Term
| Major Functions of a Regional Poison Control Center (PCC) |
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Definition
| provide poison information to health professionals & general public; use written guidelines for triage assessment & management of poisoned pts; collect & report statistical data on poisoning; provide poison prevention information to public; train healthcare professionals in toxicology |
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Term
| Typical calls received by IPC |
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Definition
| home calls: pediatric unintentional ingestions, therapeutic error, occupational, environmental, abuse/suicide; health care facility calls: suicide attempts, abuse/drug packers, occupational, unintentional pediatric, accidental occular, iatrogenic error; miscellaneous calls: Hazmat, mass casualty preparedness/drills, information calls |
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Term
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Definition
| poisoning is 2nd leading cause of injury-related death; prescription drug abuse exceeds illicit drug abuse; increase in Rx drug usage overall |
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Term
| Poison centers save society money through: |
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Definition
| preventing unnecessary healthcare visits, decreasing admissions to hospitals, and decreasing LOS (length of stays) at hospitals; estimated potential savings for IL is $97 - 159 million dollars in 2008 |
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Term
| How Pharmacists can use PCC |
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Definition
| poison information/recommendations; antidotes; pill IDs (healthcare & law enforcement ONLY); drug information |
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Term
| Poison Prevention for Medications |
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Definition
| use child resistant packaging; don't refer to meds as "candy" to children; do not take in front of children; read label every time before taking; don't take medication in the dark |
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Term
| Poison Prevention for Household Chemicals |
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Definition
| store products in original containers; don't store with food substances; do not mix cleaning products; don't leave unattended |
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Term
| Minimizing Accidental Overdose & Therapeutic Error |
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Definition
| improve written & verbal medication instructions; ensure pt or caregiver understands dosing device; increase poison prevention activities & education |
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Term
| Gastrointestinal Decontamination |
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Definition
| ipecac, activated charcoal, whole bowel irrigation, gastric lavage |
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Term
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Definition
| used as an emetic; Rationale: remove poison from GI tract ASAP; vomiting only removes 28-82% OF stomach contents; does not reduce # of pts requiring HCF evaluation; does not improve outcome; numerous C/I's & ADRs; do not keep in home; IPC Recommendation: Do not use for any poisonings EVER! |
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Term
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Definition
| highly porous material with large surface area; Rationale: comes in contact with & adsorbs poisons in GI tract, reducing systemic toxicity; binds to other drugs to varying degrees; most effective if adminstered within 1 hr; Primary complication: aspiration; C/I's: unprotected airway, caustic ingestion; use will not prevent hospital visit; IPC Recommendation: do not stock in home |
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Term
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Definition
| involves instillation & aspiration of small volumes of fluid via an orogastric tube with intent of removing toxic substances from stomach; C/I's: unprotected airway, ingestion of corrosive substance or hydrocarbon; Complications: aspiration pneumonia; Indications: ingestion of potentially life-threatening amount of a poison & procedure can be performed within 1 hr or ingestion |
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Term
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Definition
| enteral adminstration of large amounts of osmotically balanced fluid (PEG-ES); Rationale: flush substances out of GI tract begore absorption can occur; Recommended dose for adults: 1500-2000 mL/hr via NG tube until stools are clear; Minimal evidence on efficacy; C/I's: unprotected airways, hemodynamic instability, ileus, bowel obstruction, intractable vomiting, GI hemorrhage; Indications: toxins not absorbed by activated charcoal, drug packets, modified release pharmaceuticals |
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Term
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Definition
| most common cause of acute liver failure in US; drug itself is minimally toxic; one metabolite (NAPQI) causes hepatotoxicity (at therapeutic doses, liver inactivates it with glutathione); an overdose causes very high levels of NAPQI that depletes normal glutathione stores allowing NAPQI to react directly with liver cells & destroys them |
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Term
| Toxic Dose of Single Acute Ingestion |
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Definition
| 200 mg/kg or 10 grams, whichever is less |
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Term
| Toxic Dose for Chronic Ingestion in Adults |
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Definition
| 150 mg/kg per 24 hr period over preceeding 48 hrs OR 100 mg/kg per 24 hr period over preceding 72 hrs |
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Term
| Symptoms/Presentation of Acetaminophen Toxicity |
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Definition
| Early on: minimal symptoms, possible nausea/vomiting, malaise; After 24-48 hrs: increasing RUQ abdominal pain, AST/ALT levels begin to rise, PT/INR increases; 3-5 days post ingestion: acidosis, renal involvement, encephelopathy, fulminant hepatic failure, death |
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Term
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Definition
| ONLY used for single, ACUTE ingestions; used if: unknown amount ingested, known ingestion of >10 grams or 200 mg/kg, all adult intentional ingestions |
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Term
| Start Antidotal Therapy for Chronic Ingestion or Unknown Time of Ingestion |
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Definition
| in this situation, you can't use nomogram; draw LFTs & APAP level; if LFTs are elevated OR APAP level is detectable, start antidotal therapy |
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Term
| NAC (N-acetylcysteine) [Mucomyst] |
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Definition
| treatment of acute and chronic APAP toxicity; most effective when given within 8-10 hrs post-ingestion; MoA: acts as sulfhydryl group donor, detoxifies NAPQI |
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Term
| Other Treatment for APAP Toxicity |
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Definition
| antiemetics, FFP/vitamin K, liver transplant (if liver failure is occurring) |
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