POISON CONTROL CENYER AND ANYIDOYE BANKPOISON CONTROL CENTER Sp A poison control center is a medical facility that is able to provide immediate, free and S f it | | expert treatment advice and assistance da ety d over the telephone in case of exposure to poisonous or hazardous substances. aHISTORY Ls), Tv + The concept of poison control was emerged in Chicago in 1953 by Gdalman. + Nowis well established in advanced and developing countries as independent regional centers or as a part of healthcare institution. Hel ILLINOIS Nesp CENTERPoison Control Consultants in Pakistan Liaquat National Hospital & Medical College Address: Liaquat National Hospital, Stadium Road, Block 18, Cc Gulshan-e-Iqbal, Karachi. Phone: +92-21-34412209 Laquet National Hospital & Medical College Shifa International Hospital Address: Pitras Bukhari Road, H-8/4, Islamabad. Phone: +92-51-8463000 Address: 11 Kilometer, Jaranwala Road, Faisalabad. Phone: +92-41-8740951Organization of Poison Control Center Tree Pate melee coisa Ug Works under the supervisio supervision of full-time clinical toxicologist-medical director * Works without any direct medical supervision Staff: ¥ Competent Physician ¥ Medical and paramedical personnel ¥ Clinical Pharmacists ¥ Nurses | Staff: ¥ Competent Pharmacists ¥ Other personnel + Confined only to information of poisoning + Provision of Info + Treatment of poisoningServices of PCCs G&S) Toll-free communication system (3) Poison Information to both health professionals and consumers (GS) Professional and Public educational programs CS & Gs) Access to a full range of analytical toxicological services aRole of Pharmacist in Poison Control G3. Secondary Role *<—S Treatment > a ~=— - : _ Development of adequate Tertiary Role Se fees fr TreatmentPrimary Role-PREVENTION OF POISONING Gy Y Provide adequate directions for proper use of potentially toxic materials at the time of dispensing. Warn the buyer about hazards of leaving the material within reach of children Suggestions = Materials must not be transferred from their original containers = Secure storage place is to be provided for potentially toxic materials * Non-food materials must not be placed in empty food containers "Separate storage of food and non-food items * Accurate identification of poisoning materials * Return toxic materials to their respective storage space aeRO) immediately after use Medication must ideally be locked to keep them out of reach of childrenPrimary Role-PREVENTION OF POISONING Y Affixing of precautionary and warning labels on products. Explanation of precautionary labels is effective since public may not appreciate precautions. Suggestions * Medication should not be taken in dark = Labels should be examined carefully to ensure proper identification before administration. "Medication labels must be protected against destruction enonePrimary Role-PREVENTION OF POISONING Sp Y Self-medication, use of another’s medication for the ‘same problem’ and unsupervised self-diagnosis and prescription of a child’s treatment by the parents should be discouraged. yl aPrimary Role-PREVENTION OF POISONING Pharmacist may suggest "Preschool nursery and preparatory education programs for children = Providing space for displays related to poisoning preventionPrimary Role-PREVENTION OF POISONING Sy v Ask parents not to place unidentified poisonous plants in homes for decorative purposes.Primary Role-PREVENTION OF POISONING Y Ask the parents to KEEP OUT OF REACH OF CHILDERN the products like cosmetics, detergents, soaps, shampoos, insecticides, washing powders, paints and petroleum products etc.Primary Role-PREVENTION OF POISONING Y Ask the parents to discard the deteriorated or unwanted materials safely Suggestions = Pour them down in a drain ® Rinse containers of highly toxic materials before discarding * Disposed off in closed refuse container as far for normal access by children a a S>Primary Role-PREVENTION OF POISONING v Ask the parents to keep First AID information and items at home. Suggestions = Advise parents to keep POISON HELPLINE NUMBER in quick access = Ask the parents to keep ipecac syrup and activated charcoal at home but never administer it without consultation with Poison Control Center. HelpPrimary Role-PREVENTION OF POISONING Sp, Y The pharmacist association may influence the regulatory authorities for implementing a legislation for the packaging of specified potentially hazardous household chemicals and drugs in ‘safety’ containers or child resistant packaging.Primary Role-PREVENTION OF POISONING bs), v Public awareness programs regarding poisoning can be initiated like poison awareness week. i nomen an evention Week a)Role of Pharmacist Sy as — ims aia a Development of adequate og facilities for Treatment_ Secondary Role-TREATMENT OF POISONING Sp POISON! * First-Aid