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APhA CH 11-Toxicology-Final Summary
APhA CH 11-Toxicology-Final Summary
Drug Abuse & Addictive Substances (by Maya & Pearl Pages: 175-183)
First Part = Maya Bbashi
Substance
Slang name
Methods
of abuse
Orally
injection
Effects
Androgenic
anabolic
steroids(synthetic
derivatives of
testosterone)
Roids
Barbiturates
(they are CNS
depressants)
Barbs-downers
Cocaine
(it is CNS
stimulant)
Snow-crackrock
Sniffingsnortinginjectingsmoking
*cocaine
is poorly
absorbed
orally
Men:testicles shrinking
Reduce in sperm count-infertility-baldnessgynecomastia- risk for prostate cancer
Women: facial hear-male pattern baldness-changes
or cessation in menstrual cycle-clitoris enlargementdeepened voice
Adolescents:stunted growth and accelerated puberty
changes
Others: jaundice-fluid retention-hypertension-acnemood swings(manic-like symptoms)
Dextromethorphan DXM-DMrobo-rojovelvet
Ethanol
(CNS depressant)
Various
namesalcoholic
drinks
Orally
(drinking
cough
syrup)
Snorting
(powder
which is
extracted
from
syrups)
Ingestion
GHB
(CNS depressant)
Heroin
Inhalant
Various
Inhaling
Injected drugs
Shooting upmainlining
Injection
Ketamine
(it is anesthetic)
K cat-special
K
Vitamin K
Valium
Injectionsnorting
LAD
(hallucinogen)
Acid- L
blotter-cubes
sugar-dots
Ingestion
(tabletcapsuleliquid)
ascites malnutrition
abused for euphoric-sedative-anabolic effects
it causes coma and seizures
*GHB+methamphetamine=increase seizures
*GHB+alcohol =nausea+breathing difficulty
*GHB has two precursors GBL and BD
INVOLVED IN POISONING-OVERDOSEDATERAPES-DEATHS
Cause: euphoria (rush)followed by alternately
wakeful and drowsy state(on the nod)
CNS and respiratory depression-miosis(pinpoint
pupils)-pulmonary edema(can occur)
Abuse is associated with fatal overdose-spontaneous
abortion-collapsed veins-infections( HIV-AIDS and
hepatitis)
*variety of chemical vapors causes psychoactive
effects
*inhalants abuse =short term intoxicating(only few
minutes)+CNS depressant(similar to anesthetics)
*successive inhalation=loss of inhibition and control
*continued use of inhalants may lead do coma
*in some cases prolong use =heart failure and
death(sudden sniffing death)
*risk of transmitting or acquiring HIV-hepatitisinfections(bacterial-fungal)
*chronic use: collapsed veins-infection of the heart
lining and valves-skin abscesses-cellulitis-liver
disease
*EMBOLI can form when there is insoluble
materials in tablets(which is used to prepare
injecting mixture )
*in certain doses :dreamlike states and
hallucinations
*in high doses: delirium-amnesia-impaired motor
function-hypertension-depression-potentially fatal
respiratory depression
1-physical effects: mydriasis(dilated pupils)increase in temperature-tachycardia-hypertensionsweating-loss of appetite-dry mouth-tremors
2-sensational and feeling changes
*in sufficient doses LSD cause visual hallucinations
+delusions
Methods of abuse:
Health Effects:
Severe terror.
Fear of losing control.
Fear of insanity, despair, and death.
Fatal accidents.
Flashbacks.
Delirium, conjunctivitis, food craving.
Short-term memory, learning problems, distorted perception, loss of coordination, tachycardia.
Burning and stinging of mouth and throat with heavy cough like smokers.
Drug craving and withdrawal.
Risk of heart attack quadruples in first hour of smoking marijuana.
Active chemical THC (delta-9-tetrahydrocannabinol).
2. MDMA (3, 4 methylenedioxymethamphetamine):
Slang: Ecstasy, Adam, XTC, Hug, beans, love drug.
Methods of abuse:
Ingestion.
Snort.
Inject.
Suppository.
Health Effects:
Stimulant and hallucinogenic.
Increases pulse and BP.
High doses---->malignant hyperthermia-rhabdomyolysis.
Confusion, depression, insomnia, craving, paranoia days to weeks after use.
Physical symptomsmuscle tension, teeth clenching, nausea, blurred vision, fainting, chills and
sweating.
Contents of MDMA may include caffeine, dextromethorphan, heroin, and mescaline.
MDMA like substance paramethoxyamphetamine (PMA) led to death due to hyperthermia.
3. METHAMPHETAMINE:
Slang: Crank, meth, speed, chalk, ice, crystal, glass.
Methods of abuse:
Ingestion.
Snorting.
Injection.
