Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Management Of Poisoned Patient > Flashcards

Management Of Poisoned Patient Flashcards

(174 cards)

Start Studying
1
Q

What is the golden rule for poison management

A

Treat the patient not the poison

First stabilize the patient and treat the symptoms

Secondly worry about the poison

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Many poisons acts as ?

A

CNS depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common sx of poison that needs to be treated as CNS depressant

A

Coma

Loss of airway protective reflexes and respiratory drive

Flaccid tongue

Aspiration of gastric content

Respiratory arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Other poison sx that can lead to death

A

Cardiovascular toxicity

Cellular hypoxia

Seizures

Delayed symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sx of cardiovascular toxicity

A

Hypotension from depressed cardiac contractility

Hypovolemia from vomiting, diarrhea or fluid sequestration

Peripheral vascular collapse caused by blockage of alpha adrenergics

Cardiac arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signs of lethal arrhythmia

A

Ventricular tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drugs can cause lethal arrhythmia

A

Ephedrine

Amphetamines

Cocaine

Digitalis

Theophylline

TCA

Antihistamine

Some opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What agents can induce hypoxia

A

Cyanide

H2S

CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Signs of cellular hypoxia

A

Cyanosis

Tachycardia

Hypotension

Severe lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the initial management of poisoned patients

A

Treat and stabilize patient

Address coma or seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the ABCD of supportive measures

A

Airway

Breathing

Circulation

Dextrose for decreased mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is airway addressed

A

Cleared of vomit or obstacles

  • Insert endotracheal tube if needed
  • May need to lay patient on side
  • Move flaccid tongue out of airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is breathing addressed

A

Observe and assess oximetry (pulse)

  • When in doubt measure arterial blood gas if you have time
  • Patients with respiratory insufficiency should be intubated and mechanically ventilated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is circulation addressed

A

Continuous monitoring of pulse rate and blood pressure

  • Urinary output
  • Evaluation of peripheral perfusion
  • Use of IV if needed
  • Blood drawn for serum glucose and other factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is dextrose used as initial management

A

Use with patients with altered mental status

  • Don’t use if you know patient is not hypoglycemic
  • Rapid bedside test (treat patient first)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the dose of dextrose for adult and children

A

Adult = 25 g (50 ml 50% dextrose) with IV for adults

Children = 0.5 g/kg (2 mL/kg 25% dextrose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the ER Assessment: Oral Statement

A
  • Amount of drug
  • Type of drug
  • “House” everybody lies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is ER assessment: Environment

A
  • Talk to family members
  • 1st responders (fire department, paramedics)
  • What was the house like?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In ER assessment what should you bring to ER

A
  • Syringes
  • Empty bottles
  • Household products
  • OTCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the standard ER assessment to check for vitals

A
  • Pulse
  • Heart rate
  • Blood pressure
  • Temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What other part of the body can be assessed for vital signs during ER assessment

A
  • Eyes
    • Reactive
    • Dual reaction
  • Mouth
  • Skin
  • Abdomen
  • CNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What medication can induce hypertension or tachycardia

A

Amphetamines

Cocaine

Anti-muscarinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What medication can induce hypotension or bradycardia

A

Calcium channel blockers

Beta-blockers

Clonidine

Sedative hypnotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What medication can induce hypotension or tachycardia

