Post on 05-Oct-2021
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Modern Pharmacy Academy
Toxicology
General Management:
1. Skin decontamination:
• Don’t neutral as naturalization is exothermic.
• Put plenty of water.
2. Gastric Management:
a) Emesis:
• Using ipecac syrup
• Ac&ng a'er 30 & make 2 vomi&ng episode in 1 hour.
• Emesis C/I in:
1- Corrosive
2- Sharp objective
3- Children < 6 month
4- Seizure & coma
5- Already vomiting
6- Fast acting
b) Gastric lavage:
• Using it in case that emesis is C/I
c) Activated charcoal:
• Universal antidote
• 3 cases charcoal ineffec&ve:
1- Iron , Ca , Cl , Li (Metals)
2- Strong acrid or base HCL , H2SO4 , NaOH , KOH
3- Alc. Methanol , Ethylene glycol
4-
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d) Whole bowel irrigation:
• Used when charcoal is not available or not effective
• Through anus
e) Forced Diuresis:
• Acidic drugs excreted in alkaline urine & vice versa
• Urine alkalizer: acetazolamide NaHCO3
• Urine acidifier: NH4CL ascorbic acid ( Vit.C)
f) Dialysis:
• Done if drug is absorbed “ reach blood”
• Peritoneal dialysis
• Hemodialysis
• Drug must:
1- M.wt
2- Vd.
3- Binding protein
g) Hemoperfusion:
• Thrombocytopenia
• Hypoglycemia
• Hypocalcemia
• Leukopenia
• Used in theophylline toxicity
Blood + toxin
Blood
Charchoal
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Management of specific ingestion
N – Acetylcystine (ORAL/I.V)
+
Metoclopramide
Acetaminophen
Vomiting Hepatotomy
Toxic dose > 4 gm/day
-Ethanol acetic acid “ in urine”
OR - Alcohol Dehydrogenase inhibitor
e.g disulfiram , fomepizole
OR Vit.B6/B1 Form
non oxalate metabolite
Ethylene glycol
Antifreeze
Oxalic acid (toxin)
-Ethanol or fomepizole or disulfiram
-Vit.B9 Form
non metabolite
Methanol
Formaldehyde
“ Blindness”
-Physostigmine ( Ach)
-Phenytoin or BDZ for seizure
TCA
Anticholinergic S.E
Seizure
Gastric lavage & supportive treatment SSRI
Protamine sulfate I.V , S.C. 1mg
Protamine neutralize 100 I.V. heparin
Heparin
Vit.K. (oral , paretral) Warfarin
FLumazenil “short acting”
Need multiple daily dose
Activated charcoal
Cathartic ( Laxative)
Benzodiazepine
-Epi
-Glucagon hormone S.C , I.V , I.M
-Gastric Lavage & Charcoal
B.Blocker
Hypoglycemia
Alcohol
dehydrogenase
Alc.
Dehydrogenase
Alc.
dehydrogenase
Modern Pharmacy Academy
-Ca+ gluconate
-CaCl2 (I.V)
-Glucagon
C.C.B.
Hyroglancemia
BDZ for seizure
Labetalol for HT
Cocaine
C. N. S stimulant
-Avoid neutralization
-Milk + uncooked egg
Corrosive
Strong acid or base
Cyanide KIT
Amyl nitrite + Na+ (thiosulfate)
Hb Met.Hb
Met.Hb.CN
Low respiration
Excretion
Cyanide
CN blind to Hb & stop respiration
K+ , Digibind , ipecia ,
Phenytoin for seizure
Charcoal
Digoxin
CaCl2
CaCl2 , SPS ,
Mg+2
K+
(See in renal Failure)
Deferoxamine (chelating agent)
Make red urine
Ipeca , whole bowl irrigation
Iron
Overdose diarrhea
Vit.B6
Avoid vomiting
Isoniazid
6neurotoxicity Vit.B ES.
Seizure
EDTA (IM / I.V)
Dimercaprol ( I.M.)
(chelating agent)
Lead (Pb+2
)
SPS , Hemodialysis
No charcoal
Li+
Met.CN
CN
Amyl
Nitrite
Na thiosulfate
+ Hb
Modern Pharmacy Academy
Opioid antagonist:
Naloxone Short acting
Naltrexone
Nalmefene
• Atropire
• Pralidoxime (2- PAM)
cholinesterase reactivator
urine alkalizer ( NaHCO3 ,
acetazolamide)
Hemoperfusion
Adenosine (specific antidote)
Hemodialysis
Opioids
Downer
Organophosphorus c.p.d
(Irreversible anticholinesterase)
( Ach)
Salicylate “ aspirin”
Theophylline
Long acting