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Pharmacology
Poison Management
33
Pharmacology
Graduate
09/09/2009

Additional Pharmacology Flashcards

 


 

Cards

Term
Steps in management of poisoned patient
Definition

1. Stabilize

2. Clinical and lab data

3. Decontaminate

4. Decrease absorption of toxin

5. Increase elimination of toxin

6. Treat with antidote

7. Determine appropriate disposition

Term
Emergency Stabilization
Definition

1. ABCs

 

2. DONT

 

3. Seizure control

Term
DONT
Definition

Treatment for altered mental status

 

1. Dextrose: Hypoglycemia

 

2. Oxygen

 

3. Naloxone

 

4. Thiamine

Term
Seizure control
Definition

1. Benzodiazepine

 

2. Barbituate

 

3. Propofol

 

--NO phenytoin

--NO Flumazenil (benzodiazepine antagonist) because it may unmask tendency for seizures

Term
SHORTE
Definition

Substrate response

 

History

 

Observations at scene

 

Rule-Out non toxic causes

 

Toxidromes

 

EKG

Term
Rule out (+ Tests)
Definition

e.g. MI, CVA, sepsis, meningitis, trauma.

 

-Altered Mental Status: Stroke

 

-Hypotension: MI

 

Head CT: For any altered mental status of uncertain etiology

 

EKG: Provide clues if someone has an MI

-One of the fastest tests to do in ER (along with finger stick)

Term
What should you get from the EKG?
Definition
Rate, Rhythym, Axis, QRS duration, QTc
Term
The "4" As
Definition

1. Acetaminophen

 

2. Alcohol

 

3. Arterial Blood Gas

 

4. Anion Gap

 

5. Aspirin

Term
Acetaminophen (description)
Definition

1. Most common pharm toxin.

 

2. No reliable clinical signs

 

3. Can result in hepatic failure

 

4. Nomogram:

-Above 200 line = risk for hepatic toxicity

-US also treats those who are at the 150 line and above.

 

5. Excellent antidote biut it must be given in time

Term
Acetaminophen (Antidote)
Definition

NAC

 

1. Acts as a sulfhydryl donor, substitutes for hepatic glutathione and detoxifies the toxic metabolite.

 

2. Most effective when given within 8 hours but may reduce hepatotoxicity up to 24-36 hours.

Term
Alcohol (description)
Definition

1. Common cause of ams

 

2. Needed to calculate osmol gap

 

3. Continue to look for other co-exisiting problems (e.g. intracranial bleed)

Term
Arterial Blood Gas
Definition

1. Need to identify and correct acidosis early

 

2. Clues about salicylate poisioning

 

3. Obtain for any patients with abnormal respirations

 

*Shows if they need more oxygen, need to be intubated, or need to be treated for aspirin overdose

Term
Anion Gap
Definition

1. Basic metabolic panel gives anion gap, measured bicarbonate, and calculated osmolality

 

2. Most causes of metabolic acidosis have an increased (wide) anion gap usually with low HCO3

 

AnGap = Na - (Cl + HCO3)

 

Normal = 8-12 mmol/L

Term
Osmol Gap
Definition

Measured osmolality (by freezing point depression) -  calculated osmolality

 

-Normally: 5-10

 

-If large, then something is osmotically active (usually toxic alcohol)

Term
Toxins causing elevated osmol gal
Definition

MEDIE

 

Methanol

 

Ethanol

 

Diuretic

 

Isopropanol

 

Ethylene Glycol

Term
Tachycardia (EKG)
Definition

1. TCAs

 

2. Sympathomimetics

 

3. Cocaine

 

4. Theophylline

 

5. Anticholinergics

Term
Bradycardia
Definition

1. Beta-blockers

 

2. Calcium channel blockers

Term
Wide QRS (EKG)
Definition

-Normal is less than 120s

 

-Suggests a Na channel problem (longer period of depolarization)

 

1. TCAs

 

2. Propafenone

 

3. Flecainide

 

4. Quinidine

 

5. Procainamide

 

6. Disopyrmide

Term
AV Block
Definition

1. Digoxin

 

2. Beta blockers

 

3. Ca++ Channel Blockers

Term
R' in aVR
Definition
TCA
Term
Radiology
Definition

Sometimes useful in diagnosis (abd films)

 

CHIPES

 

Chloral hydrate, carbon tetrachloride

 

Heavy metals

 

Iron, Iodine

 

Penothiazine, Packers

 

Enteric coated packets

 

Sustained release

 

Term
Steps of GI decontamination
Definition

1. Prevent further absorption

 

2. Increase elimination

Term
Prevent further absorption
Definition

1. Ipecac

 

2. Gastric Lavage

 

3. Activated charcoal

 

4. Cathartic

 

5. Whole Bowel Irrigation

 

6. Polyethylene Glycol Solution

Term
Gastric Lavage
Definition

1. One hour window between overdose and use

 

2. Studies show no difference in outcome as compared to charcoal

Term
Activated Charcoal
Definition

1. Binds to most drugs and toxins, except metals

 

2. Promotes transluinal efflux of selected drugs

Term
Multidose Activated Charcoal
Definition

Used for drugs where there is enterohepatic cycling

 

1. Theophylline

 

2. Phenobarbital

 

3. Carbamazepine

 

4. Quinine

 

5. Dapsone

 

6. Salicylate

Term
Removal of Absorbed Drugs
Definition

1. Forced diuresis

 

2. Alkaline diuresis

 

3. Acid diuresis

 

4. Hemodialysis

 

5. Hemoperfusion

Term
Forced diuresis
Definition

1. IV saline + furosemide

 

-Used for lithium

Term
Alkaline Diuresis
Definition

IV sodium bicarbonate, K+

 

1. Ion trapping of salicylates, phenobarbital based on pka

 

2. Potassium is the key to successful urinary alkalinization

Term
Hemodialysis
Definition

-Hepatic and renal faiulre

 

1. Li+

2. ASA

3. Theophylline

4. Ethylene Glycol

5. Methanol

Term
Urine Tox Screens
Definition

1. Opiate

 

2. Amphetamine

 

3. PCP

 

4. TCA

 

5. Benzodiazepine

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