A

TCAs

Trazadone

Quetiapine

Vasodilator

Beta agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
During eye assessment what drugs can induce mitosis- constriction
* Opioids * Clonidine * Cholinesterase inhibitors * Sedatives (coma)
26
During eye assessment what can drugs can cause mydriasis-dilation
* Amphetamines * Cocaine * LSD * Atropine * Anticholinergic drugs
27
During eye assessment what drugs can cause horizontal nystagmus
* Phenytoin * Alcohol * Barbiturates * Sedatives
28
During eye assessment what drugs can cause both vertical and horizontal nystagmus
Phenycyclidine (PCP)
29
During ER assessment what signs of nervous system should be assessed
* Focal seizures/motor deficits * Nystagmus, dysarthria (motor speech problem), ataxia * Twitching/muscular hyperactivity * Muscular rigidity * Seizures * Flaccid coma with no reflexes
30
How can electrolytes be used during ER assessment
Calculate ion gap
31
What is the anion gap
Cations - anions Cations are usually greater by 12-16 mEq
32
What drugs can induce anion gap
Aspirin Methanol Ethylene glycol Isoniazid Iron
33
How does TCA overdose impact EKG
Widening QRS complex by > 100 msec
34
What drugs impact EKG by prolonging QTc interval by > 400 msec
Quinidine New antidepressant New antipsychotic Lithium Arsenic
35
Which drugs impact EKG through variable AV block
Digoxin Cardiac glycosides CO
36
What is the reality of toxicology screening
Time consuming Expensive Unreliable Not all drugs can be included in screen Results may take days
37
Which drugs might not be included in screenings
Beta blocker Calcium channel blockers Isoniazid
38
True or False: Every existing poison has an antidote
False
39
How is skin decontamination done as an antidote
Remove contaminated clothing and double bag to prevent exposure
40
What GI approaches are performed as antidote decontamination for GI
Emesis Gastric lavage Activated Charcoal Cathartics
41
When is GI emptying as an antidote method more effective
Within 1 hour of ingestion
42
How does activated charcoal work as an antidote
Absorbs poison
43
What can be used for emesis
Ipecac syrup not extract
44
When should ipecac Symptoms not used
If toxicants is corrosive, petroleum based or rapid acting convulsant
45
Should salt water or finger used to induce emesis
No
46
How can gastric aspiration induced mechanically
Use nasogastric or orogastric tube to remove stomach content Requires anesthesia and stomach pumping Use 0.9% saline at body temperature
47
What is the MOA of activated charcoal
Adsorb many drugs and poison due to large surface area
48
How is activated charcoal dosed compared to the weight of toxicant
Charcoal: toxicant weight (10:1)
49
What is the dosage form of activated charcoal
Tablets or powders
50
Which toxins does charcoal not bind to
Iron Lithium Potassium
51
Which toxins does charcoal bind poorly to
Alcohol Cyanide
52
What can repeated doses of activated charcoal do
Enhance systemic elimination of drugs (i.e gut dialysis)
53
What is another name of Cathartics
Laxatives
54
What is the mechanism of action Cathartics
May hasten removal of toxins from GI and alter absorption
55
What are the products are used as Cathartics
Rushpills Polyethylene glycol electrolyte solution
56
What procedure can Cathartics be used prior
Colonoscopy
57
Which toxin does cathartics increase its guts elimination
Iron
58
What is the two prone approach to designing specific antidotes
Pharmacokinetic Pharmacodynamic
59
How does the pharmacokinetic work
Prevent absorption and distribution Enhance elimination
60
How does pharmacodynamic work
Pharmacological Interfere with the binding to target Antagonistic
61
What are the non-specific antidotes
Dialysis Hemodialysis Forced diuresis and urinary pH manipulation Renal elimination
62
Dialysis: peritoneal dialysis
Simple but ineffective and works into the abdominal cavity
63
What are the benefits of hemodialysis
Assist in fluid correction and electrolyte balances Enhance removal of toxic metabolite
64
Efficiency of hemodialysis is dependent on what factor
Molecular weight Water solubility Protein binding endogenous clearance Tissue distribution
65
Can toxin be eliminated by hemodialysis if it is not in the blood
No
66
Why has forced diuresis and urinary pH manipulation lost favor
It can cause volume overload and electrolyte imbalance
