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study of the detection, chemistry, pharmacological actions, and antidotes of the toxic substances.
toxicology
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any chemical (drug, poison, or other) that causes adverse effects on an organism that is exposed to it.
toxin
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entry of a substance into the body through the GI tract
ingestion
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entry of a substance into the body through the respiratory tract
inhalation
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entry of a substance into the body directly through the skin or mucous membrane
surface absorption
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phosphorus-containing organic chemicals
organophosphates
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entry of a substance into the body through a break in the skin.
injection
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the process of minimizing toxicity by reducing the amount of toxin obsorbed into the body
decontamination
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removing an ingested poison by repeatedly filling and emptying the stomach with water or saline via a gastric tube.
gastric lavage, aka pumping the stomach
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powder usually premixed with water, that will adsorb (bind) some poisons and help prevent them from being absorbed by the body.
activated charcoal
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administration of polyethylene glycol continuously at 1 to 2 L/hr through a nasogastric tube until the effluent is clear or objects are recovered.
whole bowel irrigation
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substance that will neutralize a specific toxin or counteract its effect on the body
antidote
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a toxic syndrome; a group of typical signs and symptoms consistently associated with exposure to a particular type of toxin
toxidrome
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substance that liberates hydrogen ion (H+) when in solution
acid
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substance that liberates hydroxyl ions (OH-) when in solution; a strong base
alkali
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therapeutic index
maximum tolerated dose divided minimum curative dose of a drug; the range between curative and toxic dosages
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soluble poisonous substance secreted during growth of a bacterium
exotoxin
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an exotoxin that produces GI symptoms and diseases such as food poisoning
enterotoxin
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use of a pharmacological substance for purposes other than medically defined reasons
substance abuse
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compulsive and overwhelming dependence on a drug; an addiction may be physiological dependence or a psychological dependence, or both
addiction
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the need to progessively increase the dose of a drug to reproduce the effect originally achieved by smaller doses.
tolerance
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referring to alcohol or drug withdrawal in which the patient's body reacts severely when deprived of th abused substance.
withdrawal
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poisoning from pharmacological substance in excess of that usually prescribed or that the body can tolerate
drug overdose
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disorder found in habitual and excessive users of alcohol after cessation of drinking for 48 to 72 hours. experience visual, tactile, and auditory disturbances. death can result in severe cases.
delirium tremens DT's
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# number of poisoning that occur annually
4 million
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most common route of toxic exposure
ingestion
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most effective and widely used method of reducing absorption of toxins
activated charcoal
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Amitriptyline
amoxapine
clomipramine
doxepin
imipramine
nortripyline
tricyclic antidepressants
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treating bi polar disorder this drug is proven to be most effective
lithium
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most common pit viper
rattlesnake
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because of the presence of neurotoxin, coral snake venom primarily affects _____ tissue
nervous
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most common abused substance in US
alcohol
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What are the 3 principles of decontamination
- 1. Reduce intake of toxin
- 2. Reduce absorption of toxin body
- 3. Enhance elimination of toxin
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cathartics such as ___ increase gastric motility, thus shortening the amount of time toxins stay in GI tract.
sorbitol
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whole bowel irrigation involves the administration of ______ through a nasogastric tube
polyethylene glycol continuously at 1to 2L/hr
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activated charcoal does not bind with these
ingestion of petroleum products or corrosive agents
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Why might someone who has been working with industrial solvent like paint thinners look like a CO poisoning patient?
people exposed to high levels of methylene chloride show S/S of CO poisoning.
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often used as industrial solvent is converted to CO int he liver after inhalation
methylene chloride
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7 pathophysiological effects of CO
- 1. Limits oxygen transport
- 2. Inhibits oxygen transfer
- 3. Causes tissue inflammation
- 4. Causes reduced cardiac function
- 5. Increased activation of nitric oxide
- 6. Causes vasodilation
- 7. Induces free radical formation
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the 2 cyanide treatment kits
- 1 Lilly or Pasadena cyanide antidote kit
- 2 Cyanokit - Hydroxocobalamin
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3 things found in Lilly or Pasadena cyanide antidote kit.
- 1. amyl nitrate ampules
- 2. sodium nitrate solution
- 3. sodium thiosulfate solution
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preferred antidote where combination of CO/cyanide poisoning is suspected
Cyanokit - Hydroxocobalamin
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how cyanokit works
combine with the cyanide ion to form cyanocobalamin
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nifedipine
verapamil
nicardipine
diltiazem
amlodipine
5 common Calcium Channel blockers
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calcium channel block poisoning treatment algorhythm
- 1. evidence of possible ingestion
- 2. contact poison control center
- 3. consider gastrointestinal decontamination with activated charcoal (do not induce vomiting.)
- 4. place monitors
- 5. obtain IV
- 6. if hypotensive consider fluid bolus
- - then consider calcium, glucagon, and/or epinephrine If not hypotensive transport and monitor
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acebutolol
atenolol
bisoprolol
metoprolol
nadolol
5 common beta blockers
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beta blocker poisoning treatment algorithym
- 1. Evidence of beta blocker ingestion
- 2. Contact poison control center
- 3. consider gastrointestinal decontamination with activated charcoal (do not induce vomiting.)
- 4. place monitors
- 5. obtain IV access
- 6. if hypotensive consider fluid bolus
- - then consider glucagon
- -if not hypo tension, transport and monitor
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Amitripyline
Clomipramine
Doxepin
Imipramine
trimipramine
5 common tricyclic antidepressants
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tricyclic antidepressants poisoning algorithym
- 1. Evidence of possible tricyclic antidepressant ingestion
- 2. Contact poison control center
- 3. Consider gastrointestinal decontamination with activated charcoal. Do not induce emesis.
- 4. Place monitors
- 5. Obtain IV access
- 6. If hypotensive consider fluid bolus and check 12 lead
- -if QRS greater than 100 msec then consider sodium bicarbonate therapy
- If not hyptensive transport and monitor
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treatment for Aspirin overdoes
- 1. Evidence of possible salicylate ingestion
- 2. Contact poison control center
- 3. Consider gastrointestinal decontamination with activated charcoal. Do not induce emesis.
- 4. Place monitors
- 5. Obtain IV access
- 6. Transport and monitor
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Acetaminophen treatment algorythym (tylenol)
- 1. Evidence of possible ingestion
- 2. Contact poison control center
- 3. Consider gastrointestinal decontamination with activated charcoal. Do not induce emesis.
- 4. Place monitor
- 5. Obtain IV access
- 6. Place patient in left lateral decubitus or supine position
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treatment for pit viper bites
- - keep patient supine
- - immobilize the limb with a splint
- - maintain the extremity in a neutral position
- - apply high flow high concentration oxygen
- - start IV with crystalloid fluid
- - transport patient to emergency department for management which may include administration of antivenin
- - do not apply ice pack, Freon spray to wound
- - do not apply arterial tourniquet
- - do not apply electrical stimulation from any device in an attempt to retard or reverse venom spread
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Treatment for coral snake bites
- - wash wound with copious amounts of water
- - apply a compression bandage and keep the extremity at the level of the heart
- - immobilize the limb with a splint
- - start an IV using crystalloid fluid
- - transport patient to emergency department for management which may include administration of antivenin
- - do not apply ice pack, Freon spray to wound
- - do not incise the wound- do not apply electrical stimulation from any device in an attempt to retard or reverse venom spre
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3 examples of barbituates
- thiopental
- phenobarbital
- primidone
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4 examples of amhpetamines
- benzedrine
- dexedrine
- ritalin
- speed
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drug class of STP, mescaline, psilocybin, PCP
hallucinogen
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drug with S/S of lethargy, slurred speech, coma, emotional lability, hypotension, respiratory depression
barbituate
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drug with S/S of euphoria, hyperactivity, dilated pupils, psychosis, anxiety, hypertension, tachycardia, dysrhythmias, seizures, chest pain
cocaine
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durg with S/S of
CNS depression, constricted pupils, respiratory depression, hypotension, bradycardia, coma, pulmonary edema, death
narcotics
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drug with S/S of euphoria, dry mouth, dilated pupils, altered sensation
Marijuana
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drug with S/S of exhilaration, hyperactivity, dilated pupils, hypertension, psychosis, seizures
Amphetamines
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drug with S/S of psychosis, nausea, dilated pupils, rambling speech, headache, dizziness, distortion of sensory, suggestibility
Hallucinogens
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drug with S/S of
hypotension, slurred speech, respiratory, shock, bradycardia, seizures
Sedatives
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drug with S/S of altered mental status, slurred speech, dysrhythmias, coma
Benzodiazepines
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some S/S of alcohol withdrawal syndrom
- tachycardic, HTN, orthostatic hypotension,
- - hallucinations
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antidote for acetaminophen overdose
N-acetylcysteine
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helps to reduce the effects of benzos
Romazicon (FLUMAZENIL)
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toxicity of Acetaminophen and aspirin
150mg/kg
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