Management Of Poisoned Patient Flashcards by Anna Michaela Gatchalian

Denotes the altered pharmacodynamics of a drug when given in toxic dosage, since normal receptors and effector’s mechanisms may be altered.

Toxicodynamics

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applied to the pharmacokinetics of toxic doses of chemicals, since the toxic effects of an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material

Toxicokinetics

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apparent volume into which a substance is distributed

Volume of Distribution (Vd)

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A large VD implies that the drug is ___________ accessible to measures aimed at purifying the blood, such as hemodialysis

not readily

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Drugs with large volumes of distribution

PANAVA
1. Antidepressants
2. Antimalarials
3. Narcotics
4. Propranolol
5. Antipsychotics
6. Verapamil

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Drugs with relatively small volumes of distribution

Salicylate
Phenobarbital
Lithium
Valproic Acid
Warfarin
Phenytoin

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a measure of the volume of plasma that is cleared of drug per unit time

Clearance

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the sum of clearances by excretion by the kidneys and metabolism by the liver

Total clearance

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Cardiovascular toxicity

● Hypotension
● Peripheral Vascular Collapse
● Lethal arrhythmia

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Comatose patients frequently lose their ____________ and their ____________.

airway protective reflexes & respiratory drive

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occurs in spite of adequate ventilation and oxygen administration

Cellular hypoxia

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Signs and symptoms of Hypoxia

Hypotension
Tachycardia
Severe Lactic Acidosis
Signs of Ischemia on the ECG

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Drugs that can often cause seizures

Antidepressants
Theophylline
Isoniazid (INH)
Diphenhydramine
Antipsychotics
Cocaine
Amphetamines

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Decrease Blood Volume

Hypovolemia

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Drugs/substances that cause pulmonary fibrosis

Paraquat, Bleomycin, Amiodarone

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Massive hepatic necrosis due to poisoning by ____________ or ________________

acetaminophen or certain mushrooms

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Massive hepatic necrosis due to poisoning by acetaminophen or certain mushrooms results in

hepatic encephalopathy

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Massive hepatic necrosis due to poisoning by acetaminophen or certain mushrooms results in hepatic encephalopathy and death _________ hours or longer after ingestion.

48–72

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Intoxication with alcohol and other sedative-hypnotic drugs is a frequent contributing factor to

motor vehicle accidents

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Most common factor contributing to death from drug overdosed is usually caused by a problem in

Airway

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Patients under the influence of ________, such as phencyclidine (PCP) or LSD may die in fights or fall from high places.

hallucinogens

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AIRWAY Obstruction is caused by:

flaccid tongue, pulmonary aspiration of gastric contents, or respiratory arrest

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For many patients, simple positioning in the __________________ position is sufficient to move the flaccid tongue out of the airway

lateral decubitus

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Ideal position for a patient with obstruct airway

lateral decubitus

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Two routes for endotracheal intubation:

Nasotracheal intubation & Orotracheal intubation

A soft, flexible tube is passed through the nose and into the trachea.

Nasotracheal intubation

The tube is passed through the mouth into the trachea.

Orotracheal intubation

What technique is used in using Nasotracheal intubation?

Blind technique

Orotracheal intubation is done under ___________ vision

Direct

May be performed in a conscious patient without requiring neuromuscular paralysis.

Nasotracheal intubation

Once placed, it is better tolerated than an orotracheal tube.

Nasotracheal intubation

Disadvantages of Nasotracheal intubation

1. Perforation of the nasal mucosa, with epistaxis. 2. Stimulation of vomiting in an obtunded patient. 3. Patient must be breathing spontaneously. 4. Anatomically more difficult in infants because of anterior epiglottis.

Performed under direct vision, making accidental esophageal intubation unlikely.

Orotracheal intubation

Insignificant risk of bleeding.

Orotracheal intubation

Patient need not be breathing spontaneously.

Orotracheal intubation

Higher success rate than that with nasotracheal route.

Orotracheal intubation

Disadvantages of Orotracheal intubation

1. Frequently requires neuromuscular paralysis, creating a risk of fatal respiratory arrest if intubation is unsuccessful. 2. Requires neck manipulation, which may cause spinal cord injury after neck trauma.

major cause of morbidity and death in patients with poisoning or drug overdose

Breathing difficulties

Complications in breathing:

ventilatory failure, hypoxia, bronchospasm

The ____________ should be cleared of vomitus or any other obstruction.

airway

Medical term for nosebleed

Epistaxis

Done to unconscious or paralyzed patients

Orotracheal intubation

measures the degree of oxygen saturation

Oximeter

Breathing should be assessed by observation and oximetry and, if in doubt, by measuring _____________________.

arterial blood gases

Breathing Treatment

• correct hypoxia • treat pneumonia • treat bronchospasm

If carbon monoxide poisoning is suspected, give _______

100% oxygen

For beta blocker-induced wheezing

Aminophylline, 6 mg/kg IV over 30 minutes

For patients with bronchospasm and bronchorrhea caused by organophosphate or other anticholinesterase poisoning, give

Atropine

The circulation should be assessed by continuous monitoring of the following:

1. pulse rate 2. blood pressure 3. urinary output 4. evaluation of peripheral perfusion

number of heartbeats per minute

Pulse rate

Normal pulse rate

60-100 bpm

measure of the force that the heart uses to pump blood around the body

Blood pressure

Average urination per day

6-7

An intravenous line should be placed and blood drawn for ____________ and other routine determinations.

serum glucose

Normal BP

<120mmHg and <80mmHg

Elevated BP

120-129mmHg and <80mmHg

HTN stage 1

130-139mmHg or 80-89mmHg

HTN stage 2

140mmHg or higher or 90mmHg or higher

Hypertensive crisis BP

>180 and/or >120

What blood sugar level is required to give concentrated dextrose?

