Block 3 More, why?? Flashcards by Markus M

What is the poison control number?

1-800-222-1222

or text POISON to 797979

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Sympathomimetic toxidromes are caused by what? Tx?

Caused by caffeine, cocaine, amphetamines, alcohol/drug withdrawal

Tx = BZD

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Cholinergic toxidromes are caused by what? Sx?

Cholinesterase inhibitors, nerve gas, pesticides

SLUDGE

Salivation, lacrimation, urination, diarrhea, GI distress, emesis

Muscarinic + Nicotinic effects

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Anticholinergic toxidromes are caused by what? Sx? Tx?

Diphenhydramine, OAB rx, Atropine, glypyrollate

Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, and heart runs alone

Tx = BZD or physostigmine (dont use if you dont know what rx went in)

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What does RADAR stand for?

Recognition
Assessment
Definitive Diagnosis
Advice
Reporting

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PR prolongation
QRS prolongation
QTC prolongation

Antidepressants
Non DHB CCB
TCAs

Which Rx cause the AE?

TCA - QRS prolongation

Antidepressants - QTC prolongation

Non DHB CCB - PR prolongation

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Anion Gap elevations is due to what?

Methanol, propylene glycol, ethylene glycol, salicylate

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SDT vs UDS, which one provides quantitative values?

SDT

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What are some poor candidates to use with activated charcoal?

Inorganic
Polar
Charged
Can only adsorb to something in dissolved liquid phase

PHAILS

Pesticides, hydrocarbons, acids/alkali, iron, lithium, solvents

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Single and multiple dosing strategy for activated charcoal?

Single = 1mg/kg

Multiple = 0.25-0.5mg/kg every 1 to 6 hrs

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Activated charcoal CI?

Pt in stupor phase, coma, convulsing unless they have endotracheal tube

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Who should get whole bowel irrigation?

Any delayed/sustained release products

Large amounts of metal

Xenobiotics w/ slow absorption phase

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Hemodialysis is beneficial for xenobiotics that have..

Low or High Vd
Single or multiple PK parameters
Low or high protein binding capacity
Small or High weight
Water soluble or insoluble

Low Vd (<1L/kg)
Single PK
Low protein
Small weight (<5000 Daltons)
Water soluble

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What class do organophosphates and carbamates belong to?

Cholinesterase inhibitors

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What groups are found in the organophosphates and carbamates?

Organo - oxygen + leaving group that attaches to O2 or phosphorous + 2 side chains

Carbamates - N methyl group + NCOO

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How do you manage organophosphate toxicity?

BZD for seizures

Atropine (only works on ACh receptors); so no effect on paralysis, fasciculations

Alternatives to atropine: glycopyrrolate (only works for periphery), ipratropium, scopolamine

Pralidoxime (2-PAM), give atropine prior

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How does pralidoxime (2-PAM) work?

It attaches the N-OH group to the organophosphate’s P group (where the R20 was)

Kappa receptor is responsible for what action of opioids?

Miosis + sedation

Mu1 receptor is responsible for what action of opioids?

Analgesia, everything else is Mu2

Which opioid lowers seizure threshold?

Tramadol

Tramadol interacts with what Rx?

Antidepressant meds

Tramadol is a (mu/kappa) agonist. Oxycodone..?

Tramadol - mu

Oxycodone - both

Which opioids are metabolized by CYP2D6?

Codeine + Tramadol

Tolerance to _________ develops slower than analgesia and euphoria for opioids

Respiratory depression

RF for opioid overdose?

>50MME/day >90 days of use

Naloxone is a (mu/kappa) antagonist

Mu antagonist

Protein binding and acceptable ranges of APAP and NSAIDs?

APAP - low protein, 10-30 Aspirin - high protein, 15-30 Other NSAIDs - high protein, doesnt say :/

Metabolism of APAP

Most go through non CYP metabolism Small % goes through CYP2E1 which forms NAPQI, which glutathione attaches to. In overdose situations, glutathione is depleted and NAPQI attaches to hepatocytes

Staging of APAP toxicity?

1 = no hepatic damage, basic AE, days 0-1 2 = AST/ALT >1000, URQP, 5% of cases, days 1-3 3 = AST/ALT >10,000, hepatic failure, danger zone for death is days 3-5 4 = recovery

Limitations of Rumack-Matthew Nomogram?

No guidelines for <4hrs Altered mental status or patient history is too unreliable to plot correctly Limited evidence in children Limited evidence in ER formulation

Aspirin toxicity AE?

Inhibits the citric acid cycle - Metabolic acidosis Uncouples oxidative phosphorylation - Ketoacidosis Direct stimulation of the respiratory center - Respiratory alkalosis

Clinical triad of ASA toxicity?

Hyperventilation Tinnitus (cochlear toxicity) GI irritation

What are the non-DHP CCB?

Verapamil + Diltiazem

(DHP/Non-DHP CCB) inhibit both SA + AV nodes. What does the other one do primarily?

Non-DHP Tends to act as a peripheral vasodilator

In the event of a CCB overdose, how is insulin affected?

Less insulin release

Can you use dialysis on CCB overdose?

No, they are highly protein bound

Non DHP CCB toxic effects

Bradycardia Hyperglycemia Lactate production + metabolic acidosis

DHP CCB toxic effects

Reflex tachycardia Higher doses, bradycardia

Treatment option for Non DHP CCB or BB?

Activated charcoal, maybe more better for XR formulation ``` Atropine (treats bradycardia) Glucagon (increases adenylate cyclase) Calcium chloride/gluconate Sodium bicarb (for QRS, not for urine alkalization) Vasopressors High dose insulin IV fat emulsion ```

Digoxin toxicity AE?

Bradycardia Hyperkalemia Arrhythmias

Digoxin toxicity treatment?

Activated charcoal, even past the 1-2hr mark Atropine DigiFab (40mg reverse 0.5mg of digoxin)

Can you use BB for cocaine overdose?

No Just treat with ASA, O2, BZD, nitroglycerin