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CH 27 Toxicology > Lecture > Flashcards

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1
Q

Anticholinergic drug examples

A

atropine, antihistamines, antipsychotics

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2
Q

Anticholinergic mnemonic

A 
Blind as a bat
Red as a beet
Hot as a hare
Dry as a bone
Mad as a hatter
Blotted as a toad
The heart runs alone (tachycardia)
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3
Q

Anticholinergic signs and symptoms

A

Increase; HR, Temp, Pulip

Decrease; Bowel, Diaphoresis

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4
Q

What is a poison?

A

Toxic by nature, no matter the dose or route of entry

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5
Q

What is a drug?

A

Substance with a therapeutic effect when given at an appropriate dose and circumstance
Dose-dependent and route dependent

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6
Q

Bioavailability

A

The extent to which a drug is present in sufficient amounts to produce the desired result

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7
Q

Half life

A

The point when bio availability of a drug has decreased to 50%

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8
Q

Peak time concentration

A

How long it takes a drug to exert its maximum clinical effects

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9
Q

Excretion

A

How a drug is removed from the body

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10
Q

Potentiation

A

Enhancement of the effect of one class of drug by taking it with another drug of a different class

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11
Q

Synergism

A

Action of two drugs in the same class in which the effects are greater then the independent effects

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12
Q

Antagonist

A

Drug with affinity for cell receptor, binds but does not activate it. Preventing the normal cell from activating it. Blocks the receptor

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13
Q

Agonist

A

Binds to a receptor and activates it

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14
Q

How do toxicokinetics differ from pharmacokinetics

A

When a drug is taken in overdose, normal pharmacokinetics don’t apply due to saturated metabolic pathways and a change in the desired effect, half-life and excretion time

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15
Q

Six common routes of absorption

A 
Ingestion
Inhalation
Injection
Absorption
Ocular
Rectal
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16
Q

What does ABCD referred to in the approach to a poisoned patient

A

Airway
Breathing
Circulation
Decontamination - protect yourself and decontaminate the patient as needed

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17
Q

Common OPQRTS and SAMPLE questions to include

A

What was taken, when, route, how much, why, acute or chronic reaction, other exposures, vomiting nausea aspiration, suicidal

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18
Q

What are significant findings for the following body systems in the poisoned patient?
Eyes, Mucous membranes, Bowel sounds, Skin, Neuro

A 
Eyes - pupils and nystagmus
Mucous- hydration
Bowel - hypo/hyperactive
Skin- Rash, dry, diaphoretic
Neuro - reflexes
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19
Q

AEIOUTIPS for a neuro exam

A 
Alcohol
Endocrine/ Epilepsy
Intoxication
Oxygen
Uremia
Trauma/Tumor
Infection
Psychological
Shock/Stroke
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20
Q

OTIS CAMPBELL for seizure/neuro exam

A 
Organophosphates
Tricyclics
Insulin
Sympathomimetics
Cocaine
Amphetamines
PCP
Benz withdrawal
Ethanol
Lead/Lithium
Lidocaine
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21
Q

Anticholinergic toxidrome

A 
\+HR
=RR
\+Temp
pupil dilation
-bowel sounds
-diaphoresis
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22
Q

Cholinergic toxidrome

A 
=HR
=RR
=Temp
pupil constriction
\+bowel sounds
\+diaphoresis
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23
Q

Sympathomimetic toxidrome

A 
\+HR
\+RR
\+Temppupil dilation
\+bowel sounds
\+diaphoresis
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24
Q

