B4.014 Prework 1 Adverse Drug Reactions

Question 1

most common cause of acute liver failure in the Western world

Answer 1

acetaminophen

Question 2

pathogenesis of APAP toxicity

Answer 2

hepatic necrosis secondary to cascade of signaling events resulting in mitochondrial injury and cell death

Question 3

early APAP toxicity symptoms

Answer 3

none other than anorexia, nausea, or vomiting

Question 4

24-48 hours after APAP poisoning

Answer 4

elevated PT or INR

increases transaminase levels

Question 5

48 hours-7 days after APAP poisoning

Answer 5

increase in intracranial pressure
hepatic encephalopathy
coma
multi-organ failure
renal injury
sepsis

Question 6

therapeutic dose of APAP

Answer 6

4g in 24 h

Question 7

very early stage treatment of APAP overdose

Answer 7

gastric lavage to remove tablets from stomach

Question 8

antidote to APAP overdose

Answer 8

acetylcystein (NAC)
within 8-12 hours
adjust dose according to nomogram (plasma level and time postingestion)
may need IV glucose

Question 9

long term treatment for APAP overdose

Answer 9

liver transplant

Question 10

what is salicylate

Answer 10

anti-inflamm

common drug of overdose

Question 11

signs of salicylate overdose

Answer 11

tinnitus (ringing of ears)
dizziness
hyperpyrexia (high temp)
coma, convulsions, resp failure w increasing dose

Question 12

pathogenesis of salicylate overdose

Answer 12

metabolic acidosis due to accumulation of salicylic acid

• uncoupling of oxidative phosphorylation
• accumulation of keto acids
• impairment of renal excretion of acids
• depletion of bicarb reserve

Question 13

treatment for salicylate overdose

Answer 13

gastric lavage if practical
correct hyperthermia by external cooling
resp distress with mechanical ventilation with O2
oral or IV fluids w/ glucose and electrolytes
dialysis if renal function impaired

Question 14

how can you promote excretion and counter acidosis caused by salicylate overdose?

Answer 14

give sodium bicard

alkalize the urine

Question 15

toxidrome for cocaine/amphetamines

Answer 15

tachycardia
hypertension
seizures
mydriasis

Question 16

other symptoms of cocaine/amphetamine overdose

Answer 16

CNS stim and muscle rigidity or hyperactivity
v-tac or v-fib
circulatory failure
coma

Question 17

what treatment is contraindicated in cocaine/amphetamine overdose?

Answer 17

beta blockers

Question 18

how do you maintain BP with cocaine/amphetamine overdose?

Answer 18

fluids

vasopressors may be hazardous

Question 19

how are convulsions controlled?

Answer 19

diazepam IV

succinylcholine if convulsions interfere with respiration

Question 20

opioid triad/ toxidrome

Answer 20

unconsciousness
miosis (pin point pupils)
slow, shallow respiration

Question 21

other symptoms of opioid overdose

Answer 21

cyanosis
hypotension
spasms of GI tract
death (resp depression or coma)

Question 22

general treatments for opioid overdose

Answer 22

maintain vitals
gastric lavage/ induce emesis
maintain body warmth and adequate fluid intake

Question 23

opioid antidote

Answer 23

naloxone (naltrexone)

need to give repeat doses because of short duration of action

Question 24

examples of opioids

Answer 24

morphine
fentanyl
tramedol

Question 25

most important consequences of tricyclic antidepressant (TCA) overdose

Answer 25

blockade of myocardial fast sodium channels (QRS prolongation, tall R wave in aVR) inhibition of potassium channels direct myocardial depression

Question 26

TCA overdose symptoms

Answer 26

anticholinergic effects: tachycardia, dry mouth, nausea, confusion, urine retention seizures

Question 27

what types of cardio toxicity manifestations accompany TCA overdose

Answer 27

abnormal conduction arrhythmias (prolonged QT) hypotension

Question 28

treatment for TCA overdoes

Answer 28

maintain airways and assist ventilation diazepam for seizures give sodium bicarb to maintain arterial pH between 7.45-7.55 to reverse cardiac membrane depressant effects (magnesium if severe)

Question 29

counter indicated drugs for TCA overdose

Answer 29

``` class 1A antiarrhythmic drugs make torsade worse ```

Question 30

suprapharmalogical effects of beta blocker overdose

Answer 30

``` first degree heart block hypotension bradycardia AV block intraventricular conduction disturbances ```

Question 31

ECG findings in beta blocker overdose

Answer 31

normal QRS duration (widens with massive intoxication) | increased PR intervals

Question 32

other symptoms of beta blocker overdose

Answer 32

CNS toxicity: convulsions, coma, resp arrest bronchospasm in pts w preexisting asthma hypoglycemia and hyperkalemia

Question 33

treatment for beta blocker overdose

Answer 33

glucagon for bradycardia and hypotension | sodium bicarb for conduction defects

Question 34

sotalol poisoning

Answer 34

torsade de pointe polymorphous ventricular tachycardia associated w QT prolongation treated with: isoproterenol, magnesium

Question 35

what can cause serotonin syndrome

Answer 35

``` SSRIs alone, or in combo with: MAOIs TCAs amphetamines opioids ```

Question 36

common signs of serotonin syndrome

Answer 36

``` altered mental status fever agitation myclonus (muscle jerks) hyperreflexia ataxia diaphoresis (sweating) ```

Question 37

serotonin antagonists

Answer 37

cyproheptadine | propranolol