USMLE Step 1 Pharm Toxicity Treatment
drugs that follow zero order elimination
PEA (is "0" shaped) -Phenytoin -Ethanol -Aspirin
Amphetamines toxicity treatment
Ammonium chloride (acidify urine... amphetamines are basic), benzodiazepines/haloperidol for agitation and seizures
Ischemic priapism (painful erection > 4 hours) treatment
-corporal aspiration -intracavernosal phenylephrine (vasoconstricts) -surgical decompression
Iron toxicity treatment
Deferoxamine, deferasirox, deferiprone
Mercury toxicity treatment
Dimercaprol, succimer
Digitalis toxicity treatment
Stop digitalis, normalize K, Lidocaine, anti-dig Fab fragments, Mg2+ (KLAM)
Cyanide toxicity treatment
-nitrites: induce methemoglobinemia, which has increased affinity for cyanide (gets CN out of tissues and brings it to the lungs for removal from body) -thiosulfate: serves as sulfur donor to convert cyanide to thiocyanate, which is excreted in the urine -hydroxocobalamin (B12 precursor): cobalt binds to intracellular cyanide and forms cyanocobalamin, which is excreted in the urine
CO toxicity treatment
100% O2, hyperbaric O2
causes of normal anion gap metabolic acidosis
= hyperchloremic metabolic acidosis HARD ASS -hyperalimentation -Addison's disease (low aldo, low H secretion) -Renal tubular acidosis -Diarrhea -Acetazolamide -Spironolactone -Saline infusion
Organophosphate toxicity treatment
Atropine, pralidoxime
Arsenic toxicity treatment
Dimercaprol, succimer (note: arsenic is found in pesticides and pressure treated wood and has a garlic odor)
DIC treatment
transfuse blood products and cryoprecipitate, as needed (and remove causative agent)
Gold toxicity treatment
Penicillamine, dimercaprol, succimer
Copper toxicity treatment
Penicillamine, trientine
Norepinephrine extravastation (into tissue surrounding needle site) treatment
Phentolamine (alpha blocker to counteract the alpha-mediated vasoconstriction produced by NE)
Heparin toxicity treatment
Protamine sulfate (think H+ for proton)
Acetaminophen toxicity treatment
N-acetylcysteine (replenishes glutathione); also used for -tx of CF/COPD (liquefies mucus by disrupting disulfide bonds) -prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease
Heparin-induced thrombocytopenia treatment
NOT warfarin (a different anticoagulant) b/c there is a risk of warfarin skin necrosis in people with HIT (b/c heparin is not functioning properly to counter the acute pro-coagulant properties of warfarin)
Lead toxicity treatment
EDTA, dimercaprol, succimer, penicillamine
Salicylates toxicity treatment
Sodium bicarbonate (alkalinize urine), dialysis
Benzodiazepine toxicity treatment
Flumazenil (however, can precipitate withdrawal seizures in patients who have developed tolerance to benzos)
Alcohol overdose treatment
Fomepizole (inhibits alcohol dehydrogenase, inhibiting production of acetaldehyde from alcohol)
Methanol, ethylene glycol (antifreeze) toxicity treatment
Fomepizole > ethanol, dialysis
causes of elevated anion gap metabolic acidosis
MUDPILES -Methanol (formic acid) -Uremia -DKA -Propylene glycol -Isoniazid (or Iron supplements) -Lactic acidosis -Ethylene glycol (oxalic acid) -Salicylates (late)
Methemoglobinemia toxicity treatment
Methylene blue (reduces Fe3+ back to Fe2+), Vitamin C
TCAs toxicity treatment
Sodium bicarbonate (increases plasma protein binding of TCAs)
can be used as both a pituitary hormone analog and as a treatment for von Willebrand disease
desmopressin (DDAVP)
Antidote to cardiomyopathy caused by Doxorubicin
dexrazoxane (iron chelating agent)
Alcohol addiction treatment
disulfram, acamprosate, naltrexone
Hemmorhagic cystitis caused by cyclophosphamide
mesna (binds toxic metabolite acrolein)
Opioids toxicity treatment
naloxone (+buprenorphine = suboxone), naltrexone
HTN crisis treatment
phentolamine or phenoxybenzamine (alpha blockers)
Anticholinergic toxicity treatment
physostigmine salicylate, control hyperthermia
MPTP (synthetic demerol) treatment
selegiline: inhibits MAO-B -MAO-B converts MPTP to toxic metabolite MPP, which destroys DA cells in the SN by inhibiting electron transport chain complex 1
Warfarin toxicity treatment
Vit K (delayed effect), Fresh frozen plasma (immediate)
Cocaine toxicity treatment
alpha-blockers, benzodiazepines (NO beta-blockers)
tPA, streptokinase, urokinase toxicity treatment
aminocaproic acid: blocks activation of plasminogen (these disorders of fibrinolysis appear similar to DIC except the D-dimer is not elevated because there is not excess clot formation, just inhibition of clotting products)
Beta blocker toxicity treatment
atropine, glucagon, calcium
Delirium tremens (alcohol withdrawal) treatment
benzodiazepines
PCP (phencyclidine) toxicity treatment
benzodiazepines, rapid-acting antipsychotic (haloperidol or phenothiazines)
Theophylline toxicity treatment
beta-blocker
Nicotine withdrawal treatment
buproprion, varenicline
MDMA (ecstasy) toxicity treatment
cyproheptadine (5HT-2 blocker)
Serotonin syndrome treatment
cyproheptadine (5HT-2 blocker) and benzodiazepines (lorazepam)
Malignant hyperthermia treatment
dantrolene (muscle relaxant)
Neuroleptic malignant syndrome treatment
dantrolene (muscle relaxant), bromocriptine/cabergoline (D2 agonists)
elevated ICP treatment
decrease pCO2 (either through changing ventilator settings or hyperventilation) -> vasoconstriction of cerebral vasculature