Smoking.
Health Effects:
Addictive stimulant.
Produces euphoria, irritability, insomnia, confusion, tremors, anxiety, paranoia, aggression.
High doses ---> HTN, tachycardia, stroke, arrhythmia, CV collapse, death.
Hyperthermia and convulsion -->death.
Prolonged use-->extreme anorexia, tooth decay, lesions.
4. NICOTINE:
Slang: Various names.
Methods of abuse:
Smoking (cigarettes)
Chewing (tobacco)
Health effects:
CNS stimulant and sedative, highly addictive.
Stimulation-->depression and fatigue --> Dependence.
Women on OCP more than 30 years with increased cardio and cerebrovascular risk.
Pregnant women--->Stillborn, premature, low birthweight.
Daily cough, phlegm, frequent respiratory infections.
Tar in cigarette ---> higher risk of lung cancer, emphysema, bronchial disorder.
Carbon monoxide--->cardiovascular diseases.
Dependency and withdrawal.
5. OPIOIDS:
Slang: Various.
Methods of abuse:
Ingestion.
Injection.
Health effects:
Include morphine, codeine, oxycodone (MS Contin), propoxyphene (Darvon), hydrocodone (Vicodin),
hydromorphone (Dilaudid), meperidine (Demerol)
Drowsiness, constipation.
Large dose-->coma, hypotension, respiratory depression, also death.
Dependence, craving, withdrawal.
6. PCP (phencyclidine)
Slang:
Angel dust, Ozone, wack, rocket fuel.
Combined with marijuana called killer joint or crystal superglass.
Methods of abuse:
Snorting.
Smoking (applied to leaf like mint).
Ingestion.
Health effects:
Addictive hallucinogen, sedative--->compulsive PCP-seeking.
Violent, suicidal, dangerous to self and others.
Low doses --->slight tachypnea, moderate tachycardia, and HTN, shallow respirations, profuse
sweating, numbness of extremities, muscular incoordination.
High doses--->decreased BP, pulse, respirations. Nausea, vomiting, blurred vision, drooling, coma,
death (due to suicide)
Physiological effect--->low dose--->change in body awareness. High dose--->illusion, hallucination
like schizophrenia.
7. ROHYPNOL (flunitrazepam):
Slang: Rophie, roofie, roach, rope, date rape drug, forget me.
Methods of abuse: Ingestion.
Health effects:
Smuggled drug.
Sedative hypnotic--->muscle relaxant and amnesia.
Mixed with alcohol can incapacitate-->rape---> amnesia.
Clonazepam (Klonopin) and alprazolam (Xanax) abused like Rohypnol.
8. STIMULANTS, AMPHETAMINES AND RELATED COMPOUNDS:
Slang: Speed, dexies, uppers.
Methods of abuse:
Ingestion.
Snorting (tablets)
Health Effects:
CNS stimulant. Addictive if misused.
High dose-->arrhythmia, HTN, hyperthermia, hostility and paranoia.
Antidotes
By Ahmed Hashem
Page: 185-190
Acetylcysteine (NAC):
Indications: To treat acute Acetaminophen overdose.
MOA: Protect liver by Supplying glutathione to reacts with Acetaminophen metabolite.
Adverse effects: Oral = nausea, vomiting. IV = anaphylactic reactions (rash, wheezing, hypotension).
Atropine:
Indications: Poisoning of Organophosphates, carbamates & Bradycardia
Nontoxicologic: pre-anesthetic agent (for antisecretory effects), ophthalmic mydriasis& cycloplegia.
C.I: glaucoma, reflux esophagitis, obstructive uropathy, ulcerative colitis, paralytic ileus, myasthenia
gravis.
Pralidoxime: - dephosphorylates acetylcholinesterase regenerating its activity.
Indications: poisoning due to pesticides and organophosphates which have anticholinesterase activity and
in the control of overdosage by anticholinesterase drugs used in the treatment of myasthenia gravis.
ADEs: blurred vision, diplopia and impaired accommodation, dizziness, nausea, tachycardia,
hyperventilation, and muscular weakness.
Digoxin immune Fab (Digibind, DigiFab): - sheep antibody
- Binds to digoxin in plasma, enhances elimination in urine.
Indications: sever digoxin intoxication (symptoms: ventricular arrhythmias, second or third degree heart
block not responsive to atropine & hyperkalemia > 5 mEq/L)
ADEs: hypokalemia, hypotension.
Dose (in # of vials) = (Serum digoxin level in ng/mL) x (weight in kg) / (100).
Flumazenil: - Competitive antagonist of benzodiazepine receptor in CNS.
Indications: reversal of the sedative effects of benzodiazepines
C.I: - Mixed overdoses that can decrease seizure threshold (tricyclic antidepressants, haloperidol,
bupropion, lithium).
