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

2. Assess Perfusion

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

3. Assess for Dysfunction

• Treat apnea, seizures, cardiac arrhythmias, and hyperthermia

4. 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.