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Flashcards in Toxicology Deck (77):
1

Alcohol
Oxycodone

Most common substance abuse
Most licit abused is oxycodone

2

Posion

Substance that is toxic by nature no matter how it gets into the body or how much is taken

3

Drug

A substance that has some therapeutic effect when given in appropiate circumstance and dose

4

Overdose

When a drug, licit, or illicit, is taken in excess

5

Bioavailixbility

Describe the extent to which any drug is present in sufficient amounts to produce the desired effect

6

Toxicological emergencies

Fall into two categories,
Intentional and unintentional

7

Toddlers

Will put anything in their mouth, including dangerous medications

8

Chloral Hydrate

Also known as "knock out drops" are used to commit assault for decades

9

Rohypnol

Date Rape drug

10

Flunitrazepam

A powerful benzodiazepine that has both antegrade and retrograde amnesiac properties to erase memory for next 4-5 hours

11

Posion Center Number

18002221222

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Four Methods of Absoprtion

Ingestion
Inhalation
Injection
Absorption

13

Ingested Posions

Immediate damage to tissues, or may be delayed for several hours
-Look for stained fingers, lips, or tounge a
-Sudden report of cramps, nausea, vomiting, and diarrhea
-look for empty pill bottles
-ingestion is usually a more forgiving time frame for identification and treatment
-Goal: remove or neutralize the posion before it gains access to intestines

14

Inhaled Posions

First, the person will remained poisoned as long as they are exposed, as well as the paramedic
Second, atmosphere poisoning, you are likely to encounter more than one patient
-Home agents such as Clorox or Bleach are responsible for most inhalation Emergencies
-CO poisoning is a painless suicide
-CO can be caused by old furnaces as well
Inhaled substances reach the alveoli instantly gaining almost instant access to the circulatory system

15

Carbon Monoxide

Binds to hemoglobin 250x more readily than oxygen

16

Injection Poisioning

Sting, bites from insects and animals
IV drugs such as meth, heroin, cocaine

17

Absorption Posioning

When substance is absorbed through skin
E.g organophosphate

18

Toxidrome

The Syndrome-like symptoms of a class or group of similar posionous agents
Are useful for remembering and management of different substances that fall under same clinical umbrella

19

Toxidrome Categories

Stimulants
Narcotics
Cholinergics
Anticholinergics
Sympathomimetics
Sedative/Hypnotics

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Stimulant Examples

Amphetamine
Methamphetamine
Cocaine
Diet Aids
Nasal Decongestants
Bath Salts

21

Stimulants Signs and Symptoms

Restlessness, agitation, incessant talking
Insomnia, anorexia, dilated pupils, tachycardia, tachypnea, paranoia, seizure

22

Narcotic Examples

Heroin
Opium
Morphine
Dilaudid (hydromorphine)
Fentanyl
Oxycodone
Ambien
Secobarbital

23

Narcotic Signs and Symptoms

Constricted pupils, respiratory depression,
Needle tracks, drowsiness, coma

24

Sympathomimetic Examples

Pseudoephedrine, amphetamine, methamphetamine

25

Sympathomimetic Signs and Symptoms

Hypertension, tachycardia, dilated pupils, hyperthermia, seizures

26

Sedative/Hypnotic Examples

Phenobarbital, diazepam, midazolam, lorazepam

27

Sedative/Hypnotic Signs and Symptoms

Drowsiness, ataxia, slurred speech, ams, CNS depression, hypotension

28

Cholinergic Examples

Acephate
Diazinon
Celthion
Cythion
Sarin
Parathion

29

Cholinergic Signs and Symptoms

Increased salivation, lacrimation, diarrhea. Respiratory depression, apnea, seizures

30

Anticholinergic Examples

Atropine
Antihistamines
Antipsychotics

31

Anticholinergic Signs and Symtpoms

Dry, flushed skin, hyperthermia, dilated pupils, blurred vision, dramatic delirium

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Odor

Almonds: cyanide
Garlic: arsenic
Acetone: methyl alcohol

33

Pupils

Constricted: narcotics, organophosphate
Dilated: barbiturates, atropine, amphetamine, cyanide, CO

34

Mouth

Salivation: organophosphate, arsenic, mercury
Dry: atropine, amphetamines, diphenhydramine
Burns: iodine, plants, pine oil, acids

35

Skin

Pruritus: Jimson weed
Dry, hot: atropine, CO
Sweating: organophosphate, arsenic, aspirin, amphetamine

36

Respiratory

Depressed: narcotics, alcohol
Increased: Aspirin, cyanide, nicotine
Pulmonary Edema: CO, narcotics, organophosphates

37

Drug Abuse

Use of drugs that cause physical, psychological, or social harm

38

Habituation

Psychological dependence on a drug

39

Physical Dependence

Physiological state of adaption to a drug, with tolerance and withdrawals to the drug

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Psychological Dependence

Emotion state of craving a drug to maintain a well being

41

Tolerance

Physiological adaptation to the effects of a drug in which larger doses are required

42

Potentiation

Enhancement of the effect of one drug by taking it with another

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Synergism

Two substances in which total effects are greater than the sum of the independent effects 2+2=5

44

Alcohol

Mot widely abused drug in America

45

Alcoholism

Drinking early in day
Drinking alone or in secret
Periodic Binges
Loss of Memory

46

Delirium Termens

"Alcohol withdrawal syndrome" results in fever, disorientation, confusion, and seizures