70mg/dL and below

Normal blood sugar level for non-diabetic person

80-100 mg/dL

Normal blood sugar level for diabetic person

100-120 mg/dL

Adults are given of how many g of dextrose?

25 g (50 mL of 50% dextrose solution) IV

Children are given of how many g of dextrose?

0.5 g/kg (2 mL/kg of 25% dextrose)

Alcoholic or malnourished patients should also receive ________________ or in the IV infusion solution at this time to prevent Wernicke's syndrome.

100 mg of thiamine IM

Thiamine deficiency

Wernicke's syndrome

Opioid antagonist

Naloxone, Naltrexone

The opioid antagonist naloxone may be given in a dose of

0.4–2 mg IV

Antidote for propoxyphene overdose

Naloxone

narcotic, pain reliver with cough suppressant property

Propoxyphene

narcotic cough suppressant

Codeine

may be needed for patients with overdose involving propoxyphene, codeine, and some other opioids

Larger doses of naloxone

Potent, short-acting synthetic opioid. Derivative of Fentanyl

Alfentanil

Narcotic nasal spray, used for migraine

Butorphanol

Powerful synthetic opioid analgesic, similar to morphine. (50 to 100x more potent than morphine)

Fentanyl

Semisynthetic hydrogenated ketone. Derivative of morphine

Hydromorphone

Dilaudid

Levomethadyl acetate

Orlaam

Levorphanol

Levo-Dromoran

Used widely for therapy of moderate to severe pain

Meperidine

Demerol

Pain relief and tx of drug addiction

Methadone

Dolophine

Nalbuphine

Nubain

Semisynthetic opioid analgesic derived from Thebaine (alkaloid). Has high risk of addiction

Oxycodone

main alkaloid of Opium, potent analgesic, and high risk of depedence

Morphine

Derived from Thebaine. 6 - 8x stronger than morphine

Oxymorphone

Numorphan

Treat moderate to severe pain in adults and children 12 yrs old and above.

Pentazocine

Talwin

Narcotic pain reliver with cough suppressant (weaker than codeine)

Propoxyphene

Darvon Pulvules

Very short-acting opioid

Remifentanil

Ultiva

Sufentanil

Sufenta

Analogue of codeine, very strong pain killer used by cancer px

Tramadol

Ultram

Empirin Compound

Codeine/aspirin

Percocet, Tylox

Oxycodone/acetaminophen

Percodan

Oxycodone/aspirin

Darvon

Propoxyphene/aspirin or acetaminophen

Opioid Antitussives

● Codeine ● Dextromethorphan

Dextromethorphan

Benylin DM, Delsym

DOC for benzodiazepine overdose

Flumazenil

Should not be used if there is a history of tricyclic antidepressant overdose or a seizure disorder

Flumazenil

If a px has a history of TCA overdose or seizure disorder, the use of Flumazenil may induce ______

Convulsions

a constant amount of drug is eliminated per unit time

Zero order kinetics

This concentration would affect the rate of drug elimination.

First Order Kinetics

It is a concentration-dependent process.

First Order Kinetics

Drug Examples of zero-order kinetics

Ethanol, Omeprazole, Salicylates, Aspirin, Cisplatin (SACOE)

Ratio of dose of the drug to the concentration of the drug in the body

Volume of Distribution

Special aspect of toxocokinetics

Volume of Distribution

necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasma

Volume of Distribution

a theoretical volume wherein a drug is not readily accessible to measure

Volume of Distribution

Caused by pulmonary aspiration of gastric contents.

Pneumonia

Low levels of oxygen in the blood

Hypoxia

Blood oxygen concentration of hypoxic patient

85-94%

Examples of hallucinogens

Phencyclidine (PCP) or Lysergic acid diethylamide (LSD)

ABCD meaning

Airway, Breathing, Circulation, Diagnosis/Decontamination

Compensatory reaction of a person with hypoxia

Tachycardia

Low cardiac contractility

Hypotension

Drugs that can cause ventricular tachycardia [VT - CADET]

Cocaine, amphetamine, digitalis, ephedrine, TCA (CADET)

Drugs that can cause hypothermia

Beta blockers, Antipyretics

Drugs that can cause hyperthermia

Antipsychotic drugs

Adr of antipsychotic drugs

Neuroleptic malignant syndrome (NMS)

Substances that can cause hypoxia

Cyanide, hydrogen sulfide, carbon monoxide

Acute toxity of Isoniazid causes

Seizure

Chronic toxicity of Isoniazid causes

Peripheral neuropathy/neuritis

Dose of aminophylline given for beta-blocker induced wheezing

6mg/kg IV over 30 mins

Management Of Poisoned Patient Flashcards

(129 cards)