Fomepizole
- Metabolized to glycolic acids which causes stupor, autonomic dysfunction and metabolic acidosis
- Glycolic acid metabolized to oxalic acid which combines with Ca to cause stones and renal damage.
- May require dialysis at high levels
17
Q
Opiods
A
- Naloxone: opiod antagonist
- Naltrexone helps with cravings
- Signs are respiratory depression, miosis
18
Q
Benzodiazapines
A
- Flumazenil
- Rarely occurs on own, but maybe in the context of alcohol or barbituates
- Competetive antagonist at benzo A site.
19
Q
TCA’s
A
- Alkalanization of urine to increase excretion
- Most commonly die of arrythmias, also see dry mouth, hypotension and siezures
- Alpha and muscarinic blockade (Coma, Cardiac, convulsions)
20
Q
Heparin
A
- Protamine
- Heparin activates AT3 to cleave clotting factors. Protamine is an arginine rich compnd that can occupy activated AT3
21
Q
Warfarin
A
- FFP and vitamin K
- FFP for rapid clotting factor replacement
- Vitamin K to quench warfarin
22
Q
tPA, streptokinas,urokinase
A
- Aminocaproic acid
- Lysine analog that occupies binding and cleavage site of plasmin
23
Q
Theophyline
A
- Beta Blockers
- Narrow theraputic window and can be effected by inhibitors (cimetidine, etc)
24
Q
Torsades
A
-Magnessium sulfate and cardioversion
25
Eclampsia
-Magnessium sulfate for siezures
26
Phenytoin, Carbemazepine, Barbituates
Inducer
27
Modafanil
Inducer
28
Rifampin, Griseofulvin,
Inducer
29
St Johns Wort
Inducer
30
Chronic Alcohol Abuse
Inducer
31
Macrolides, INH, Sulfonamides, Ketocolanazole, Ciprofloxacin
Inhibitors (MAGIC RACKS in GQ)
32
Amiodarone, quinidine
Inhibitor
33
Gemfibrozil
Inhibitor
34
Grapefruit juice
inhibitor
35
Gemfibrozil
Inhibitor
36
Ritonavir
Inhibitor
37
Acute Alcohol Abuse
Inhibitor
38
Flushing
Vancomycin, Niacin, Ca Channel Blockers
39
Vasospasm
Cociaine, Triptans, Ergot alkaloids
40
DCM
-Doxyrubicin, andriaomycin, danorubicin
41
Torsades
Class I and IIIa anti-arrythmics
42
Agranulocytosis
Chloramphenicol, carbemazepine, cochicine, PTU, Methimazole, Dapsone
43
Aplastic Anemia
Chloramphenicol, Benzene, NSAIDs, PTU/Methimazole
44
Direct Coombs Hemolytic Anemia
Penicilin, Methyldopa
45
G6PD Hemolysis
-Primaquine, Sulfonamide, Nitrates, INH, NSAIDs
46
Megaloblastic Anemia
-Methotrexate, Sulfonamides, Phenytoin (also birth defects)
47
Thombotic
-OCP (Smoking and facor V Lieden)
48
Cough
-ACEI (prevent bradykinin breakdown) angiodemea
49
Pulmonary Fibrosis
Bleomycin, Busulfan (chemotherapy), amiodarone
50
Acute Cholestatic jaundice
-Erythromycin
51
Acute hepatic necrosis
-Halothane (Days) acetomeniphen, valproate, amantadine phyllodes
52
hepatitis
INH
53
Pseudomembranous colitis
-Clindamycin, ampicilin
54
Adrenocortical Insufficency
-Withdrawl steroids
55
Gynecomastia
Spironolactone and CYP inhibitors (Cimetidine, alcohol, ketocolanazole)
56
Hot flashes
Tamoxifen, Chlomafine
57
hyperglycemia
-Steroids, protease inhibitors, thiazides, niacin, tacrolimus
58
Hypothyroidism
-Amiodarone, sulfonamides, Lithium