67
How does renal elimination work
Can increase by adjusting urinary ph Salicylate are eliminate by urinary alkalization Can increase rhabdomylosis
68
What is rhabdomylosis
Damaged skeletal muscle break down quickly and enters the bloodstream and proteins cause damage to the kidney and cause renal failure
69
What can cause rhabdomylosis
Seizure Muscle rigidity Crush injury
70
What are the symptoms of rhabdomylosis
Muscle pain Vomiting Confusion Brown-urine house
71
When is acetaminophen over dose usually seen
Suicide attempts Accidental poisonings
72
What are the symptoms of acetaminophen overdose
Initial mild GI Nausea Vomiting
73
When does lever toxicity occurs and what are the signs and symptoms
24-36 hours Increased aminotransferases Hypoprothrombinemia
74
Severe acetaminophen poisoning is characterized by
Liver failure Hepatic encephalopathy Renal failure
75
Come back to the flow chart on slide 25
Sure will
76
What is acetaminophine overdose concentration after the
>150-200 mg/L
77
Who are at greater risk of acetaminophen toxicity
Alcoholics or those taking drugs metabolized by CYP450
78
What is the antidote of acetaminophen overdose
Acetylcysteine - acetate or mucomyst
79
MOA of acetadote
Acts like GSH and binds to toxic metabolite of acetaminophen
80
When is acetadote most effective
When given early (8-10 hours)
81
What is the antidote in severe cases of acetaminophen toxicity
Liver transplantation
82
What drugs contribute to amphetamine overdose
Cocaine Methamphetamine Methyldioxymethamphetamine (MDMA, ecstasy) Pseudoephedrine Ephedrine (Ma-Huang) Caffeine
83
When used recreationally, what can a person experience with amphetamine
Sense of power Euphoria Well being
84
What results from amphetamine taking higher doses at
Restlessness Agitation Acute psychosis HTN and tachycardia Increased muscle activity (dehydration and hypotension) Seizures ( hyperthermia or rhabdomylosis) Extreme increase in body temperature 42°C or 107.6°F (brain damage, hypotension, coagulopathy, renal failure )
85
How is amphetamine overdose treated
Supportive care No specific antidote Manage seizures and hyperthermia aggressively
86
What medication is used to battle amphetamine seizure overdose
IV benzodiazepines
87
What does anticholinergics do
Inhibit acetylcholine effect on muscarnic receptors
88
Which anticholinergics do not target cholinergic receptors
Antihistamine TCAs
89
What is the muscarnic symptoms of anticholinergic toxicity
Skin flushing Hyperthermia Dry mucosal membrane w/o sweating Blurred vision, cychoplegia Confusion Delirium
90
What are other anticholinergie toxicity
Sinus tachycardia Dilated pupil Coma Seizures (if patient took TCA or anti histamine)
91
What is the treatment for anticholinergic toxicity
Largely supportive Agitation is controlled with sedation, benzodiazepine or antipsychotics Physostigmine
92
What is the MOA of physostigmine
Inhibits acetycholine esterase activity to increase acetylcholine levels
93
What receptors does physostigmine work on
Nicotinic and muscarinic
94
How is physostigmine dosed
0.5-1 mg IV
95
What is physostigmine ADR
Bradycardia Seizure
96
Who should avoid physostigmine use
Patient with TCA overdose due to increased risk of cardiotoxicity and asystole
97
What dose of antidepressant can be lethal or classified as an overdose
1 g or 15-20 mg/kg
98
What's antidepressant such as TCA MOA
Competitive antagonist at muscarinic receptors
99
What are the ADR of TCA antidepressants
Tachycardia Dry mouth Dilated pupils Strong alpha blockers can lead to vasodilation
100
What are the symptoms of antidepressant toxicity
* Tachycardia * Dilated pupils * Vasodilation * Seizures * Depression * Hypotension
101
What are quinidine like depressants effect that can be symptoms of antidepressants toxicity
* Slowed conduction * Wide QRS interval * Depressed cardiac contractility * Lead to arrhythmias with ventricular conduction block * Ventricular tachycardia
102
What is the antidepressant overdose treatment
* General supportive care * Endotracheal intubation with assisted ventilation * IV fluids for electrolyte loss * Dopamine or norepinephrine if needed
103
In antidepressants overdose when is norepinephrine used as the initial drug
If hypotension is present
104
How is quinidine like cardiac toxicity with wide QRS managed
