Midterm Pre & postlab (Antidotes)

Question 1

A processed charcoal that is obtained from the burning of carbonaceous substances. It involves extensive treatment w/ steam, CO2, O2, ZnCl, H2SO4, H3PO4, at 500-900°F that increases surface area.

A. Activated Charcoal
B. EDTA
C. N-acetylecysteine
D. Naloxone

Answer 1

A. Activated Charcoal

Question 2

they are significantly bound?

Answer 2

Organic molecules

Question 3

they are generally less well bound?

Answer 3

LMW & polar compounds

Question 4

they are also not appreciably bound?

Answer 4

certain inorganic salts

Question 5

this antidote has an adsorption at a ratio of approximately 10:1 and administered in1g/kg PO or gastric tube as aqueous suspension?

Answer 5

Activated charcoal

Question 6

chelating agent especially for lead intoxication; hypercalcemia

Answer 6

Ethylenediaminetetraacetic acid (EDTA)

Question 7

in chronic chronic Pb exposure, a medical condition characterized by high levels of calcium in the blood?

Answer 7

Hypercalcemia

Question 8

the BLL that can be considered as Pb poisoning?

Answer 8

> 150mcg/dL

Question 9

Dosing of EDTA for adult and children?

Answer 9

Adult: 2-4g or 30-50mg/kg
Children: 1000-1500mg/m2

IV q24H as continuous IV dil. 2-4mg/mL in NS or D5%
symptomatic: admin. for 3-5days

Question 10

a precursor to glutathione, direct sulfhydryl binding agent; an antioxidant that helps neutralize the toxic metabolites of APAP that can damage the liver?

Answer 10

N-acetylcysteine (NAC)

Question 11

Dosing of NAC:

Answer 11

140mg/kg LD dil. in juice or soda
MD: 70mg/kg q4H

Question 12

competitive opioid antagonist; takes effect 1-2 mins. after IV. Used in opioid overdose

Answer 12

Naloxone

Question 13

longer elimination t1/2 and DoA; discontinued in US. Used to treat alcohol dependence.

Answer 13

Nalmefene

Question 14

active Po; prevent recidivism in patients detoxified after opioid abuse, and reduce alcohol craving.

Answer 14

Naltrexone

Question 15

Dosing of Naloxone:

Answer 15

Adults: 0.4-2mg IV initially, repeat at 2-3 mins. interval; 0.4-0.8mg/h continuous IV (NS or D5%), titrate for effect.

Question 16

Specific chelating agent for iron (free)

Answer 16

Deferoxamine

Question 17

it is water soluble & renally excreted as (?)

Answer 17

Red ferrioxamine complex…orange-pink/vin rose

Question 18

Dosing of Deferoxamine:

Answer 18

5 mg/kg/h IV increasing over 15 mins as tolerated,
do not exceed 15mg/kg/h

Question 19

enzyme that converts a small portion of the drug into a toxic metabolite known as N-acetyl-p-benzoquinone imine (NAPQI).

Answer 19

P450 (CYP2E1)

Question 20

product of the combination of glutathione to NAPQI to form nontoxic substance?

Answer 20

Cysteine & Mercapturic acid conjugates

Question 21

Dosing of Paracetamol poisoning:

Answer 21

Children: >200mg/kg
Adults: 6-7g

Question 22

Early manifestations of Paracetamol poisoning

Answer 22

anorexia & NV

Question 23

After 24-48 hrs. manifestations of Paracetamol poisoning

Answer 23

AST & ALT levels rise; evident hepatic necrosis

Question 24

Paracetamol poisoning is diagnosed by?

Answer 24

Nomogram; electrolytes (anion gap), liver enzymes

Question 25

a tool used to assess the risk of liver damage following paracetamol overdose.

Answer 25

Rummack-Matthew nomogram

Question 26

chemical asphyxiant binds to these to block the aerobic utilization of oxygen?

Answer 26

cellular cytochrome oxidase

Question 27

a much less toxic compound that is excreted in the urine?

Answer 27

Thiocyanate

Question 28

level of Hydrogen cyanide to be considered as cyanide poisoning:

Answer 28

150-200ppm

Question 29

level of ingested Na or K salts to be considered as cyanide poisoning:

Answer 29

200mg

Question 30

Antidote for Cyanide poisoning

Answer 30

Hydrocobalamin Nithiodote

Question 31

Universal antidote is composed of:

Answer 31

2 parts AC 1 part TA 1 part MgO

Question 32

forms a protective film relieving inflammation and irritation

Answer 32

Demulcent

Question 33

Examples of demulcent:

Answer 33

Milk egg albumin (egg white)

Question 34

this prevents absorption by binding with heavy metals

Answer 34

Demulcent

Question 35

Cyanide poisoning is diagnosed by:

Answer 35

lactic acidosis elevatad venous O2 saturation "bitter" almond odor

Question 36

Abrupt onset of profound toxic effects present in cyanide poisoning shortly after exposure:

Answer 36

Headache Nausea Dyspnea (SOB) Confusion

Question 37

2 active ingredients of Nithiodote:

Answer 37

Na nitrite inj. IV Na thiosulfate IV

Question 38

Management of Poisoning:

Answer 38

1. Accurate history taking 2. Stabilization of patient’s condition 3. Physical examination 4. Laboratory examination 5. Decontamination 6. Poison-specific treatment – antidote 7. Disposition

Question 39

History Taking: 5 W’s

Answer 39

Who – demographics (name, age, weight, etc.) What – identify the drug/ toxin and dose When – time and date Where – route of administration and the geographic location Why – intentional or accidental

Question 40

Emergency evaluation treatment:

Answer 40

A-irways, B-reathing, C-irculation, D-isability, E-xposure

Question 41

Essential Laboratory Tests:

Answer 41

• Serum osmolality and osmolar gap • Electrolytes • Serum glucose • BUN and creatinine • Liver profile • Urinalysis • ECG • Pregnancy test • Tests to detect specific chemical/drug levels

Question 42

Decontamination:

Answer 42

• Wash skin and irrigate eyes • Emesis or gastric lavage • Charcoal or cathartic • Hemodialysis, Hemoperfusion

Question 43

neutralizes the poison by changing its chemical nature or oxidize the poison into non-toxic or insoluble form. Ex, Na thiosulfate

Answer 43

Chemical antidote

Question 44

one that prevents absorption of the poison. Ex. AC

Answer 44

Mechanical antidote

Question 45

one that counteracts the effects of poison by producing opposing physiologic effect. Ex. Naloxone

Answer 45

Physiologic antidote

Question 46

work by forming a complex with the metal ion, which can then be excreted from the body through urine or feces. Ex. EDTA

Answer 46

Chelating agents