toxicology farra
TRANSCRIPT
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OPIODS TOXICITY
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OPIOIDS
• Mainly used for analgesic eects
NATURAL SEMISYNTHETIC SYNTHETIC• Codeine• Morphine
• Buprenorphine• Hydrocodone• Hydroorphone• O!ycodone• O!yorphone
• Dipheno!ylate• "entanyl• Meperidine• Methadone• Penta#ocine• Propo!yphene• Traadol
Tintinalli’s Emergency Medicine A Comprehensive Study Guide 7th Edition
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$ects ofOpioids
Mureceptors
%nalgesia
$uphoria
&espidepression
Miosis
Constipation
'appareceptors
%nalgesia
Miosis
&espidepression
Sedation
Constipati
on
Sigareceptors
Dysphoria
Hallucination
Psychosis
Deltareceptors
%nalgesi
a$uphoria
Sei#ures
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https://storifycom/nataliemmay/fcem!mnemonics
CLINICAL FEATURES
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M%(%)$M$(T
• %ssessent* H! + P$
• Con,ratory test* Serum druglevel (gold stadard!" -rine drugscreening
• %dit the pt. Monitor /0102H
• %ntidote* nalo!one
• 3atch out signs of o4er1t!*hyper4entilation5 tachycardia5 highBP
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NALO#ONE
• &e4erses eects of opioids* displaces opiatesfro the receptors
• Onset 6ithin 0 in
• Dose* – 7.210 g 4ia I8 route in adults5 7./g9:g in children
– &epeat dose of 0g e4ery ;1<in5 up to /7g
–
&econsider diagnosis if fail to respond after /7g
• Caution* – Potential precipitation of 6ithdra6al syptos
Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning
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SYMP%THOMIM$TICS TOXICITY
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SYMP%THOMIM$TICS
• %cti4ates sypathetic response=,ght9>ight?
• %gents* – Cocaine
– %phetaine
– Methaphetaine
– &italin
– Theophylline
– caeine
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CLINICAL FEATURES
https://storifycom/nataliemmay/fcem!mnemonics
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In4estigations
• -rine drug screening =detected 21@Hafter dose?
• -rinalysis* detect yogloAinuria cocaine1induced rhaAdoylosis
• Creatine :inase le4el* rhaAdoylosis
• Plasa le4el is rarely helpful5 d9tcocaine has short T/90* ;712<in
• $C) + cardiac en#yes* cocaine1induced MI
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MANA$EMENT
• Physical restraints + cheical sedation – Sypathoietic to!icity freuently a96 signi,cant agitation
• %e&od'a&e'es =eg5 8aliu? is safest /st approach – Should Ae adinistered freuently in titrated doses
• )astric decontaination – If oral ingestions of sypathoietic agents
– %96 suAseuent 4oiting + aspiration5 thus need air6ay control staAili#ed
•
&educe hypertheria if present – Controlling agitation signi,cantly helps )ool'g
• Sei#ures – Should Ae rapidly controlled 6ith Aen#odia#epines and9or AarAiturates
http://emedicinemedscapecom/article/&'&(&)!treatment*a''+,
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O&)%(OPHOSPH%T$S TOXICITY
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• used as coercialinsecticides
• Manifestationsoccur ;7ins to 0hours follo6ing
e!posure.• (icotinic +
uscarinic eects
O&)%(OPHOSPH%T$S
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M-SC%&I(IC
$""$CTSD* diaphoresis
U* urination
M* iosis
%* Aradycardia
%*Aronchoconstriction
E* enuresisL* lacriation
S* sali4ation
S* s6eating
(ICOTI(IC$""$CTS
D%YS O" TH$ 3$$'
M* uscle craps
T* tachycardia
+* 6ea:nessuscle
T* hyperTension
F* fasciculations
S* sugar=hyperglyceia?
ILLER Bs:
• %radycardia• %ronchorrhia• %ronchospas
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Add't'oal o,to-'dromal e.e)ts
• %cute pancreatitis
• Prolonged Tc on $C)
•
91 Torsades de pointes
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I(8$STI)%TIO(S
• &BC %Ch$ le4el
• I! for pancreatitis – "BC
– E"T =%ST?
– Blood glucose
– Seru EDH
• $C)
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M%(%)$M$(T
, De)otam'at'o* If the insecticide 6as incontact 6ith s:in or eyes5 3ash thoroughly
1 If drug is ingested F gastric la4age if
presentation is 6ithin /H5 follo6ed Aya)t'vated )/ar)oal
1 %ir6ay control + adeuate o!ygenation
1 OAtain I8 access5 infuse (S or D<G5 ta:e Alood
for cholinesterase01Atro'e
21D'a&eam
31 Pral'do-'me
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ACTI4ATED CHARCOAL
• 8ia gastric la4age tuAe
•
Dose* – / g9:g Aody 6eight
Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning
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ATROPINE
Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning
• /st drug to Ae gi4en
– Maor use in reduction of Aronchorrhoea9Aronchospas
– Earge doses ay Ae needed to control air6ay secretion
• Dose* – Adult* 0 g I8 /71/< in prn
• DouAled /7 in until secretions ha4e Aeen controlled orsigns of atropini#ation are oA4ious
– "lushed + dry s:in5 tachycardia5 ydriasis + dry outh?
– C/'ldre* 7.7< g9:g Aody 6eight /< in prn• DouAled /7 in until secretions controlled
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DIA5EPAM
• &educe an!iety + restlessness
• Control con4ulsion
• Dose* – <1/7 g I8
– -p to /7107 g I8 for con4ulsion
Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning
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PRALIDO#IME
/. Should Ae gi4en 6ith atropine to e4ery syptoatic patient
0. $ects 6ill Ae apparent 6ithin ;7 in
;. -sually necessitates reduction in atropine + ay unas:atropine to!icity
•. Dose* – Adult* / g I8 o4er /<1;7 in
• Can Ae repeated in / 10 hours prn
– C/'ldre* 0<1<7 g9:g9Aody 6eight I8 o4er /<1;7 in• Can Ae repeated in /10 hours
•. Contraindication* – CarAaate
– Organophosphorus copounds 6ithout anticholinesterase acti4ity
Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning- Sara.a 0and"oo of Medical
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