Sodium bicarbonate
105
Why should physostigmine not used in quinidine like cardiac toxicity
Can aggravate depression of cardiac conduction and cause seizure
106
What other form can patients overdose with antidepressants
With MAOIs
107
MAOIs
Tranylcypromine Phenelzine Older antidepressants
108
What are MAOIs Symptoms
Anticholinergic Severe hypertension Interact with SSRIs
109
What new anti depressants can cause toxicity
Fluoxetine Paroxetine Citalopram Venlafaxine Bupropion
110
Mostly SSRIs Generally safer than TCA and MOI Can cause seizures
Venlafaxine
111
Not an SSRI but can cause seizures
Bupropion
112
Old antipsychotics
Phenothiazine Butyrophenones
113
New atypical
Clozapine Quetiapine Risperidone
114
What are the symptoms of antipsychotic overdose
Drowsiness - proceeds to coma with brief agitation QT prolongation CNS depression Seizures Hypotension
115
What class of antipsychotics can cause parkisonian like disorder
D2 blocker
116
How is antipsychotic overdose treated
Supportive care * Gastric lavage * Activated charcoal * Saline cathartic
117
Antidote for antipsychotic induced hypotension
Norepinephrine
118
Antidote for antipsychotic induced seizures
Diazepam
119
Antidote for antipsychotic lithium overdose
Dialysis
120
What accounts for numerous suicide and accidental poisonings
Aspirin
121
Chronic overdose of aspirin in elderly is usually due to
Forgetting if they took it or not
122
Aspirin MOA
* Ion gap * Metabolic acidosis * Respiratory alkalosis * Platelet dysfunction and bleeding
123
Acute aspirin overdose symptoms
* Hyperventilation * Respiratory alkalosis with medulla stimulation * Metabolic acidosis * Increased ion gap from lactate excretion of bicarbonate in urine * Increase in body temperature from uncoupled oxidative phosphorylation * Vomiting * Hyperpnea
124
Aspirin severe overdose symptoms
Profound metabolic acidosis * Seizures * Coma * Pulmonary edema * Cardiovascular collapse
125
Aspirin overdose treatment
Supportive care Treat ion gap Treat seizures Treat fever Aggressive gut decontamination Gastric Savage Repeated activated charcoal
126
Why is I.V fluid given in aspirin overdose treatment
To replace fluid loss from tachycardia, vomiting and fever
127
How is moderate intoxication of aspirin treated
• IV with sodium bicarbonate to Alkalizes urine, which increases salicylate excretion by trapping ion
128
What is considered severe aspirin intoxication
> 100 tablets
129
How is severe cases of aspirin intoxication managed
Hemodialysis Restore acid/ base balance Restore salts
130
Why are beta blockers administered
Raise BP and HR
131
Glucagon function of cardiac cells
Increase cAMP independent of b-adrenoreceptor
132
Treatment of beta blocker overdose
B-agonist Atropine: won't work for Na block Glucagon
133
Why is the aim to increase cAMP for better blocker over close
Because cAMP inhibits MLCK phosphorylation preventing contraction
134
Why should one be careful with calcium channel blockers
Toxicity and death can occur at relatively low doses
135
How can calcium charnel blockers induce toxicity and death
Depress sinus node automaticity * Slow AV node conduction * Decrease cardiac output * Decrease blood pressure * Serious hypotension
136
Example of calcium channel blockers
Nifedipine Dihydropyridines
137
For calcium channel blocker in sustained released form how can toxicity be addressed
Whole bowel irrigation Oral activated charcoal
138
Calcium intravenous at 2-10 g are good to treat what type of calcium channel blocker toxicity
Depressed Cardiac contractility but not for peripheral collapse
139
What drugs can be given for Cardiac channel blocker toxicity
Glucagon Vasopressin Epinepherine High dose insulin and glucose
140
What are the types of cholinesterase inhibitor
Organophosphate Carbamate cholinesterase inhibitors Insecticides
141
How can one be exposed to cholinesterase inhibitors
Insecticides/pesticides Suicides Rarely food
142
What tragic event has Cholinesterase inhibitors be used for
Warfare Tokyo subway 95
143
What are the muscarinic stimulation Symptoms of cholinesterase inhibitor overdose
* Abdominal cramps * Excessive salivation * Sweating * Increased urinary frequency * Increased bronchial secretion
144
What are the CNS effect Symptoms of cholinesterase inhibitor overdose
* Agitation * Confusion * Seizures
145
