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Common Toxic Syndromes
P. 309 in pharm book Kaplan
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Heavy Metal Poisoning: ARSENIC
- Where it is found: wood preservatives, pesticides, ant poisons)
- Sxs: ACUTE: gastroenteritis, hypotension, metabolic acidosis, garlic breath, "rice water" stools, torsades, seizures CHRONIC: pallor, skin pigmentation (raindrop pattern), alopecial, stocking glove neuropathy, myelosuppression
- Intervention/antidote: activated charcoal, dimercaprol, penicillamine or succimer
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Heavy Metal Poisoning: Iron
- Where it is found: medicinal for anemias, prenatal vitamins)
- Sxs: ACUTE: mainly children, severe GI distress, necrotizing gastrogeneteritis with hematemesis & blood y diarrhea, dysnpea, shock, coma (blood from both ends)
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Heavy Metal Poisoning: Lead
- Where it is found: tap water, leaded pain chips, herbal remedies, gas sniffing, glazed kitchenware)
- Sxs: ACUTE: nausea/vomiting, GI distress, pain, malaise, tremor, tinnitis, paesthesia, encephalopathy (red or black feces). CHRONIC: multisystem effects: anemia (decreased heme synthesis), neuropathy (wrist drop), nephropathy (proteinuria, failure), hepatitis, mental retardation (from pica), decreased fertility, increased stillbirths, will see Pb on Xray in long bones
- Intervention/antidote: DECONTAMINATION: gastric lavage + dimercaprol (severe) or EDTA or succimer (penicillamine if unable to use dimercaprol or succimer), children: succimer PO
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Heavy Metal Poisoning: Mercury
- Where it is found: elemental in instruments, salts in amalgams, batteries, dyes, electroplating, fireworks, photography
- Sxs: ACUTE: vapour inhalation- chest pain, dyspnea, pneumonitis, inorganic ingestion- hemorrhagic gastrogenteritis, acute tubular necrosis, shock. CHRONIC: organic Hg- CNS effects, ataxia, paresthesias, auditory and visual loss, loosening of teeth
- Interventions/antidote: succimer PO or dimercaprol (IM). Activated charcoal for ingestion, then support with succimer PO or dimercaprol (not IV) bc it causes redistribution of Hg to CNS = neurotoxicity
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Antidotes: (note chart on page 311 in kaplan)
Acetaminophen poisioning
Acetylcysteine
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Antidotes:
AChEI inhibitors poisoning: physostigmine, neostigmine, pyridostigmine, organophsophates (insecticieds like malathion & parathion)
Atropine + pralidoxime (or irreversible AChE inhibitors)
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Antidotes:
Iron and Iron Salts
Deferoxamine
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Antidotes:
Digoxin
Digoxin immune F(ab)
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Antidotes:
Arsenic, gold, mercury, lead
Oral succimer for milder lead and mercury toxicity, dimercaprol (BAL)
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Antidotes:
theophylline, beta agonist
Esmolol
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Antidotes:
Benzodiazepine, zolpidem, zalplon
Flumazenil
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Antidotes:
Opiod analgesics
Naloxone
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Antidotes:
Carbon monoxite
oxygen
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Antidotes:
copper (Ex: Wilson's disease), iron, lead, mercury
Penicillamine
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Antidotes:
Anticholinergics: atropine, antihistamine, antiparkinsonian- not TCAs
Physostigmine
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Antidotes:
Heparins
Protamine
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Antidotes:
warfarin, coumarin anticoagulants
Vitamin K
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Antidotes:
Nonspecific: all oral poisonings except Fe, CN, Li, solvents, mineral acids, corrosives
activate charcoal (time dependent though)
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Natural Medicinals: ECHINACEA
- Medicinal use: decrease cold sxs
- Possible mechanism: increases IL and TNF
- Toxocity: GI distress, dizziness, headache
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Natural Medicinals: GARLIC
- Medicinal use: hyperlipidemia, cancer (weak evidence)
- Possible mechanism: inhibitos HMG-CoA Reductase and ACE
- Toxicity: allergies, hypotension, antiplatelet actions, caution when using with anticoagulants
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Natural Medicinals: *GINKO*
- Medicinal use: intermitten claudication, AD (weak evidence)
- Possible mechanism: antioxidant, free radical scavenger, increases NO
- Toxicity: anxiety, GI distress, insomnia, antiplatelet actions, caution when using anticoagulants
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Natural Medicinals: GINSENG
- Medicinal use: possible increas in mental and physical performance (weak evidence)
- Possible mechanism: uknown
- Toxicity: insomnia, nervousness, htn, mastalgia, vaginal bleeding
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Natural Medicinals: *SAW PALMETTO*
- Medicinal use: symptomatic BPH
- Possible mechanism: 5alpha-reducaste inhibitor and androgen receptor antagonist
- Side effects: GI pain, decreased libido, headache, htn
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Natural Medicinals: *ST. JOHN'S WART*
- Medicinal use: depressive disorder variable evidence for clinical efficacy)
- Possible mechanism: may enhance brain 5HT functions
- Toxicity: major drug interactions serotonin syndrome with SSRI, induces P450, leading to decreased effects of multiple drugs
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Purified Nutritional Supplements: DHEA
- Pharmacology: androgen precursor used for tx of AIDS (increases CD4 count in females), AD & "aging" diabetes, hypercholesterolemia, SLE (decreases sxs of flareups)
- Toxicity: FEMALES: androgenization & CV dz and breast cancer MALES: feminization in young, BPH and cancer in elderly
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Purified Nutritional Supplements: Melatonin
- Pharmacology: serotonin derivative, used for 'jet lag' and sleep disorders
- Toxicity: drowsiness, sedation, headache,
- Contraindication: PREGNANCY, women trying to conceive (decreases LH), nursing mothers (decreases PRL)
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