7 - Clinical Toxicology

b. heparin

1. Protamine Sulfate is intended for the management of toxicity due to

   a. warfarin

   b. heparin

   c. argatroban

   d. isoniazid

b. it blocks the muscarinic receptor

2. What is the MOA of Atropine in the management of malathion toxicity

   a. it regenerates the cholinesterase enzyme

   b. it blocks the muscarinic receptor

   c. it blocks the metabolism of ACh

   d. NOTA

a. digibind

3. Life-threatening toxicity due to ingestion of large amount of digoxin is treated w

   a. digibind

   b. IV calcium

   c. diuretics

   d. Inamrinone

a. N-ac

4. Which of the ff is the antidote for paracetamol poisoning

   a. N-ac

   b. BAL

   c. Pralidoxime

   d. Atropine

d. A & B only

5. Antidote for warfarin toxicity

   a. Vitamin K1

   b. Phylloquinone

   c. Protamine Sulfate

   d. A & B only

b. histamine

6. Vancomycin infusion reaction happens due to the release of

   a. prostaglandin

   b. histamine

   c.Bradykinin

   d. Nitric Oxide

Strychnine

7. A poison that mimics the effect of tetanospasmin

a. glucagon

8. Useful in cases of beta-blocker poisoning

   a. glucagon

   b. Pilocarpine

   c. nifedipine

   d. echothiopate

a. ASA toxicity

9. Salicylism refers to

   a. ASA toxicity

   b. Paracetamol toxicity

   c. Iron toxicity

   d. Morphine Poisoning

PARACETAMOL

• aka acetaminophen

• for fever (especially for children)

Glutathione Conjugation

Enzyme that converts NAPQI to non-toxic form

Hepatic Injury

Paracetamol Toxicity:

sulfation

at birth, the child already has:

Redox (Reduction & Oxidation)

at 1 week old, the child already has:

Acetylation

at 1 month old, the child already has:

Glucuronide Conjugation

at 2 months old, the child already has:

Glycine & Gluthathione Conjugation

at 3 months old, the child alre

Stage 1

What stage of Paracetamol Toxicity:

• n/v, anorexia, diaphoresis

Stage 2

What stage of Paracetamol Toxicity:

• Clinical improvement (increase AST &ALT)

Stage 3

What stage of Paracetamol Toxicity:

• Peak hepatotoxicity (fatal)

Stage 4

What stage of Paracetamol Toxicity:

• recovery from paracetamol toxicity

Salicylates

• -   Anti-platelet (low dose)

• -   Analgesic/Antipyretic

• -   Anti-inflammatory

• -   Uricorusic agent (high dose)

Salicylism

Salicylates Toxicity:

• Sodium Carbonate – metabolic acidosis

• Vitamin K1 – Bleeding

• Hemodialysis – (>100mg/dL)

Treatment for Salicylate Toxicity:

Lanoxin

Famous Brand Name for Digoxin:

Digoxin

Increase Calcium ion myocytes

• Mild: N/V, anorexia, confusion

• Severe: Arrhythmia

Digoxin Toxicity:

• Cholestryramine – inhibits the reabsorption of enterohepatic cycling

• *Lidocaine or Phenytoin – tx for digoxin induced arrhythmia

Treatment for Digoxin Toxicity::

Tricycline Antidepressants

• 3^rd line treatment of depressants

• Use: Inhibits the re-uptake of 5-HT, NE

• CNS (coma)

• Cardiotoxicity (TCAs blocks Na channels = arrhythmia)

• Convulsion – tx Diazepam

• *Anticholinergic s/e

• *Pulmonary Depression (metabolic acidosis)

Tricycline Antidepressants Toxicity:

NaHCO3 – Metabolic acidosis & resolves cardiotoxicity

Treatment for Tricycline Antidepressant Toxicity:

• -   Bradycardia (blocks beta1 R)

• -   Hypotension

• -   Bronchospasm (blocks beta2 R)

Signs & Symptoms for beta-blockers toxicity:

• *Glucagon ( inotropy & HR)

• Atropine – (tx of beta-blocker tox)

• Epinephrine

Treatment for beta-blockers toxicity

• Hypotension

• *Reflex Tachycardia

Dihydropidines toxicity

• Bradycardia

• Hypotension

Nondihydropidines toxicity

• Glucagon – Bradycardia

• Calcium Chloride/Calcium Gluconate

Treatment for CCB’s toxicity:

Warfarin

inhibition of Vitamin K dependent clotting factors: IX, X, VII, II

Vitamin K

blocks VKOR

Bleeding

Warfarin Toxicity:

Bleeding

Heparin Toxicity:

Heparin

• -   Inactivates anti-thrombin III

• -   Inactivates factor IIA (thrombin) = no clotting

• -   Inactives XA

Chloramphenicol

• Use: Typhoid Fever

• At risk: Infants & Neonates (immature kidney & liver)

Gray Baby Syndrome

Chloramphenicol toxicity for children

Idiosyncrasy: Aplastic Anemia, Bone Marrow Depression: Adults

Chloramphenicol toxicity for Adult

Vancomycin

• for gram (-) infections; MRSA; pseudomembranous enterocolitis (C.difficile)

Red Man Syndrome/ Red Neck Syndrome; NM: Vancomycin Infusion Reaction

Vancomycin Toxicity:

Vancomycin Infusion Reaction

New name for Red Man Syndrome:

• -   Antihistamine

• -   Vancomycin (slow infusion)

Treatment for Vancomycin Toxicity:

Isoniazid

Use: Anti-TB

Vitamin B6

Treatment for Isoniazid Toxicity