What are the Nicotinic stimulation Symptoms of cholinesterase inhibitor overdose
* Generalized ganglionic activation * Hypertension * Tachycardia or bradycardia * Muscle twitching and fasciculations
146
What other Symptoms are shown in cholinesterase inhibitor over dose
* Diarrhea * Urination * Miosis and muscle weakness * Bronchospasm * Excitation * Lacrimation * Seizures, sweating and salivation
147
Cholinesterase inhibitor treatment
Generalized supportive care Atropine: muscarnic Only Pralidoxine; nicotinic and muscarinic receptors The Rock
148
What are cyanide forms
CN salts HCN
149
Uses of cyanide
* Chemical synthesis * Rodenticides * Executions at one time * Suicide/homicide
150
Sources of cyanide
* Burning of plastics * Burning of wool * Synthetic and natural products * Plant and seeds * Apple seeds * Peach
151
Cyanide MOA
Bind cytochrome oxidase in mitochondria to induce cellular hypoxia and lactic acidosis
152
Symptoms of cyanide poisonings
* Shortness of breath * Agitation * Tachycardia * Seizures * Hypotension * Death * Characterized by severe metabolic acidosis
153
Cyanide treatment
Rapid Administration of activated charcoal General supportive care Antidote Kit Cyanokit (EMD pharmaceuticals)
154
Cyanide antidote kit
* Forms of nitrite * Amyl nitrite * Sodium nitrite * Sodium thiosulfate * Induce methemoglobinemia that binds free CN- * Creates a less toxic cyanomethemoglobin * Thiosulfate * Enzyme cofactors * Facilitates conversion to CN to less toxic hydroxocobalamin
155
Cyanokit
* Concentrated Hydroxocobalamin | * Combines with CN- to form cyanocobalamin (B12)
156
Symptoms of acute digoxin overdose
* Renal insufficiency * Diuretics with digoxin * Vomiting * Hyperkalemia * Hypokalemia with long term use * Cardiac rhythmic distrubances * Sinus bradycardia * AV block * Atrial tachycardia * Accelerated junctional rhythm
157
When is atropine used in digoxin overdose treatment
Bradycardia or sinus block occur
158
What type of antibiotics can be used with digoxin overdose treatment
Digoxin antibodies * IV administration at indicated dosages * Symptoms usually improve 30-60 min * Can be used for other cardiac glycosides * Oleander
159
Ethanol and sedative hypnotic drugs
* Ethanol * Benzodiazepines * Barbiturates * G-hydroxbutyrate (GHB)- date rape * Carisoprodol (Soma)
160
Symptoms of ethanol and sedative hypnotic drugs
* Drunk * Euphoria • Rowdy * Dead drunk * Stupor • Coma • Decreased respiratory drive * Decreased protective respiratory reflexes * Can result in aspiration of gastric contents * Tracheal aspiration * Hypothermia * Exposure * Decreased shivering
161
Ethanol and sedative hypnotic drugs treatment
* Supportive care * Protect the airway * Intubation if needed * IV fluids for hypotension * Dopamine if needed
162
Benzodiazepine antidotes
* IV flumazenil * Benzodiazepine antagonist (Can cause seizures in patients addicted to benzodiazepines) * Don’t give with patients with TCA overdose
163
True/False: There is no antidote for ethanol, barbiturates or other sedative drugs
True
164
Ethylene glycol and methanol description
Metabolized into organic acids * Cause CNS depression * Drunken state similar to Ethanol
165
Product of methanol metabolism and effect
Metabolized to formic acid and Causes metabolic acidosis
166
Product of ethylene glycol metabolism and effect
Metabolized to hippuric acid and oxalic acid and causes renal failure
167
Symptoms of ethylene glycol and methanol overdose
* Drunkenness and altered mental status * Anion gap * Severe metabolic acidosis * Hyperventilation * Blurred vision and blindness
168
Treatment of ethylene glycol and methanol
* Fomepizole (4-methypyrazole) * Inhibits alcohol dehydrogenase * Don’t use with alcohol * Hemodialysis * Ethanol, but hard to get to high enough dose
169
What was thophylline once used to treat
* Bronchospasm * Asthma * Bronchitis * 20-30 tablets is toxic
170
What are Symptoms of theophylline toxicity
* Sinus tachycardia * Tremor * Vomiting * Hypotension * Hypokalemia * Hyperglcemia
171
Antidote for opioid overdose
Naloxone: short window of action Patient can slip in and out of coma
172
Naloxone dose
0.1-0.4 mg
173
How is naloxone used to block all effects of heroin
Give on alternate days
174
Used to maintain addicts
Naloxone

Pharmacology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions