1. Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Toxicology 10

2. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 10-1 In the majority of accidental childhood poisonings, poisonous materials are left in easy reach of children. Cathy Melloan / PhotoEdit, Inc.

4. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Prevention Child-resistant packaging Poison Control Centers Medication error prevention Safe storage of toxins in home

5. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 10-2 Child-resistant packaging.

6. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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

7. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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 cardiac glycoside and methylxanthine poisoning, heavy metal and corrosive chemical poisoning

8. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Treatment of Poisoning Cathartic agents: shorten transit time of chemicals through GI tract; work by retaining water in bowel to stimulate peristalsis

9. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 10-1 Poisons and Antidotes

10. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poisons: Acetaminophen Acetaminophen (Tylenol): nausea and vomiting (early stages); liver injury after 2–3 days Antidote: acetylcysteine given within 8–10 hours

11. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poisons: Alcohols Ethanol or ethyl alcohol Treatment includes: –Emesis, gastric lavage –Hemodialysis

12. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poisons: Ethylene Glycol Antifreeze, windshield de-icing solutions Signs/symptoms: within 1–12 hours: nausea, vomiting, ataxia, seizures, cerebral edema, coma, death; 12–14 hours: tachypnea, cyanosis, tachycardia, pulmonary edema, pneumonitis

13. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poisons: Ethylene Glycol Treatment: gastric lavage within 30 minutes; 10% solution of ethanol; and hemodialysis

14. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Methanol Wood alcohol; antifreeze, windshield- washer fluid, solvent in photocopier solutions Signs/symptoms: visual disturbances, bradycardia, seizures, metabolic acidosis, respiratory depression, coma; blindness, and permanent retinal damage

15. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Methanol Treatment: gastric lavage, IV administration of 10% solution of ethanol; hemodialysis

16. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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

17. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poisons: Amphetamines Methamphetamine most common; also pseudoephedrine, ephedrine Signs/symptoms: agitation, restlessness, acute psychosis, hypertension, tachycardia, brain damage, renal failure No specific treatment

18. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Mechanism of Action of Cocaine Animation Click on the screenshot to view an animation showing the mechanism of action of cocaine. Back to Directory

19. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Antihistamines Signs/symptoms: CNS excitement or depression; drowsiness, stupor, coma Supportive treatment, phenobarbital or diazepam to control convulsions

20. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Benzodiazepines Signs/symptoms: CNS depression occurs within 30 minutes; coma, respiratory depression Treatment: activated charcoal, respiratory support

21. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Bleaches Signs/symptoms: corrosive action in mouth, pharynx, esophagus Treatment: dilute ingested bleach with milk or water

22. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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)

23. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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

24. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Cyanide Medical emergency Signs/symptoms: odor of bitter almonds Treatment: nitrite to produce methemoglobin; supportive measures such as 100% oxygen

25. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Digoxin Signs/symptoms: anorexia, nausea, vomiting, lethargy, abdominal cramping, diarrhea, vertigo, fatigue, muscle weakness, blurred vision, seizures, diplopia, electrolyte imbalance, bradycardia Treatment: ipecac, activated charcoal, lavage

26. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Electrolyte Imbalances Magnesium: treatment is IV of 10 mL of a 10% solution of calcium gluconate Potassium: treatment is calcium administration, sodium bicarbonate or glucose/insulin Iron: treatment is whole bowel irrigation, deferoxamine

27. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Isoniazid (INH) Signs/symptoms: fever, peripheral neuritis, jaundice, skin rash, hepatic injury Treatment: pyridoxine, gastric lavage, activated charcoal, sodium bicarbonate, hemodialysis

28. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Lead Signs/symptoms: metallic taste, abdominal pain, vomiting, CNS depression, respiratory failure Treatment: chelating agents, IV EDTA and dimercaprol, gastric lavage

29. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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, sodium polystyrene sulfonate, volume resuscitation

30. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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, IM dimercaprol

31. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Opioids Signs/symptoms: euphoria, drowsiness, constricted pupils, hypotension, bradycardia, hypothermia, coma, respiratory arrest Treatment: gastric lavage or emesis, activated charcoal, naloxone

32. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Organophosphates Signs/symptoms (30 minutes–2 hours): nausea, vomiting, urinary and fecal incontinence, abdominal cramps, increased bronchial secretions, wheezing, coughing, salivation, sweating, blurred vision

33. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Organophosphates Treatment: remove clothing, wash skin with soap and water; activated charcoal; supportive measures: treatment of seizures, ventilatory assistance, oxygen

34. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Petroleum Distillates Signs/symptoms: pulmonary edema, pneumonitis, resembles alcohol intoxication, nausea, headache, burning sensation in chest Treatment: emesis (if alert), oxygen therapy

35. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Salicylates Signs/symptoms: vertigo, hearing impairment, nausea, vomiting, diarrhea, sweating, drowsiness, fever, headache, convulsions, hallucinations, cardiovascular collapse, coma Treatment: emesis, gastric lavage, activated charcoal, osmotic cathartic, artificial ventilation

36. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Specific Poison: Theophylline Signs/symptoms: hypokalemia, hyperglycemia, hypercalcemia, hypophosphatemia, acidosis; nausea, vomiting, abdominal pain, tachycardia; seizures, hypotension, dysrhythmias Treatment: endotracheal intubation and gastric lavage, activated charcoal, benzodiazepines and phenobarbital to treat seizures; hemoperfusion or hemodialysis

37. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini 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: reduce venom absorption; incision and suction; ice should not be applied to bite