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Focus on Pharmacology Essentials for Health Professionals

Focus on Pharmacology Essentials for Health Professionals. Jahangir Moini, MD, MPH. Chapter 28 Toxicology. Toxicology. 10 million people are poisoned in U.S. each year Attempted suicide Accidental legal drug overdosage Illegal drug overdosage Snake, spider bites

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Focus on Pharmacology Essentials for Health Professionals

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  1. Focus on PharmacologyEssentials for Health Professionals Jahangir Moini, MD, MPH Chapter 28Toxicology

  2. Toxicology • 10 million people are poisoned in U.S. each year • Attempted suicide • Accidental legal drug overdosage • Illegal drug overdosage • Snake, spider bites • Exposure to toxins in workplace

  3. Prevention • Child-resistant packaging • Poison Control Centers • Medication error prevention • Safe storage of toxins in home

  4. Poison Detection • Some poisons have specific symptoms to assist in giving an accurate diagnosis: • Cyanide: unmistakable odor of bitter almonds • Insecticides: GI hyperactivity, salivation, pupillary constriction • Carbon monoxide: cherry-colored flush of skin and mucous membranes

  5. Treatment of Poisoning • Emetics: (e.g., ipecac): trigger vomiting; contraindicated in ingestion of corrosives • Absorbents: (activated charcoal): bind poison molecules to charcoal and excreted; effective in heavy metal and corrosive chemical poisoning

  6. Specific Poisons: Acetaminophen • Acetaminophen (Tylenol): nausea and vomiting (early stages); liver injury after 2–3 days • Antidote: acetylcysteine given within 8–10 hours

  7. Specific Poisons: Alcohols • Ethanol or ethyl alcohol • Treatment includes: • Emesis, gastric lavage • Hemodialysis

  8. Specific Poisons: Ethylene Glycol • Antifreeze, windshield de-icing solutions • Signs/symptoms: within 1–12 hours: nausea, vomiting, seizures, cerebral edema, coma, death; 12–14 hours: tachypnea, cyanosis, tachycardia, pulmonary edema, pneumonitis • Treatment: gastric lavage within 30 minutes; 10% solution of ethanol; and hemodialysis

  9. Specific Poison:Heparin and Warfarin • Heparin signs/symptoms: hemorrhage, ecchymoses, melena • Heparin treatment: slow IV infusion of protamine sulfate • Warfarin signs/symptoms: hemorrhage • Warfarin treatment: phytonadione (vitamin K); blood products with clotting factors

  10. Specific Poison: Antihistamines • Signs/symptoms: CNS excitement or depression; drowsiness, stupor, coma • Supportive treatment; phenobarbital or diazepam to control convulsions

  11. Specific Poison: Benzodiazepines • Signs/symptoms: CNS depressants occur within 30 minutes; coma, respiratory depression • Treatment: activated charcoal, respiratory support

  12. Specific Poison: Bleaches • Signs/symptoms: corrosive action in mouth, pharynx, esophagus • Treatment: dilute ingested bleach with milk or water

  13. Specific Poison:Carbon Monoxide • Signs/symptoms: cherry color in skin and mucous membranes, coma, death • Treatment: pure oxygen, ventilation support, diuretics and steroids (to treat resultant cerebral edema)

  14. Specific Poison: Corrosives • Ingestion almost always with suicidal intent • Signs/symptoms: irritation, severe pain, bleeding, severe burns in mouth, esophagus, stomach; profound shock • Treatment: immediate dilution with water or milk; emesis or gastric lavage contraindicated

  15. Specific Poison: Lithium • Signs/symptoms: tremor, diarrhea, polydipsia, anorexia, polyuria, vomiting, blurred vision, hypothyroidism, hyperglycemia, weight gain • Treatment: gastric lavage within 1 hour; activated charcoal, whole bowel irrigation

  16. Specific Poison: Mercury • Signs/symptoms: burning sensation in throat, metallic taste, discoloration and edema of mouth, vomiting, bloody diarrhea, shock • Treatment: gastric lavage, activated charcoal

  17. Specific Poison: Opioids • Signs/symptoms: euphoria, drowsiness, constricted pupils, hypotension, bradycardia, hypothermia, coma, respiratory arrest • Treatment: gastric lavage or emesis, activated charcoal

  18. Bites and Stings • Scorpion: treatment is antivenom, calcium gluconate, and phenobarbital • Spiders: antivenom, IV calcium gluconate, antibiotics, tetanus immunization, oxygen, antihistamines, adrenalin, muscle relaxants • Snake bites: reducevenom absorption; incision and suction; ice should not be applied to bite

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