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NURS116 toxicity 2025

Toxicity Overview

  • All images are used for educational purposes only, not for further distribution.

Urine Collection Tube

  • Sample collection with Boric and preservative for accurate analysis.

Drug Effects

  • Undesirable Drug Effects

    • Non-deleterious (side effects)

    • Deleterious (toxic effects)

  • Toxicity Classification

    • Therapeutic (medicinal effects)

Factors Influencing Patient Response to Drugs

  • Clinical Factors

    • Age and weight of the patient

    • Present health disorders and other disease entities

    • Client drug compliance and administration methods

  • Drug Factors

    • Form and route of drug administration

    • Use of multiple drug therapy and drug interactions

  • Pharmacokinetics

    • Absorption, distribution (protein binding), metabolism, and excretion

  • Pharmacodynamics

    • Onset, peak, and duration of effect

    • Therapeutic range and side effects/adverse reactions

Genetic Factors Affecting ADME

  • Genetic Polymorphisms

    • Variation in liver enzymes, e.g., decreased CYP2D6 leads to reduced metabolism of drugs, causing toxicity and decreased efficacy of prodrugs like Codeine.

Special Safety Considerations Across Lifespan

  • Pregnancy Risk Categories

    • Category A: Appropriate human studies, no risk

    • Category B: Insufficient human studies but animal research suggests safety

    • Category C: Animal studies show issues; insufficient human studies

    • Category D: Risk evident; benefits may justify use

    • Category X: Fetal risks evident; use is unjustifiable

Pregnancy & Pharmacotherapy

  • Altered gastrointestinal function and delayed drug absorption

  • Increased blood volume and heart rate affecting placental blood flow

  • Most drugs can cross the placenta and enter breast milk

  • Examples of contraindicated drugs during breastfeeding include Ibuprofen and Opioids.

Pediatric Pharmacotherapy (0-18 Years)

  • Calculated by body mass, often on a per kg basis

  • Pediatric blood volume is 80 mL/kg

  • Caregiver-dependent management and education required

  • Risks of poisoning, especially in teens; focus on menstrual cramps, sports injuries, and STIs.

  • Organ function must be monitored as neonates and infants have lower liver and renal function.

Older Adult Pharmacotherapy

  • Decreased Organ Function

    • GI: Decreased peristalsis, acidity, and elimination

    • Renal: Decreased GFR leading to potential toxicity

    • Interactions of changes in body composition affecting drug distribution and metabolism

  • Increased risk for dehydration affecting plasma volume and GFR.

Common Toxicities

  • Most Common Toxicities

    • Aspirin (ASA), Acetaminophen, Opioids (Oxycodone, Fentanyl), Benzodiazepines (Xanax, Valium), Alcohol (ETOH), THC, and Cocaine.

Medication Errors

  • Common nursing errors include dose errors, late charting, and issues with checking medication rights during administration.

Clinical Procedure in Toxicity (Overdose)

  1. Stabilize & Analyze

  • Airway, breathing, circulation assessment

  • Check for patency, effort, rate, color

  1. Assess Perfusion

  • Evaluate level of consciousness, pulses, skin condition, and blood pressure

  1. Assess for Dysfunction

  • Treat apnea, seizures, cardiac arrhythmias, and hyperthermia

  1. Identify Drug/Substance

  • Initiate appropriate treatment

Identifying Toxicities

  • Common Toxidromes

    • Aspirin: Confusion, tachycardia, hyperthermia

    • Acetaminophen: Abdominal pain, nausea, diaphoresis

    • Opioids: Bradypnea, Bradycardia, constricted pupils

    • Cocaine: Agitated state, dilated pupils, hypertension

Cannabis Toxicity & Toxidrome

  • Neurocognitive effects and variable presentations

  • Vital signs can show changes like tachycardia and hypertension

  • Treatment often requires supportive measures.

Treatment Strategies

  • Supportive Treatments

    • Variable dosing for seizures, hypertension, respiratory issues, and psychosis

  • Activated Charcoal

    • Used to bind drugs and decrease absorption via multiple routes.

Inducing Metabolism in Toxicity Cases

  • Acetaminophen Toxicity

    • N-acetylcysteine (NAC) as a precursor to glutathione enzyme enhances metabolism and protects the liver.

Treatment Algorithms for Specific Overdoses

  • Follow protocols for time since ingestion and paracetamol levels to effectively manage overdose, focusing on supportive care and monitoring liver function (AST/ALT).

Alcohol Effects and Management

  • Alcohol is metabolized in the liver, leading to vitamin B depletion, CNS effects, and potential dehydration.

  • Treatment may include Metadoxine and IV fluids.

Increasing Elimination of Toxic Substances

  • Methods

    • GI tract via activated charcoal

    • Kidneys using sodium bicarbonate for acidic substance excretion

    • Blood using hemodialysis for active removal.

Antagonism in Toxicology

  • Receptor Antagonism

    • Use of opioid receptor antagonists (e.g., Naloxone) for opioid toxicity, or GABA receptor antagonist (Flumazenil) for benzodiazepine toxicity.