L11.Poisons

Poisons

  • Definition: Poisons are substances that cause injury, illness, or death.

  • Toxicity: Refers to the degree to which a substance is poisonous; higher toxicity indicates a more dangerous poison.

  • Importance: Knowledge of toxic substances is essential for pharmacy professionals due to potential emergencies involving poisoning, especially with children.

Poison Control Pharmacists

  • Role: Field emergency calls and create action plans for dealing with poisons.

  • Staffing: Poison control centers are staffed by clinical toxicology pharmacists and nurses 24/7.

  • Duties: Provide information on poison prevention, toxicity of drugs, and collaborate with poison treatment facilities.

  • Job Opportunities: Positions available in state poison control centers, hospitals, and universities for those with clinical toxicology coursework or residency.

Common Poisons and Treatment

Household Products

  • Acetaminophen:

    • Over-the-counter analgesic.

    • Dosage: Toxic doses (approximately 7.5 grams) can cause liver damage with symptoms like nausea and lethargy.

    • Antidote: N-acetylcysteine (NAC) is administered orally and may require a tube if necessary.

    • Activated Charcoal: May be given to absorb poisons still in the GI tract.

  • Sulfuric Acid:

    • Found in cleaners and batteries; ingestion leads to severe burns and GI bleeding.

    • Treatment: Dilution with water or milk; emergency treatments include bronchoscopy and fluids.

  • Alkalis:

    • Found in drain cleaners, causing severe tissue damage.

    • Treatment: Large amounts of water or milk; esophagoscopy within 24 hours.

Drug Overdose

  • Antihistamines:

    • Can cause CNS stimulation or depression; treatment may include activated charcoal and monitoring vital signs.

  • Benzene:

    • A solvent that can cause dizziness, euphoria, and severe symptoms with exposure.

    • Treatment: Emergency care for symptomatic treatment.

Special Cases

  • Sodium Hypochlorite (Bleach):

    • Can cause damage through ingestion or inhalation; treated with dilution and hospital care.

  • Carbon Monoxide:

    • A colorless gas that can lead to brain damage; treatment involves oxygen administration and potentially hyperbaric therapy.

  • Cyanide:

    • Rapidly deadly poison; skin may appear pink/red in poisoning.

    • Treatment: Immediate medical intervention is crucial.

  • Cationic Detergents:

    • Can cause severe health effects; treatment often includes gastric lavage.

Metals and Chemicals

  • Fluoride:

    • Toxic at high levels; symptoms include respiratory distress.

    • Treatment: Gastric lavage and activated charcoal.

  • Formaldehyde:

    • Exposure can result in circulatory collapse; treatment may involve dilution with milk or charcoal.

  • Iodine:

    • Poisoning leads to GI damage; treatment involves dilution and possible hospitalization.

  • Lead:

    • Particularly a risk for children; treatment includes chelation for lead excretion.

Poisoning from Other Substances

  • Mercury:

    • Causes severe symptoms and is hazardous due to long-term neural damage.

  • Methyl Alcohol:

    • Delayed symptoms; treatment includes IV ethanol as an antidote.

  • Opiates:

    • Cause respiratory shutdown; antidote is naloxone.

Organophosphorus Compounds

  • Symptoms: Nausea, vomiting, and possibly death.

  • Treatment: Removal of contaminated clothing and supportive care; no antidote is available.

Petroleum Distillates

  • Symptoms: Effects mimic alcohol intoxication; treatment includes stomach emptying and possibly oxygen therapy.

Other Symptoms and Treatments

  • Phenol: Can result in mucous tissue destruction; treatment includes assessment and supportive care.

  • Salicylates (Aspirin): Overdose leads to serious symptoms; treatment includes activated charcoal and potential oxygen therapy.

Snake Bites and Other Natural Poisons

  • Emergency: Ensure prompt first aid and avoid food or drink for victims.

  • Antidotes: Various antidotes exist for specific poisons; emergency medical care is crucial for effectiveness.

Overview of Antidotes

  • Antidotes Available:

    • Acetaminophen: N-acetylcysteine

    • Cyanide: Amyl nitrate

    • Iron: Deferoxamine

    • Methanol: Ethanol

    • Opiates: Naloxone