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Flashcards in Toxicology Deck (40):
1

When assessing poisoned patients, which drugs cause Mydriasis (Dilated)

Adrenergic agonists
Anticholinergics

2

When assessing poisoned patients, which drugs cause Miosis (Constricted)

Sympatholytics
Cholinergics

3

Acetone odor

Ketosis, ethanol, isopropyl alcohol, salicylates

4

Acrid (pear like) odor

Paraldehyde, chloral hydrate

5

Acrid (aldehyde like) odor

Carbon monoxide

6

Almond odor

Cyanide, amygdalin, apricot pits

7

Carrots odor

Cicutoxin (water hemlock)

8

Disinfectant odor

Phenol, creosote

9

Rotten eggs odor

Hydrogen sulfide, mercaptans, disulfiram

10

Rotten fish odor

Zinc/aluminum phosphide

11

fruit-like odor

Amyl nitrite, alcohol, isopropyl alcohol

12

Garlic odor

DMSO, organophosphates, phosphorous, arsenic, arsine gas, thallium

13

Mothballs odor

Camphor

14

Peanuts odor

Rodenticides

15

Wintergreen odor

Methylsalicylate

16

Syrup of Ipecac

Onset 15-20 min
95% vomit in 20 min, 30% reduction in bioavailablity at 1 hour
Side effects:
Acute: Diarrhea, Drowsiness
Chronic: Cardiac arrhythmias, neuropathy, muscle weakness

17

Lavage

Orogastric retrieval of substance
30% reduction in bioavailability at 1 hour
Lavage fluid- saline
End point- clear returns
Indications-same as general

18

Lavage:contraindications and ADRs

Contraindications same EXCEPT
Can lavage patients with CNS Depression if intubated and cuffed with endotracheal tray.
If seizures are controlled and patient is intubated (but don’t lavage if seizure uncontrolled)
DO NOT lavage patients with underlying pathology of esophagus or stomach (ulceration, Chrons)
ADRS
Aspiration (that’s why you provide airway), esophageal/gastric bruising, fluid/electrolyte imbalance (can worsen the situiation. Monitor this), EKG changes, hypoxia, esophageal rupture

19

Activated charcoal

Will NOT bind: Low molecular weight, charged compounds; cyanide, bromide, potassium, ethanol, methanol, iron, lithium, alkaline corrosives, mineral acids
Highly concentrated solutions; gasoline, kerosene, alcohols
Efficacy 40% reduction in bioavailability at 1 hour
Cathartics: Promote movement of AC bound drug through GI tract
May cause hypovolemia and electrolyte imbalance
ADR: Vomiting, constipation, aspiration, GI obstruction, charcoal empyema, GI perforation

20

Whole Bowel Irrigation

Reserved for:
Substances not adsorbed to AC
Very large ingestions
Significant GI hemorrhage
Intestinal obstruction
Unprotected airway
Hemodynamic instability
Endpoint: clearing of rectal effluent
Solutions used: Golytely

21

Multiple Dose Activated Charcoal

Interrupts entero-enteric and entero-hepatic recirculation of poison and or poison metabolite
1gm/kg initially followed by ½ g / kg every 2-6 hours
Indications
Theophylline (used to be used for asthma, not anymore, crazy kinetics), carbamazepine, phenobarbital overdose
Contraindications
Ileus, intestinal obstruction, unprotected airway
ADR
Pulmonary aspiration, constipation, fluid and electrolyte imbalance

22

Ion Trapping

Change pH of urine to ionize poison preventing reabsorption
Weak acids (salicylate, phenobarbital) admin sodium bicarb to achieve a urine pH of > 7

23

Chelator: Dimercaprol (BAL)

Uses:As, Hg, Pb, Cd
Toxicity: Hypertension, tachycardia

24

Chelator: Penicillamine

Uses: Cu, Pb, Hg, As
Toxicity: Allergic reactions

25

Chelator: DMSA (succimer)
Uses:
Toxicity:

Uses: Pb, As, Hg
Toxicity: gas, ab pain

26

Chelator: Edetate Calcium Disodium (EDTA)

Uses: Pb
Toxicity: Nephrotoxicity

27

Chelator: Deferoxamine
:

Uses: Fe
Toxicity: Hypotension, anaphlyactoid reaction, ARDS

28

Antivenins/Biologic Agent: Crotalidae Antivenin

Rattlesnake envenomation

29

Lactrodectus antivenin

black widow spider envenomation

30

Elapidae Antivenin

Eastern and Texas coral snake envenomation

31

Trivalent botulinum

Botulism types A, B and E

32

Digoxin Immune Fab

Digoxin and Digitoxin

33

Pharmacologic antagonist agents: (List)

N-acetylcysteine
Naloxone
Flumazenil
Atropine
Fomepizole

34

Antivenin/biologic agents (list)

Crotalidae Antivenin
Lactrodectus antivenin
elapidae antivenin
trivalent botulinum
digoxin immune fab

35

Chelators (list)

dimercaprol (BAL)
penicillamine
DMSA (Succimer)
Edetate calcium disodium (EDTA)
Deferoxamine

36

N-acetylcysteine

Used for acetaminophen poisoning.
Prevents NAPQI binding at hepatocyte

37

Naloxone

For opioid poisoning. Opioid receptor antagonist

38

Flumazenil

For benzodiazepine poisoning. Benzodiazepine receptor antagonist.

39

Atropine

For organophosphate and pesticide poisoning. Muscarinic receptor antagonist

40

Fomepizole

For methanol and ethylene glycol poisoning. Blocks metabolite formation