Posion & Chemical Warfare

patho/pharm 2

what are the three types of anthrax?

inhalation, cutaneous, gastrointestinal

which type of anthrax is most deadly?

inhalation anthrax (NOT person-to-person)

first line of treatment for anthrax?

IV ciprofloxacin

what is raxibacumab used for?

adjunct treatment for anthrax → neutralizes toxin and used WITH antibiotics

who recieves anthrax pophylaxis (preventative measures)?

soldiers & lab workers

what vaccine is used for anthrax prophylaxis (preventative measures)?

BioThrax

how is tularemia transmitted?

ticks, contaminated water, deer flies, inhalation

key symptoms of tularemia?

painful lymph nodes, ulcers, fever, chest pain, dyspnea

first-line treatment for tularemia?

IM streptomycin or gentamicin (preferred)

alternative tularemia treatments?

doxycycline or ciprofloxacin

what are the two main forms of plague?

bubonic (lymphatic system) and pneumonic (respiratory system)

key symptom for bubonic plague?

large swollen lymph nodes

key symptom for pneumonic plague?

rapid severe pneumonia + bloody sputum

shared symptoms for bubonic and pneumonic plague?

SEVERE fatigue, tender enlarged lymph nodes, warm red skin, FEVER

how is bubonic plague transmitted?

rats → lymphatic system (NOT contagious)

how is pneumonic plague transmitted?

inhalation/droplet (CONTAGIOUS)

first-line treatment for plague?

streptomycin or gentamicin

alternative plague antibiotics?

doxycycline, ciprofloxacin, chloramephenicol

how does smallpox rash spread?

starts on face → moves down to hands & feet

how does smallpox differ from chickenpox?

smallpox includes hands/feet; chickenpox starts on trunk of body

smallpox transmission source?

contaminated bedding or clothing

symptoms of smallpox?

RASH (begins flat → papules or pustules), FEVER

antivirals used for smallpox?

cidofovir, adefovir, ribavirin, topical idoxuridine

best way to eradicate smallpox?

vaccines

mechanism of botulinum toxin?

neurotoxin that blocks acetylcholine release → paralysis

how does botulism present?

afebrile, normal LOC, descending paralysis

greatest nursing concern for botulism?

respiratory failure

nursing priority for botulism?

ABC’s → prepare to intubate due to respiratory distress

antidote for botulinum toxin?

botulinum antitoxin and/or botulism immune globulin

what is ricin derived from?

castor beans

routes of ricin exposure?

inhaled, ingested, injected

effects of ricin poisoning?

inhibits protein synthesis causing multiple organ failure

is there an antidote for ricin?

NO

treatment for ricin exposure?

supportive care only meaning symptom management (oxygen, intubation, antibiotics, fluid control, pain management)

what do nerve agents cause?

irriversible cholinergic crisis by blocking or exciting nerves

key symptoms of nerve agent exposure?

salivation, urination, wheezing, bradycardia, muscle twitching, pinpoint pupils, atrophy

nursing priority for nerve agent exposure?

control ABC’s and manage ssecretions

what systems can sulfur mustard gas be exposed by?

respiratory, GI, eyes, skin

what does damage form sulfur mustard gas cause?

delayed, long lasting damage to skin, eyes, respiratory tract, and/or GI tract

treatment for sulfur mustard gas?

decontamination + supportive care + antibiotics

antidote for plutonium, americium, curium?

pentetate zinc trisodium or pentetate calcium trisodium

(zinc + calcium)

antidote for cesium and thallium?

prussian blue (binds to agent and bring to intestine for excretion)

why is poisoning difficult to diagnose?

symptoms often mimic disease

correct order of poison management?

understand what the poison is and how to treat while giving supportive → once poison is identified we prevent further absorption → by giving the antidote and treating

what is the most important element of poison treatment?

supportive care

primary concerns in supportive care?

airways, breathing, circulation (ABC’s)

methods used to prevent further absorption?

activated charcoal, gastric lavage + aspiration, whole-bowel irrigation, surface decontamination

preferred method to remove ingested poisons?

activated charcoal through NG tube

how does activated charcoal work?

absorbs poison → prevents absorption into the bloodstream → cannot give antidote immediately before or after

who cannot undergo a gastric lavage?

pregnant pts

when is gastric lavage indicated?

life-threating posion within 60 minutes of ingestion

how does gastric lavage work?

flushing the stomach with fluids and then aspirating back out

solutions used for whole-bowel irrigation?

CoLyte, GoLYTELY

poisons best treated with whole-bowel irrigation?

iron, lithium, lead, sustained-release drugs

how is whole bowel irrigation administered?

NG tube (causes diarrhea)

how do drugs promote poison removal?

increase renal excretion (can be through dialysis)

antidote for opioid overdose?

naloxone (narcan)

antidote for anticholinergic poisoning (atropine)?

physostigime

acetaminophen overdoes antidote?

acetylcysteine

heparin overdose antidote?

protamine sulfate

insulin overdoes antidote?

glucagon

warfarin overdose antidote?

vitamine K

most common heavy metal poisonings?

iron, lead, mercury, arsenic, gold (binds more)

copper, zinc (binds less)

what is the antidote for heavy metal poisoning?

chelating agents ( work by binding to metal and excreting in urine or stool)

antidote for lead poisoning?

EDTA (edetate calcium disodium)