Flashcards in Pharm clinical toxicology Deck (27):
1
opioid toxidrome
altered mental status, decreased RR, pinpoint pupils, decreased bowel sounds
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what are the opioids?
heroin, fentanyl, codeine, hydrocodone, meperidien, oxycodone, methadone, buprinorphine
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what is the competitive opioid receptor antagonist used in overdose?
naloxone (short half life)
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what are the other opioid receptor antagonist?
nalmefene and naltrerxone (longer half lives)
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naloxone associated opioid withdrawal
flu like symptoms (nausea, vomiting, diarrhea), piloerection ,yawning, irritability, NORMAL MENTAL STATUS, lasts 15-30 min
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benzodiazepine toxidrome
depressed mental status, normal vital signs
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benzodiazepine mechanism and what are they used to treat?
enhance the effect of GABA - treat anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal
-also used to treat toxicity caused by other toxins that cause CNS stimulation such as anticholinergic toxins
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what is the competitive non-selective benzodiazepine receptor antagonist? (used to treat overdose)
flumazenil
9
flumazenil dangers (benzo overdose drug)
can precipitate acute withdrawal and cause seizures
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acetaminophen toxicity - mechanism?
hepatic necrosis and renal failure - when too much acetaminophen - broken down into different by product that is toxic to the liver
11
APAP (acetominophen) poisoning treatment
antidote = n-acetylcysteine (NAC) - best given within 8 hours of overdose
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tricyclic antidepressant toxidrome
anticholinergic, catechol reuptake inhibitor, alpha adrenergic blocker (hypotension), GABA antagonist (seizures), sodium channel blocker (THE KILLER)
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what effect does sodium channel blocker have?
wide QRS segment for heart action potential
14
antidote for tricyclic antidepressant overdose
sodium bicarbonate (replace sodium to overcome inhibition and alkalinization to reduce TCA affinity to its receptor in the myocardium)
15
anticholinergic toxidrome
mydriasis (dilated), dry, flushed skin, decreased bowel sounds, urinary retention, increased temperature, altered mental status (confusion, hallucinations, seizures)
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what are the anticholinergics?
atropine, diphenhydramine, scopolamine
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antidote for anticholinergic overdose
physostigmine (anticholinesterase)
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cholinergic toxidrome
miosis, salivation, lacrimation, ruination, defecation, CNS excitation, bronchorrhea/spasm, fasciculations
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what are the cholinergic agents
anticholinesterases (including nerve gases, organophosphates, carbamates, physostigmine, neostigmine) and cholinomimetics (bethanechol)
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what is the cholinergic overdose antidote?
atropine (anticholinergic) for MUSCARINIC ONLY
and pralidoxime (enzyme regenerator) for NICOTINIC AND MUSCARINIC!
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what is the DD for anion gap metabolic acidosis?
MUDPILES!
Methanol
Uremia
Diabetic ketoacidosis (all ketoacidosis)
Paraldehyde, phenformin, metformin
Iron, INH
Lactate (CO, CN, methemoglobinemia)
Ethylene glycol
Salicylate
22
what is used to treat methanol overdose?
femopizole and hemodialysis
23
calcium channel overdose clinical effects
-if nifedipine and other dihydropyridines (blood vessels) peripheral vasodilation, reflex tachycardia, hypotension
-if verapamil or diltiazem (heart and blood vessels) = hypotension d/t vasdilation, bradycardia, negative inotropic effects
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amphetamines/cocaine toxicity
CNS stimulation, agitation, hallucinations, seizures, increased muscle activity = increased temp, increased CK, kidney injury
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phencyclidine (PCP)/ketamine/DM toxicity
dissociative anesthetic = depends on dose
low = euphoria
medium = agitation, anesthesia, increased strength
high = CNS anesthesia
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what are downers?
GABA agonists (GHB, roofies)
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