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Flashcards in Toxins Deck (26):
1

Tricyclic antidepressant symptoms

PNS blocked
-early tachycardia
-widening of QRS (late sign)
-Aberrant SVT
-Torsades, VFVT

2

Tricyclic antidepressant treatment

-Magnesium for Torsades,
-Sodium bicarbonate (ion trapping, alkaline blood promotes drug binding to proteins, Na overrides Na blockade)
-norepinephrine pressor of choice
-dialysis not helpful.

3

Cardioselective beta blocker OD

Atenolol, metoprolol, esmolol, betaxolol
-effects heart only
-bradycardia w/ hypotension
-escape rhythms

4

Cardioselective beta blocker OD: Caution with B agonists (Epi) why?

Inverse Epi response, beta 1 blockade, alpha 1 = vasoconstriction, baroreceptors note increase pressures! stimulate parasympathetic system! will result in bradycardia and hypotension

5

Non-cardio selective OD

Propanolol, sotolol, nadolol, timolol
-respiratory distressed, exacerbation RAD

6

Beta block OD treatment

-Atropine - parasympathetic rule out
-TCP
-dopamine for hypotension (in conjunction with tcp)
-glucagon (release cAMP via glucagon cells on heart)

7

Cardioselective Ca Cannnel blockers

Verapamil, Diltiazem
-sever bradycardia
-AV dissociation (3rd degree HB)
-hypotension

8

Vasculomotor specific

Nifedipine, nicardipine, amlodipine
-sever hypotension

9

Ca channel blocker OD tx

Calcium chloride/Gluconate
-override blockade
-will increase HR, BP.
TCP -backup to Ca
Monitor BS
-as we drive Ca, cells bUrn sugars

10

Digitalis examples

Digoxin, digitoxin, foxglove, oleander

11

Digitalis process

Poisons Na/K pump
-Na retained, Antiporter removes Na, Ca exhanged
-Ca improves squeeze, performance, slows repolarization
-stronger squeeze, slower rate
-can alter K, can lower K

12

Digitalis s/s

Visual disturbances, yellow / green halos
Bradycardia
SVT, VT, AV block

13

Digitalis treatment

-Digoxin immune fab (digiband) - binds dig
-correct electrolytes (k first, then Ca, mg)
-TCP for bradycardia
-lidocaine, mg sulfate, phenytoin (Dilantin) for tachycardia
-Procainamide will make pt worse,
-defibrillation and cardioversion will put pt right into asystole

14

Hypokalemia causes

     -Loop Diuretic misuse/OD
     -“Diet Pills"
     -Serum Potassium important as well as pH
          -Think Acid/Base first. 

15

Hypokalemia EKG findings

     -Peaked Pwaves
     -flattened/slurred T waves
     -Appearance of U waves

16

Asa mild intoxication

     -Tinnitus (ringing in the ears)***
     -Hyperventilation***
     -HA
     -Vertigo
     -Mental Confusion
     -Thirst
     -Sweating
     -N/V

17

Asa severe intoxication

     -Seizures***
     -Electrolyte Disturbances (TCO2, HCO3)***
          -Metabolic Acidosis
     -Agitation / restlessness
     -Coma
     -Non-cardiac pulmonary Edema

18

Asa OD tx

     -Gastric empyting
     -Charcoal
     -Alkaline Diuresis using NaHCO3
          -Ion Trapping mechanism
     -Hemodialysis
          -Can work
     -Management of Acid/Base & Electrolyte disturbances. 

19

Acetaminophen (APAP) poisoning - Stage 1

Stage I - Flu Like Symptoms***
     -Occurs within 30 minutes to 24 hours ***
          -Stage 1 - Day 1
     -N/V
     -Anorexia
     -Pallor
     -Diaphoresis

20

Tricyclics antidepressants action and examples

Examples: imipramine, amitriptlyine, nortriptyline, desipramine

Mimic class I AA (blocks Na channels)
Inhibits NE reuptake. (NE secreted into synaptic cleft, exhibits action, reuptook by secreting cell. This mechanism prevented. Excess NE in cleft)

21

Acetaminophen (APAP) poisoning Stage 2

Stage II - Owe My Liver ***
     -24-48 hours ***
          -Stage 2 - Day 2
     -R upper quadrant pain/tenderness
     -Increased liver enzymes ***
          -Liver is taking a hit
     -Increases serum Bilirubin ***
          -Liver processes Bilirubin
     -Increased Prothrombin Time ***
          -Liver cannot make clotting factors
          -Worse bleeding 
     -Oliguria as result of ATN
          -Acute tubular necrosis

22

Acetaminophen (APAP) poisoning stage 3

Stage III - Gonna Die Now ***
     -72-96 hours ***
          -Stage 3 - Day 3.
     -Peak for liver function abnormalities
     -Return of anorexia, N/V and malaise
     -Jaundice becomes apparent***
     -Hepatic Encephalopathy ***
     -DIC***
     -Death***
          -Due to fulminant hepatic necrosis

23

Acetaminophen (APAP) poisoning stage 4

Stage IV - Im not dead yet***
     -IF they don’t die in stage III
     -4 days - 2 weeks***
          -Stage 4 - day 4
     -Resolution Period
     -Liver functions return to normal***
          -Baseline Values
     -Patients are asymptomatic

24

Acetaminophen (APAP) poisoning Toxic level

     -Ingestion of 7.5 g or 150 mg/kg is typically toxic
     -Measure serum levels 4 hours after ingestion
          -Otherwise could show false low. 

25

Acetaminophen (APAP) poisoning treatment

     -N-Acetylcysteine (Mucomyst)***
          -Orally 140 mg/kg
          -Maint. 70mg/kg q 4 hours for 14 dosings
               -May be given IV
               -Used to complete the liver’s normal biotransformation in place of glutathione. 

26

Glutathione

Glutathione used in last step of tyelenol biotransformation to non-harmful substance. 
Overwhelmed by high tyelenol levels. Precursor to glutathione intervention is very harmful and kills liver. Mucomyst can substitute glutathione.