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What does CBRNe stand for?
- Chemical
- Biological
- Radiation
- Nuclear
- explosive
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What are the 6 category A biologic agents?
- anthrax
- smallpox
- plague
- botulism
- tularemia
- viral hemorrhagic fever
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Why are category A agents considered such?
- available
- relatively easy to disseminate
- high mortality rate
- high infectivity
- little to no treatment
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Is anthrax contagious?
no
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What is the key identifier for anthrax?
widening of the mediastinum
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How do we prevent anthrax?
- 5 shot series
- ABThrax (still not approved, but in the SNS stock)
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How do we treat anthrax?
- Doxycycline x 60d (prophylaxis)
- Ciprofloxacin x 60d (prophylaxis & tx)
- Amoxicillin (susceptible bugs only)
- usually add 1-2 more AB's to this regimen (rifampin, vanco, chlorampenicol, clindamycin, clarithromycin, imipenem, PCN, ampicillin)
- STILL TREAT PREGNANT WOMEN - death if we don't
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What is the mortality rate of anthrax?
100% if untreated
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How does anthrax kill you?
- lethal factor toxin
- protective factor toxin
- edema factor toxin
- (any one of these gets to high enough level means no tx will work)
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What is the time-frame of anthrax sx?
- incubation period of 2-60d
- symptom initiation to death as short as 3d
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How is anthrax used as a weapon?
most likely aerosolized
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Is smallpox contagious?
Very
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What is the key identifier of smallpox?
- rash:
- spreads centrifugally and uniformly
- scabs contain the virus
- starts in mouth and on palms
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What do we do to treat smallpox?
- ACAM2000 (bifurcated needle,
- in SNS stock only)
- Vaccine ImmunoGlobulin (VIG)
- CI in pregnancy
- supportive care (nutrition, fluids, eye care)
- isolation
- Imvamune (in Phase III now)
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What is the mortality rate for smallpox?
30%
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What is the time-frame for smallpox sx?
7-17d incubation period
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Is plague contagious?
yes
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What is the key identifier of plague?
swollen lymph nodes or "bubo" (bubonic type)
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What is the treatment of plague?
- Doxycycline
- Ciprofloxacin
- STILL TREAT PREGNANT
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What is the mortality rate for plague?
- 50-90% untreated
- 15% treated
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What are the 3 types of plague?
- bubonic
- pneumonic
- septicemic
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How is plague used as a weapon?
can be aerosolized
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What are is the key identifier of botulism?
- The 4 D's:
- diplopia
- dysarthria
- dysphonia
- dysphagia
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How do we treat botulism?
- Anti-toxin (heptavalent):
- prevents further paralysis (existing paralysis is permanent unless new nerve grows to area)
- must call CDC to get it
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How toxic is botulinum toxin?
1g can kill 1 million people (most toxic substance known)
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What is the time-frame for botulism?
probably >72h incubation period
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Is tularemia contagious?
not usually person to person
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What is the key identifier of tularemia?
ulcers of the skin or mouth
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How is tularemia used as a weapon?
- can be aerosolized
- can be engineered to resist AB's
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What is the mortality of tularemia?
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What is the tx for tularemia?
- doxycycline x 14d
- ciprofloxacin x 14d
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What are the viruses that can cause Hemorrhagic Fever?
- ebola
- marburg
- lassa
- rift valley fever
- hantavirus
- yellow fever
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What is the key identifier of Viral Hemorrhagic Fever?
- hemorrhagic state:
- petechiae
- mucous membrane and conjunctival involvement
- Frank ecchymosis
- epistaxis
- hematuria
- hematemesis
- melana
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What is the mortality rate for Viral Hemorrhagic Fever?
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How do we prevent Hemorrhagic Fever?
- vaccine (yellow fever only)
- ribavirin for contained or mass prophylaxis (not for pregnant)
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How is Viral Hemorrhagic Fever used as a weapon?
aerosolized (ebola, marburg, lassa, hantavirus)
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How do we treat Viral Hemorrhagic Fever?
supportive care only
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What are the nerve agents commonly used?
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How do nerve agents work?
inhibit acetylcholinesterase
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How do we treat nerve agent exposure?
- decontamination
- antidotes:
- atropine
- 2-PAM
- diazepam (seizures)
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What are the blood agents (asphyxiants) commonly used?
- methane (simple)
- nitrogen (simple)
- CO (chemical)
- cyanide (chemical)
- hydrogen sulfide (chemical)
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How do simple blood agents (asphyxiants) work?
interfere with inhalation
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How do chemical blood agents (asphyxiants) work?
interfere with cellular respiration
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What are the sx of cyanide poisoning?
- tachypnea
- convulsions
- hypotension
- loss of consciousness
- respiratory failure
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How do you treat cyanide poisoning?
- amyl nitrate (1 amp over 30s q 3min)
- sodium nitrite (IV, no < 5min)
- sodium thiosulfate (50ml IV over 10-20 min)
- cyanokit - complexes w/ CN to form B12 (turns urine red)
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What are the responsibilities of the pharmacist in a crisis?
- mass dispensing
- pharmaceutical caches
- planning
- SNS request
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