Pharm - Tx of OD (part 2) Flashcards Preview

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Flashcards in Pharm - Tx of OD (part 2) Deck (12)
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1
Q

mg/kg of iron in ferrous sulfate, gluconate, fumarate

A
  • ferrous sulfate: 60-65 mg tab = 20% elemental iron
  • ferrous gluconate: 12% elemental iron
  • ferrous fumarate: 33% elemental iron
2
Q

Identify whether or not the ingestion is considered a serious toxicity

A
  • Minimal toxicity: < 350 mcg/dL
  • Mild-moderate GI symptoms: 350-500 mcg/dL
  • Serious systemic toxicity: > 500 mcg/dL
  • Significant morbidity/mortality: > 1000 mcg/dL
  • > 60 mg/kg considered serious toxicity
3
Q

Identify the 5 phases of iron overdose and the expected timeframe of each

A

• GI phase:
o 30 minutes-6 hours after ingestion → direct injury to GI mucosa (V/D, abdominal pain, hematemesis, melena, shock)
o Vomiting most sensitive indicator
• Latent, relative stability phase
o 6-24 hours after ingestion
• Shock and metabolic acidosis:
o 6-72 hours after ingestion → CV toxicity (shock, pallor, tachycardia, hypotension), coagulopathy, jaundice, coma
• Hepatotoxicity/hepatic necrosis:
o 12-96 hours after ingestion → liver particularly vulnerable to iron so hepatocytes have high metabolic activity and liver failure is 2nd MCC of death from iron poisoning
o If die, usually in this stage
• Bowel obstruction:
o 2-8 weeks after ingestion → occurs as result of GI scarring (possible V)

4
Q

Identify the antidote of choice for an iron overdose

A

IV deferoxamine

5
Q

Indications for use of IV deferoxamine

A
  • Severe sx: hypovolemia, shock, lethargy, coma, persistent n/v
  • anion gap metabolic acidosis
  • peak serum concentration >500 mcg/dL
  • significant # pills on radiograph
6
Q

Identify the classic signs of an opioid overdose

A
  • Depressed mental status
  • Decreased respiratory rate
  • Decreased tidal volume
  • Decreased bowel sounds
  • Miotic pupils (constriction due to parasympathetic stimulation)
7
Q

best predictor of an opioid poisoning

A

RR < 12

8
Q

physical exam findings that are consistent with an opioid poisoning

A
  • Respiratory rate: decreased, perform pulse ox, hypercapnia can be present
  • HR: normal to low
  • BP: hypotensive due to histamine release
  • Hypothermia: measure temp due to environmental exposure/impaired thermogenesis
  • Pupil exam: miosis
  • Mental status: euphoria to coma, seizures secondary to tramadol or meperidine due to hypoxia
  • Head trauma
  • Skin exam: track marks
  • Pulmonary findings: rales (aspiration/ARDS)
9
Q

lab evaluation of the person with a suspected opioid overdose

A
  • Obtain serum glucose concentration
  • Acetaminophen level
  • Serum creatinine phosphokinase
  • EKG
  • Chest X-ray
10
Q

Identify the antidote of choice for an opioid overdose.

A

Naloxone

11
Q

Identify the dose based on patient presentation for an opioid overdose.

A
  • When spontaneous ventilations present: 0.04-0.05mg titrated upwards every few minutes until RR is ≥ 12
  • Apneic patients: 0.2-1.0mg
  • Cardiorespiratory arrest: 2mg
12
Q

Identify the goal of naloxone in the tx of opioid OD

A

adequate ventilation, not normal level of consciousness!