- In patients given benzodiazepine for control of a potentially life-threatening condition (e.g. control of
intracranial pressure or status epilepticus).
ADEs: agitation, sweating, abnormal vision, dizziness.
Naloxone: - Opioid competitive antagonist, competes at three CNS receptors (mu, kappa and delta).
Indications: - reversal of narcotic depression, including respiratory, CNS depression, induced by opioids.
ADEs: - In postoperative patients >> hypertension, dysrhythmias
- Use in opiate-dependent patient can cause withdrawal. Withdrawal convulsions in neonates.
Toxin
Acetaminophen
Organophosphates
Carbamates
Digoxin
Benzodiazepines
Oipoids
Anticholinergic compounds
Heavy metal poisoning (Arsenic,
Lead, Mercury)
-blockers
Ca-channel blockers
Cyanide
Heparin
Antidote
Acetylcysteine
(NAC)
Atropine
Pralidoxime HCl
Atropine
Digoxin immune antibody
fragment
Flumazenil
Naloxone
Nalmefene
Physostigmine salicylate
Succimer
(heavy metal chelating agent)
Dimercaprol
( chelating agent)
For patients unable to tolerate
succimer
Glucagon
Ca chloride 10%
Glucagon
Cyanide antidote kit:
1. Amyl nitrite
2. Na nitrite 3%
3. Na thiosulfate
Trade name
Mucomyst
Acetadote
Hydroxocobalamin
Cyanokit
Ethanol 10%
Fomepizole
Deferoxamine
Pyridoxine
(vitamin B6)
Methylene blue
Na bicarbonate
Crotalidae polyvalent immune
Fab(ovine)
Protopam
Digibind, DigiFab
Romazicon
Narcan
Revex
Antilirium
Chemet
BAL
GlucaGen
GlucaGen
Antizol
Desferal
Na bicarbonate
(alkalinization)
Fresh frozen plasma
Vit. K1
Protamine
Mephyton,
AquaMEPHYTON
Determines true poison. Recommend first aid & programs & materials. Refers for further investigation & treatment.
Monitors.
Poison Prevention Packaging Act 1970 -> Use safety caps (most drugs). Exceptions (birth control pills, nitroglycerin).
Pharmacy Requirements
Maintain available: Antidote information, approved stock Antidotes & Others emergency drugs. Phone number PCC.
Agent
Smallpox
(variola virus)
Direct-Aerosol
Anthrax
(Bacillus
anthracis)
Gram +
Spore-rod
No contagious
Feedborne
or airbone
No contagious
Tularemia
(Francisella
tularensis)
No contagious
Inhalation
Nonspecific febrile illness (3-5). Incipient
pneumonia, pleuritis, hilar lymphadenopathy.
Respiratory failure, shock maybe death
Ciprofloxacin or doxycicline
Streptomycin or Gentamycin
& Others
Streptomycin, Gentamicin,
chloramphenicol, doxycycline,
ciprofloxacin
Supportive
Maintain fluid & electrolyte balance,
circulatory volume & BP.
Ricin
(Castor beans)
Inhib protein
synthesis
Supportive.
By Talha
Chemical Threats
Chemical Name
Clinical Features
Treatment
Rapid decontamination
(Military name)
Nerve Agents
(G&V; Sarin(GB);
Soman (GD); Tabun(GA);
Cyclohexyl sarin (GF)
Blood Agents
Arsine (SA)
Cyanide Gases = >
Hydrogen Cyanide (AC)
& Cyanogen ChlorideCK)
Cyanide Solids => Kcyanide (KCN) & Nacyanide (NaCN)
Lacrimators = Chloroacetophenone
(CN); Chloropicrin (PS);
Bromobenzylcyanide (CA);
Dibenzoxazepine (CR).
No Antidote.
Vomiting Agents
Incapacitating Agents
Radiological Threats
Radiological & nuclear weapons and materials involving Radio-nucleotides produce topical &
systematic effects (immediate/delayed).
Radiation Emergency Assistance Center/Training Site (REAC/TS) = Guidance on treatment center.
Stable-Iodine supplements (Na/K iodide Tablets, etc.) help reducing uptake of radioiodine by thyroid.
Prussian blue 500mg Capsules = Treatment of exposures of Radioactive Cesium & Thallium.
Ca & Zinc salts of DTPA in IV & Aerosols for pts who exposed to Dirty Bombs radio-nucleotides.
Emergency Preparedness
CDC maintains Strategic National Stockpile (SNS) for rapid deployment of life-saving pharmaceuticals,
antidotes & other supplies in US to use in any kind of Threats.
CHEMPACK is stock of drugs to treat Nerve Agents.
Congrats guys for finishing CH 11. Keep it Up
THE END