Sedative Hypnotic toxidrome

A

-HR
-RR
-Temp
=pupils
-bowel sounds
-diaphoresis

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25
Opioid toxidrome
-HR -RR -Temp pupil constriction -bowel sounds -diaphoresis
26
6 examples of anticholinergic agents
``` Atropine Antihistamines Antipsychotics Scopolamine TCA's Jimson Weed ```
27
Treatment for anticholinergic toxicity
Supportive care
28
Typical S&Sy of anticholinergic OD (mneumonic)
``` Hot as a hare Blind as a bat Dry as a bone Red as a beat Mad as a hatter ```
29
Causes of cholinergic toxicity
Organophosphates Carbonates Nerve Agents
30
Treatment for cholinergic toxicity
``` Atropine Pralidoxime (2PAM) ```
31
S&Sy of cholinergic toxicity
Muscarinic Sy - SLUDGE Nicotinic Sy - MTWTF (Muscle Cramps, Tachycardia, Weakness, Twitching, Fasciculations)
32
Muscular effects of cholinergic toxicity
weakness, fasciculation, paralysis, similar to Succs, don't use Succs to intubate
33
Cardiovascular effects of cholinergic toxicity
Sinus tachydysrhythmias, bradycardia, QT prolongation causing Torsades
34
S&Sy of sedative-hypnotic toxicity
sleepy, decreased RR | +/- variable BP, HR, Temp
35
Treatment of sedative-hypnotic toxicity
Supportive care, monitor RR
36
Causes of sedative-hypnotic toxicity
Benzodiazepines, barbiturates, zolpidem
37
S&Sy of opioid toxicity
Sleepy, - RR, pinpoint pupils
38
Causes of opioid toxicity
heroin, morphine, oxycodone, fentanyl, methadone
39
Treatment for opioid toxicity
Narcan, supportive, monitor RR
40
S&Sy of sympathomimetic toxicty
Altered, agitated, mydriasis (dilation of the pupil), diaphoretic elevated HR, RR, BP
41
Causes of sympathomimetic toxicity
amphetamines, cocaine, bath salts, huffing
42
Major concerns of Sympathomimetic toxicity
Rhabdo, Hyperthermia, Safety
43
Treatments for sympathomimetic toxicity
High doses of Benzodiazepines in hopes of decreasing neural output and preserve ATP Use non-depolarizing paralytics to preserve ATP Actively cool if hyperthermic (tylenol ineffective)
44
Examples of TCA OD
amitriptyline, nortriptyline, amoxapine
45
S&Sy of TCA OD
cardiovascular and neurologic toxicity | tachycardia, drowsiness, N/V, monitor for peaked T waves, Widened QRS, Prolonged QT, ALOC, hypotension, seizures
46
Treatment for TCA OD
``` Widened QRS (50mEq IV Bicarb), QT prolongation Mag 2g if needed, Maintain BP with Dopamine as needed ```
47
Causes of SSRI Toxicity
SSRI, MAOI, cocaine, dextromethorphan
48
S&SY of SSRI Toxicity
AMS, Clonus, Rigidity, Hyperthermia
49
Treatment of SSRI Tocicity
Benzodiazepine, Ciproheptadine
50
Causes of Ca++Channel Blocker Toxicity
amlodopine, diltiezam, verapamil, felodipine
51
S&SY of Ca++ channel blocker toxicity
Hypotension, Brady dysrhythmias, prolonges R-R, Cardiac arrest, seizure, syncope, N/V, ALOC, Hyperglycemia, Hypokalemia
52
Treatment of Ca++ channel Blockers
Ca++Cl- 500-1000 SLOW IVP consider 2nd dose with base contact IV fluids, vasopressor, consider TCP, supportive care
53
Causes of Beta Blocker Toxicity
Atenolol, Metoprolol, sotalol, propanolol
54
S&Sy of Beta Blocker toxicity
Bradycardias, AV Blocks, prolonged R-R, Torsades, drowsiness, hypotension, CHF type symptoms -HR, -inotropic, -dromotropic
55
Treatments for Beta Blocker toxicity
Glucagon 3-5mg IV over 10 min (will cause vomiting) | Dopamine to maintain BP >100
56
what is the level to consider acetaminophen Toxicity
Acute within 8 hr period Adult: >6g Children: >200mg/kg
57
Describe the 4 phases of acetaminophen toxicity
P1: 0-24hrs N/V P2: 24-72hrs RUQ Px, Elevated liver enzymes and INR P3: 72-96hrs hepatic necrosis, renal failure P4: 4days-weeks resolution of S&Sy if pts survive this long
58
Salicylate Toxicity S&Sy
Tinnitus, GI upset, respiratory stimulant, AMS, acute lung injury, Central hypoglycemia (give D50)
59
CO poisoning S&Sy
flu-like, dizzy, bounding pulse, dilated pupils, cyanosis, cherry red skin
60
CO treatment and management
high flow O2, reduce anxiety, monitor EKG and LOC
61
Cyanide Poisoning S&SY
burning sensation in ENT, cyanosis, shock, seizures
62
Cyanide Poisoning Treatment
High flow O2, irrigate eyes and skin
63
Nicotine OD S&SY
Tachycardia, N/V and seizures, bradycardia | Parasympathomimetic alkaloid
64
Lethal dose of nicotine
30-60mg (.5-1.0mg/kg) ave e-cigarette contains 9mg, but less than 1 mg is ingested Have 0-48mg/ml of nicotine solution

CH 27 Toxicology (1 decks)

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