Drug Tox Flashcards Preview

MS2 Unit 6 Pharm > Drug Tox > Flashcards

Flashcards in Drug Tox Deck (35):
1

opioid toxidrome

altered mental status. Decreased respiratory rate. decreased heart rate, blood pressure, and temperature. pinpoint pupils. decreased bowel sounds. "sleeping" vital signs

2

naloxone

competitive mu, delta, and kappa opioid receptor antagonist. depressed respiratory rate best predicts response. higher doses needed for synthetic opioids. can precipitate withdrawal. lasts 45 minutes

3

nalmefene and naltrexone

similar action to naloxone, but differ in pharmacokinetics. doesnt change patient observation time, and may prolong it. may produce a prolonged withdrawal state: N/V, pilorection/yawning

4

naloxone associated opioid withdrawal symptoms

flu-like. N/V, diarrhea. piloerection. yawning, irritability. NORMAL MENTAL STATUS. lasts 15-30 minutes

5

benzodiazepine toxidrome

depressed mental status. NORMAL VITAL SIGNS. sedative hypnotics can cause this toxidrome.

6

treatment for benzo overdose

ABCs, supportive care. consider flumazenil.

7

flumazenil

competitive non-selective benzodiazepine receptor antagonist. only works for benzos! doesnt work for barbitol ODs

8

side effects of flumazenil

can precipitate acute withdrawal. seizures reported in mixed OD. not uniform in reversal of respiratory depression.

9

acetaminophen toxicity stages

1: asymptomatic, mild GI irritation. 0.5-25 hrs.
2: LFT and renal function abnormalities, sometimes RUQ pain. 24-72 hrs.
3: Hepatic necrosis, sometimes renal failure. 72-96 hrs.
4: resolution of organ function. 4 days - 2 weeks.

10

what happens biochemically when you take too much acetominophen

run out of glutathione so you can't get rid of the toxic substrates from the acetaminophen. leads to central lobular toxicity

11

antidote for acetominophen OD?

N-acetylcysteine. best if given within 8 hrs of overdose. effective for all stages of poisoning

12

N-acetylcysteine mechanism

resupplis glutathione stores!

13

rumack-matthew nomogram

tells you if the patient is in danger from their OD on acetominophen.

14

late acetominophen hepatotoxicity signs

known as Kings Criteria.
prothrombin time > 200s. Serum creatinine > 3.3 mg/dl. Hepatic encephalopathy III-IV. blood pH 30

15

what two tests got added to kings criteria and made the sensitivity better

serum lactate and serum phosphate

16

tricyclic antidepressant toxidrome

anticholinergic. catechol reuptake inhibitor. alpha adrenergic blocker (hypotension). GABA antagonist (seizures). Sodium channel blocker (This is lethal)

17

if your QRS is over 100ms or over 160ms, what are you at risk for?

>100ms, at risk for seizures. >160ms, at risk for dysrhythmias.

18

antidote for tricyclic overdose?

sodium bicarb!

19

sodium bicarbonate mechanism

provides sodium to fight the sodium channel blockade, and alkalinization to reduce TCA affinity to its receptor in the myocardium.

20

anticholinergic toxidrome

mydriasis, dry flushed face, decreased bowel sounds, urinary retention, increased temperature, altered mental status. increased sympathetic nervous system signs

21

what is the antidote for anticholinergic overdose?

physostigmine! can also use sedative hypnotics instead of physostigmine when unsure of indications

22

physostigmine mechanism

anticholinesterase. prevents breakdown of ACh.

23

cholinergic toxidrome

opposite of anticholinergic. miosis, salivation, lacrimation, urination, defecation. CNS excitation, bronchorrhea/spasm, fasciculations

24

what is antidote for cholinergic overdose?

atropine or pralidoxime

25

atropine mechanism

anticholinergic

26

pralidoxime mechanism

enzyme regenerator. decreases atropine requirement. can take the toxin off the acetocholinesterase

27

ethylene glycol or methanol overdose treatment

treat with ethanol or fomepizole. fomepizole blocks further metabolism by using up ADH. ethanol competes with toxic things for the enzymes

28

when is hemodialysis indicated in ethylene glycol/methanol ODs?

methanol or ethylene glycol level > 25-50 mg/dL. metabolic acidosis. coma. hemodynamic instability.

29

pathophysiology of calcium channel blocker OD

blocks the slow inward calcium current, causing decreased ventricular contractility. sinus node depression leads to bradycardia. AV node depression leads to various blocks. vasodilation leads to hypotension.

30

clinical effects of calcium channel blocker OD

vital signs: pulse and BP decreased. Temp and RR normal. Shock: CNS depression and lactic acidosis

31

management of calcium channel OD

decrease absorption, increase elimination. specific treatment/antidotes

32

antidotes for Calcium channel blocker OD

calcium salts. glucagon. High dose insulin. pacing. amrinone. vasopressors. intraeortic baloon pump. lipid emulsion

33

Cocaine / Amphetamines Toxicity

CNS stimulation, agitation, hallucinations, seizures. increased muscke activity. can lead to increased temperature and kidney injury, even heart attacks.

34

PCP / Ketamine toxicity

low: euphoria. medium: agitation, anesthesia, increased strength. high: CNS anesthesia

35

LSD/psilocybin toxicity

produces alterations in perceptions and hallucinations. adverse effects are related to the experience. no inherent toxicity.