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

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-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

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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