47

Effects of Alcohol

Have chronic malnutrition causing them to fall a lot
Decreases life span 10-20 years

48

Alcohol Suscepitble Medical Problems

Subdural Hematoma
GI bleeding
Pancreatitis
Hypoglycemia
Pneumonia
Burns
Hypothermia
Seizures
Dysrhythmia
Cancer
Esophageal Varices

49

Acute Alcohol Intoxication

Give thiamine

50

Delirium Termens

Usually 48-72 hours after last intake
Mortality as high as 15%

51

*Stimulants*

Only takes days to become addicted and abuse drugs
Commonly recognized as wide eyed and thin as a rail

52

Cocaine

Natural occurring alkaloid
"Blow, flake, lady, nose, candy, snow, toot"
-Local anasthetic and CNS stimulant and creates a euphoria
-Causes widened QRS and QT intervals

53

Amphetamine-like Drugs

Include ecstasy, meth, and amphetamine
-most nasal decongestants and diet pills are members of this family
Meth: ingredients to make are available locally
Compared to cocaine very similar, however, meth last much longer, up to 12 hours

54

Bath Salts

Contain active ingredient such as "Sudafed"
Can snort, smoke or ingest drug

55

Management of Stimulant Abuse

Maintain maximum oxygen saturation levels, present seizures with adequate sedation and monitor vitals
-Excessive pulse rates, preload can drop drastically
-Consider beta blocker to lower pulse rate
-Apply ice packs or mist patients skin for hyperthermia

56

*Marijuana and Canabis Compounds*

-Does not produce true hallucinogens
-Results in bronchodilator and slight tachycardia

57

Spice

Can produce deliriums and produce psychotic long term and short term effects

58

*Hallucinogens*

Causes distortion of perception

59

LSD

Non habit forming drug
-primarily affects senses rather than altering physiologic functions
-"I was watching music play"
-Effects are mostly sympathomimetic in nature

60

PCP

"Phencyclidine"
-Also called angel dust or dust
-Classified as a dissociative anesthetic
-slurred speech, staggering gait, hypertension
-experience a mind-body separation
Can cause patients to be ver violent !
Haldol IM for sedative

61

Ketamine

Physically and psychologically addicting
Used as an elephant tranquilizer

62

Peyote and Mescaline

Native tribes use for religious purposes
-experience hallucinations of outer experiences
-support abc's

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Psilocybin Mushrooms

Cause hallucination effects
-nausea, vomiting, tachycardia, hypertension

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*Sedative Hypnotic

Reduce anxiety and calm agitated patients, used as sleep aids, in either cases, they function primarily as CNS depressants

65

Barbituates

Long Hx use as sleep aids, anti anxiety and seizure control medications
"Barbitals"
-management: oxygen, 12 lead, IV
IF SHOCK present, rapidly infuse 1-2 L of fluid.
For LONG ACTING such as Phenobarbital, administer BiCarb 1meq/kg to help alkaline the urine and traps the drug in its ionized form.
Lasix can also be used to deplete body of urine and bring closer to an alkalytic state
Activated Charcoal can also be used

66

Benzodiazepines

Used to treat anxiety, seizures, d alcohol withdrawal (ambien) easy to buy
-CNS depressant
-management: oxygen, 12 lead, IV romazicon, contraindicated for head injury and increased ICP

67

*Narcotics, Opiates, Opiods*

Is a drug that produces sleep, or AMS

68

Opiate

Natural drugs derived from opium

69

Opiod

Refers to non-opium derived synthetics
Produces effects on CNS by binding with receptor sites in the brain and other tissues
Management: abc! Bag and ventilate in necessary. Administer Narcan .4-2mg

70

Narcs example

Oxycodone, morphine, fentanyl, codeine. Heroin, hydrocodone, Demerol, robitussin

71

Cardiac Medications

Types of Antidysrhythmics

72

Type 1

Lidocaine
Na Channel Blocker affecting depolarization and impulse conduction
In certain cases, BiCarb may be used for QT prolongation, bradycardia and hypotension by reversing the inhibition of fast Sodium channels within cardiac cells

73

Type 2

Beta-adrenergic and Beta-Blocker medications
Control pulse rate and BP
Hypotension, AMS, bradycardia
HYPOGLYCEMIA AND HYPERKALEMIA occur with beta overdoses
Management: IV Glucagon, Epinephrine infusion, pacing

74

Type 3

Block cell potassium channels causing prolongation of cardiac action potential
E.g Amiodarone
Hypotension, bradycardia

75

Type 4

Ca channel blocker medications
Verapimil or Cardizem (ca channel blockers)
Slow calcium influx into present cells in the heart, blood vessels and other types of smooth muscles.
OD treatment is calcium

76

Organophosphates

Insecticides used in agriculture and nerve gases in the military
Except effects at neuromuscular junctions of Nerves and release acetylcholine.
Management: oxygen, IV, 12 lead, atropine 1mg up to 3mg

77

Carbon Monoxide

Odorless, tasteless gas and is 250x more affinity to bind with hemoglobin than oxygen
Assessment: cherry red skin color, pressure in the head, unable to think clearly
Management: highest concentration oxygen available. Hyperbaric chamber.