Pharm III - Exam 8 - Poisoning

How does the poisoned patient die?

cardiovascular toxicity with arrhythmia (TCAs, cocaine, amphetamines)

What medicine can kill you by cardiovascular toxicity with arrhythmia?

TCAs, cocaine, amphetamines

Cocaine causes what abnormality with vital signs?

hypertension

What medication can cause rapid respirations?

salicylates, carbon monoxide, and or any toxin that produces metabolic acidosis

What medications can cause hyperthermia?

sympathomimetics, anticholinergics, salicylates, and drugs causing muscular rigidity.

What medications can cause dilated eyes?

amphetamines, cocaine, LSD, and anticholinergics

What medications can cause twitching?

anticholinergics, cocaine, and sympathomimetics

Anticholinergics, cocaine and sympathomimetics can cause?

all of the following

3 multiple choice options

What medications can cause seizures?

TCAs, cocaine, bupropion, amphetamines, theophylline, isoniazid, and diphenhydramine

Is ipecac recommended anymore? why?

no; risk of aspiration, delayed presentation, lack of evidence of improved outcomes, unpredictable effectiveness, complications

When is gastric lavage used in poisoning?

only in rare, potentially life-threatening ingestion (TCA overdose), that present within 60 minutes of ingestion and only when patient's airway can be protected to prevent aspiration.

When is activated charcoal used?

for most acute toxic ingestions presenting within one hour, it is preferred method of gastric decontamination if it binds well to charcoal.

What substances are examples that DO NOT get absorbed by charcoal?

lithium and iron

What do you use for lithium and iron?

WBI uses large volumes of osmotically balanced polyethylene glycol electrolyte solution until the rectal effluent is clear.

What is urinary arlkalinization used for?

key treatment modality for enhancing the elimination of specific acidic drugs, SALICYLATES and PHENOBARBITAL.

When is hemodialysis used?

severe toxicity, end-organ damage, or when conventional therapies fail.

What substances are dialyzable?

SLIME: salicylates, lithium, isopropanol, methanol, ethylene glycol, and phenobarbital.

What medication is the MC cause of acute liver failure in the US?

acetaminophen

When should NAC, acetylcysteine be administered?

if the acetaminophen level plots on or above the "probable risk" line. within 8 hours of ingestion, nearly 100% effective in preventing hepatotoxicity.

High doses of amphetamines and sympathomimetics can cause what?

restlessness, agitation, acute psychosis, hypertension, and tachycardia. Seizures and hyperthermia can occur.

What is the saying for what anticholinergic toxicity can cause?

red as a beet, full as a flask, hot as a hare, dry as a bone, blind as a bat, and mad as a hatter.

what is the treatment for cholinesterase inhibitors toxicity?

atropine and pralidoxime.

What is the 1st line treatment for cyanide toxicity?

hydroxocobalamin.

What is the MOA of hydroxocobalamin?

directly binds to cyanide to form a nontoxic compound that is excreted in the urine, and it may also help stabilize blood pressure

What are the signs of opioid toxidrome?

CNS depression, miosis, respiratory depression, hypothermia, bradycardia.

What can cause a salicylate OD?

oil of wintergreen

What are synonymous names with quinidine-like effect?

membrane stabilizing, and local anesthetic effect.

With TCA OD, when is sodium bicarb therapy indicated?

for QRS prolongation >100ms.

What is an opioid?

the class of drugs that includes opiates, opiopeptins, and all synthetic and semi synthetic drugs that mimic the actions of the opiates

what are kappa receptors good for?

contribute to spinal analgesia and sedation.

Opioids are contraindicated in what disease process and why?

biliary colic due to constricting biliary smooth muscle which leads to increased intrabiliary pressure.

When on opioid, what SE DO NOT develop tolerance?

miosis, constipation and convulsions

What medication is a potent agonist at mu receptors?

morphine

What is the MOA of codeine ?

converted to morphine by the cytochrome P450 isoenzyme CYP2D6. (watch for polymorphisms, ultra rapid metabolizers).

How potent is fentanyl?

100 times as potent as morphine.

What can meperidine cause?

antimuscarinic effects, serotonin syndrome (avoid other serotonin meds),

When is meperidine used?

pts with pancreatitis and cholecystitis due to less effect on sphincter of Oddi than morphine.

What does the toxic metabolite of meperidine cause?

seizure; limit use to 48 hours or less

When is methadone used?

used to treat morphine failures and difficult cases such as cancer and neuropathic pain

What is the MOA of methadone?

long acting opioid, potent Mu receptor agonist, useful in the treatment of opioid abuse.

T/F: methadone causes euphoria.

false

What is the MOA of tramadol?

dual action analgesic

What is true of tramadol?

all of the following

3 multiple choice options

What is true of dextromethorphan?

all of the following

3 multiple choice options

What is true of loperamide?

low abuse potential because of very poor penetration into the CNS

1 multiple choice option

What is true of buprenorphine?

both

3 multiple choice options

What is true of nalbuphine?

resistant to naloxone

What is true of butorphanol?

greater analgesia in women than men

How often would you want to give naloxone?

1-2 hours repeated doses due to short duration of action

T/F: nalmefene has a long duration of action (8-10 hrs) compared to naloxone.

true

Naltrexone duration of action?

24-48 hours after oral administration, long acting

When is naltrexone used?

to decrease cravings in alcoholics, and to decrease cravings and psychological dependence in opioid use disorder

What is the primary psychoactive substance in marijuana?

delta-9-tetrahydrocannabinol

What is hashish?

the dried resin from the top of the female plant

What are the physiological effects of marijuana?

decrease IOP, antiemesis, and pain relief

What can LSD cause?

colored visions of tunnel, spiral, and lattice shapes that move

Why and who invented phencyclidine (PCP)?

developed as a dissociative anesthetic - by Parke-Davis in 1963.

What is the MOA of PCP?

antagonist at the NMDA receptor for glutamate

What are the clinical features of a patient on PCP?

may be violent or catatonic; hypertension and nystagmus are the MC findings.

What would you want to give to a patient that is having a trip on PCP?

benzodiazepines

Where is psilocybin found?

present in more than 200 species of psychedelic mushrooms.

What is cocaine?

the 1st local anesthetic

What happens when cocaine and ethanol are combined?

produces cocaethylene which has a half life of 2 hours. This metabolite is much more toxic to the brain and heart.

What would you want to NOT give your patient that has cocaine toxicity?

beta blockers - causes unopposed alpha activation and profound hypertension

What would you give to a patient with vasoconstriction from amphetamine toxicity?

nitroglycerin

What is molly?

MDMA, 3, 4-methylenedioxymethamphetamine; pure powder form which is usually snorted.

What is true of molly?

synthesized by Merck and patented in 1914; never used until it appeared on the street in the 1960's.

What happens with chronic use of molly?

depletion and deterioration of serotonergic neurons that is irreversible

What is nesbitt's paradox?

nicotine causes an arousal in brain wave activity and stimulates the sympathetic system, yet smokers report that smoking makes them feel relaxed.

What is the presentation of nicotine poisoning?

symptoms of cholinergic excess

When do most people begin smoking?

in their teens

What is true of smoking with pregnant patients?

increased prematurity and spontaneous abortion

Medication used for smoking cessation?

bupropion

What is the MOA of varenicline?

nicotinic acetylcholine receptor partial agonist

What are the adverse effects of varenicline?

nicotine withdrawal symptoms

What may happen with aerosol propellants toxicity?

cardiac arrest due to either ventricular arrhythmia or asphyxiation.

Steroids such as testosterone are classified as what schedule drug?

3