Toxicology & Antidotes Flashcards
(39 cards)
What is one of the ways to prevent accidental overdose in the patient population?
- Child Resistant Packaging (the push-and-turn caps or squeeze-and-turn caps)
This is required for all prescriptions unless waive by the patient (Some drugs are excluded like NTG
What is the basic first aid that should be done for Topical Exposure for initial overdose managment?
- Remove contaminated clothes and wash skin with soap and water for at least 15 mins
What is the basic first aid that should be done for Ocular Exposure for initial overdose managment?
- Remove contacts and Rinse eye with a gentle water stream for at least 15 mins
What is the basic first aid that should be done for Oral Ingestion for initial overdose managment?
- Remove any remaining substance from the mouth
- If any burning or irriation drink small amounts of water or milk immediately
What is the basic first aid that should be done for inhaled exposure for initial overdose managment?
- Move to fresh air immediately & stay away from the toxic fumes
What is the basic first aid that should be done for ingestion of button batteries for initial overdose managment?
- give 2 teaspoons of honey (helps with slowing the damage of the esphagus and airways) every 10 mins while seeking immediate medical care
What was Ipecac syrup used for? Is it still used?
- Used to induce emesis
- NO LONGER RECOMMEDED
What is “CAB” and what are the first steps?
- “CAB”: Circulation, Airways, Breathing
- 1st: Check for pulse - if pulseless then start CPR (2 breathes for every 30 chest compressions)
When should Contramination with activated charcol be used? What is the dosing for it?
- Used fro certain orally ingested drugs (is OTC but NOT recommended to use at home)
- Most effective when used 1 hour of ingestion (to decresae the absorption) normally giving 1g/kg
Before starting, the airway should be protected to prevent aspirations
What can excessive ingestion of Acetaminophen lead too? What is the max daily limit?
- Hepatotoxicity (Caused by the increased metabolism of tylenol by 2E1 to NAPQI which binds tot he liver cells)
- MAX: < 4000 mg per day
What are the four phases of acetaminophen toxicity
- Phase 1 (1 - 24 hours): commonly asymptomatic or non-specific symptoms (Nausea or Vomiting)
- Phase 2 (24 - 72 hours): Hepatotoxicity is evident (i.e.; elevated INR, AST/ALT…)
- Phase 3 (72 - 96 hours): fulminant hepatic failure (i.e.; jaundice, coagulopathy, renal failure and/or death)
- Phase 4 (> 96 hours): Patient recovers and gets a liver transplant
What is the antidote for someone that has acetaminophen toxicity?
- NAC - N-Acetylcystine (Given quickely)
- The acetaminophen level is plotted on a Rumack-Matthew Nonogram to show risk of toxicity
NAC is PO or IV
What is the Symptoms/Treatment for someone having Anticloinergics overdose/toxicity?
I.e.; atropine, benadryl, draimine, scopolamine, atropa belladonna, jimson weed…
- Symptoms: flushing, dry skin, mydriasis with blurry vision, AMS, fever
- Treat: Primarily supportive care; rarely is Physostigmine is given (this helps breakdown ACh)
What is the Symptoms/Treatment for someone having Anticoagulants overdose/toxicity?
i.e.; warfarin, direct thrombin inhibitors, Xa inhibitors, herparin, LMWH
- Symptoms: BLEEDING
- Treat (specific to what drug was used): Andexent alfa (Xa inhibitors), Idraucizumab (Dabigatran), Vitamin K (Phytonadione) (Warfarin), Protamine (Heparin, LMWH), Prothrombin Complex Concentrate (Warfarin)
What is the Symptoms/Treatment for someone having Antipsychotics overdose/toxicity?
- Symptoms: Seizures
- Treat: Primarily supportice care; Benztropine for dystonia, Benzos for seizures & Bicarb for QRS-widening
What is the Symptoms/Treatment for someone having Benzodiazepine overdose/toxicity?
- Flumazenil: can cause seizures when patient is taking benzos chronically; may sometimes be used for non-benzos (zolpidem)
What is the Symptoms/Treatment for someone having Beta-Blockers overdose/toxicity?
- Supportive Care (i.e.; fluids, vasopressor), Glucagon (if not responding to supportive)
- High Dose Insulin if Glucagon not working
What is the Symptoms/Treatment for someone having calcuam channel blockers overdose/toxicity?
- Same as beta blockers (using glucagon) +
- IV calcium
What is the Symptoms/Treatment for someone having cyanide overdose/toxicity?
i.e.; smoke inhalation, nitroprusside in high doses/ long durations/ renal impairment
- Hydroxocobalamin (Cyanokit)
What is the Symptoms/Treatment for someone having Digoxin overdose/toxicity?
- Digoxin Immune Fab (DigiDab)
What is the Symptoms/Treatment for someone having ethanol overdose/toxicity?
- Can increase anion gap
- If chronic alcohol use; give thiamine (Vitamin B1) to prevent wernicke encephalopathy)
What is the Symptoms/Treatment for someone having 5-FU or Capecitabine overdose/toxicity?
- Uridine Triacetate (Vistogard)
What is the Symptoms/Treatment for someone having Hydrocarbons overdose/toxicity?
i.e.; Petroleum Products, Gasoline, Kerosene, Mineral Oil, Paint thinner
- DO NOT vomit it use; Keep patient NPO dur to aspiration risks
What is the Symptoms/Treatment for someone having Insulin or Hypoglycemics overdose/toxicity?
- Dextrose injection or infusion (DO NOT GIVE if the patient is unconscious
- Glucagon (when dextrose can not be used)
- Sulfonylurea: Octreotide
