Toxicology Farra

7/23/2019 Toxicology Farra

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OPIODS TOXICITY



OPIOIDS

• Mainly used for analgesic eects

NATURAL SEMISYNTHETIC SYNTHETIC• Codeine• Morphine

• Buprenorphine• Hydrocodone• Hydroorphone• O!ycodone• O!yorphone

• Dipheno!ylate• "entanyl• Meperidine• Methadone• Penta#ocine• Propo!yphene• Traadol

Tintinalli’s Emergency Medicine A Comprehensive Study Guide 7th Edition



$ects ofOpioids

Mureceptors

%nalgesia

$uphoria

&espidepression

Miosis

Constipation

'appareceptors

%nalgesia

Miosis

&espidepression

Sedation

Constipati

on

Sigareceptors

Dysphoria

Hallucination

Psychosis

Deltareceptors

%nalgesi

a$uphoria

Sei#ures





https://storifycom/nataliemmay/fcem!mnemonics

CLINICAL FEATURES



M%(%)$M$(T

• %ssessent* H! + P$

• Con,ratory test* Serum druglevel (gold stadard!" -rine drugscreening

• %dit the pt. Monitor /0102H

• %ntidote* nalo!one

• 3atch out signs of o4er1t!*hyper4entilation5 tachycardia5 highBP





NALO#ONE

• &e4erses eects of opioids* displaces opiatesfro the receptors

• Onset 6ithin 0 in

• Dose* – 7.210 g 4ia I8 route in adults5 7./g9:g in children

– &epeat dose of 0g e4ery ;1<in5 up to /7g

–

&econsider diagnosis if fail to respond after /7g

• Caution* – Potential precipitation of 6ithdra6al syptos

Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning



SYMP%THOMIM$TICS TOXICITY



SYMP%THOMIM$TICS

• %cti4ates sypathetic response=,ght9>ight?

• %gents* – Cocaine

– %phetaine

– Methaphetaine

– &italin

– Theophylline

– caeine









CLINICAL FEATURES

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In4estigations

• -rine drug screening =detected 21@Hafter dose?

• -rinalysis* detect yogloAinuria cocaine1induced rhaAdoylosis

• Creatine :inase le4el* rhaAdoylosis

• Plasa le4el is rarely helpful5 d9tcocaine has short T/90* ;712<in

• $C) + cardiac en#yes* cocaine1induced MI



MANA$EMENT

• Physical restraints + cheical sedation – Sypathoietic to!icity freuently a96 signi,cant agitation

• %e&od'a&e'es =eg5 8aliu? is safest /st approach – Should Ae adinistered freuently in titrated doses

• )astric decontaination – If oral ingestions of sypathoietic agents

– %96 suAseuent 4oiting + aspiration5 thus need air6ay control staAili#ed

•

&educe hypertheria if present – Controlling agitation signi,cantly helps )ool'g

• Sei#ures – Should Ae rapidly controlled 6ith Aen#odia#epines and9or AarAiturates

http://emedicinemedscapecom/article/&'&(&)!treatment*a''+,



O&)%(OPHOSPH%T$S TOXICITY



• used as coercialinsecticides

• Manifestationsoccur ;7ins to 0hours follo6ing

e!posure.• (icotinic +

uscarinic eects

O&)%(OPHOSPH%T$S





M-SC%&I(IC

$""$CTSD* diaphoresis

U* urination

M* iosis

%* Aradycardia

%*Aronchoconstriction

E* enuresisL* lacriation

S* sali4ation

S* s6eating

(ICOTI(IC$""$CTS

D%YS O" TH$ 3$$'

M* uscle craps

T* tachycardia

+* 6ea:nessuscle

T* hyperTension

F* fasciculations

S* sugar=hyperglyceia?

ILLER Bs:

• %radycardia• %ronchorrhia• %ronchospas



Add't'oal o,to-'dromal e.e)ts

• %cute pancreatitis

• Prolonged Tc on $C)

•

91 Torsades de pointes



I(8$STI)%TIO(S

• &BC %Ch$ le4el

• I! for pancreatitis – "BC

– E"T =%ST?

– Blood glucose

– Seru EDH

• $C)



M%(%)$M$(T

, De)otam'at'o* If the insecticide 6as incontact 6ith s:in or eyes5 3ash thoroughly

1 If drug is ingested F gastric la4age if

presentation is 6ithin /H5 follo6ed Aya)t'vated )/ar)oal

1 %ir6ay control + adeuate o!ygenation

1 OAtain I8 access5 infuse (S or D<G5 ta:e Alood

for cholinesterase01Atro'e

21D'a&eam

31 Pral'do-'me



ACTI4ATED CHARCOAL

• 8ia gastric la4age tuAe

•

Dose* – / g9:g Aody 6eight




ATROPINE


• /st drug to Ae gi4en

– Maor use in reduction of Aronchorrhoea9Aronchospas

– Earge doses ay Ae needed to control air6ay secretion

• Dose* – Adult* 0 g I8 /71/< in prn

• DouAled /7 in until secretions ha4e Aeen controlled orsigns of atropini#ation are oA4ious

– "lushed + dry s:in5 tachycardia5 ydriasis + dry outh?

– C/'ldre* 7.7< g9:g Aody 6eight /< in prn• DouAled /7 in until secretions controlled



DIA5EPAM

• &educe an!iety + restlessness

• Control con4ulsion

• Dose* – <1/7 g I8

– -p to /7107 g I8 for con4ulsion




PRALIDO#IME

/. Should Ae gi4en 6ith atropine to e4ery syptoatic patient

0. $ects 6ill Ae apparent 6ithin ;7 in

;. -sually necessitates reduction in atropine + ay unas:atropine to!icity

•. Dose* – Adult* / g I8 o4er /<1;7 in

• Can Ae repeated in / 10 hours prn

– C/'ldre* 0<1<7 g9:g9Aody 6eight I8 o4er /<1;7 in• Can Ae repeated in /10 hours

•. Contraindication* – CarAaate

– Organophosphorus copounds 6ithout anticholinesterase acti4ity

Guide to the Essentials in Emergency Medicine "y Shirley #oi $ %eter Manning- Sara.a 0and"oo of Medical



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Toxicology Farra