Treatment for poisoning * Antidotal Therapy Se * Other treatment measures va Supportive Treatment » — Hastening Poison EliminationFIRST AID First-Bid Vreatment for ‘poisoningSecondary Role-TREATMENT OF POISONING FIRST AID First-Aid Treatment for poisoning 1. DO THESE BEFORE YOU CALL Eyes irrigation Skin wash Cleaning of mouth Fresh air exposure : a7Secondary Role-TREATMENT OF POISONINGSecondary Role-TREATMENT OF POISONING FIRST AID 2.CALL FOR INFORMATION ABOUT WHAT TO DO NEXT CALL YOUR DOCTOR OR POISON CONTROL CENTRE U Identify your self and your relationship to victim Q Describe the victim by name, age and gender Q Identify the poison and also identity how much poison he tookSecondary Role-TREATMENT OF POISONING * 3. If you are instructed to induce vomiting, then induce vomiting using IPECAC SYRUP DOSE * 2 TABLESPOONFUL (30ML], FOLLOWED. BY GLASS OF LIQUID ‘+ 1 TABLESPOONFUL (15ML), FOLLOWED BY GLASS OF LIQUID + 2 TEASPOONFULS (10ML), FOLLOWED BY GLASS OF LIQUID * Incase of no vomiting with in 20 minutes, repeat dose ADULTS cen MD YON a} 1 YEAR’ CHILD LESS THAN? YEARSecondary Role-TREATMENT OF POISONING Never induce vomiting if the patient elSecondary Role-TREATMENT OF POISONING 4. IF YOU GO TO HOSPITAL * Take with you poison container or poisonous plant if any * Take any vomitus you collect * Don’t give any stimulant to victim dnAnti-detal Vherapy er PeiseningSecondary Role-TREATMENT OF POISONING ANTIDOTAL THERAPY Antidote is a therapeutic substance used to counteract the toxic action(s) of a specified xenobiotic Universal Classical Antidote: combination of activated charcoal ,tannic acid or magnesium oxide Antidote either QiInactivate poison QRetard absorption In poison control center information must be available concerning antidotes so that they can be used properly without wasting time in searching for suitable antidoteSecondary Role-TREATMENT OF POISONING * Antidotes have been classified by IPCS as | ANTIDOTES | \ | Immediately | | | (with in 30mins) | | eg. | With in 2 hours | With in 6 hours. | Charcoal in aspirin poisoning] ,Secondary Role-TREATMENT OF POISONING Availability of Antidotes differed from one country to another eect e Ty pee Rey aro ynremecettte oy bea Ome NCTC aT tag feet meets tto Tee am ree) ony High cost Short shelf life Lack of formulations Lack of import lack of suitable preparationsSecondary Role-TREATMENT OF POISONING Astudy was conducted in 2016 to evaluate availability of antidotes in tertiary care hospitals of Punjab According to this study Ere Taroom aoiaeaeehentees EOP Cos Pear Cee eee Led SUSE) Sin Preece MECN u kate cey Aud CCORDINGITC) NATIONAL Megan) SantaSecondary Role-TREATMENT OF POISONING To ensure availability of antidotes Q_ Establishment of a central agency Alternative Q The task Is performed by clinically oriented poison control centres having Antidote Bank.POISONS \CETAMINOPHEN ANTICHOLINERGIC DRUGS CHOLINERGIC DRUGS ISONIAZID POISONING WARFARIN, HEPARIN, COUMADIN lopio1D OVERDOSE CYANIDE POISONING IBETA BLOCKER/CALCIUM CHANNEL BLOCKER POISONING HEAVY METAL POSONING BENZODIAZEPINE POISONING IRON POISONING IHYDROFLOURIC ACID DERMAL BURNS TIDEPRESSENT ANTIDOTE (Sie N-ACETYLCYSTEINE (IMMEDIATELY IN EMERGENCY DEPARTMENT) PHYSOSTYGMINE (IMMEDIATELY IN EMERGENCY DEPARTMENT) ATROPINE, PRALIDOXIME IN ORGANOPHOSPHATE OVERDOSE (IMMEDIATELY IN EMERGENCY DEPARTMENT) PYRIDOXINE(VITAMIN B6) IMMEDIATELY IN EMERGENCY DEPARTMENT) VITAMIN K1, PROTAMINE WITH IV 1HOUR NALOXONE (IMMEDIATELY IN EMERGENCY DEPARTMENT) HYOROXYCOBALAMINE (IMMEDIATELY IN EMERGENCY DEPARTMENT) GLUCAGON, CALCIUM CHLORIDE INJECTION (IMMEDIATELY IN EMERGENCY DEPARTMENT) PENICILLAMINE,DIMERCAPROL EDTA (WITH IN 1H) FLUMAZENIL (IMMEDIATELY IN EMERGENCY DEPARTMENT) DEFEROXAMINE(WITHIN 1 HOUR) ‘CALCIUM GLUCONATE GEL (IMMEDIATELY IN EMERGENCY DEPARTMENT) SODIUM BICARBONATE (IMMEDIATELY IN EMERGENCY DEPT.)ee]iommnal=l0) support Suppertive VYreatment fer ‘peisgningSecondary Role-TREATMENT OF POISONING &p. POISON! Supportive Treatment: It includes O Maintenance of Airway, breathing and circulation O Maintenance of fluid balance QO Correct vomiting and convulsions if any * Supportive care is required in conditions like vomiting ,diarrhea,fluid and electrolyte imbalance, respiratory insufficiencies, cerebral edema etc. & 2 SUPPORTIVE PATIENT TREATMENT SURVIVAL se ANTIDOTAL THERAPYSecondary Role-TREATMENT OF POISONING & POISON! Elimination of Poison: Methods of eliminating absorbed poisons from the body includes QaAlkaline diuresis(salicylates) QHemodialysis QHemoperfusionSecondary Role-TREATMENT OF POISONING &p POISON! HOSPITAL PHARMACIST CLINICAL PHARMACIST ADVICE ON TREATMENT AVAILABILITY OF REGIMEN AND EVALUATE aS “«ROLE OF PHARMACIST Sn RECOGNIZE SIGN AND REGULAR EXPIRY DATES SYMPTOMS OF TOR EXPOSURE “ADEQUATE STORAGE OF ‘MONITOR PATIENT FOR, ANTIDOTES ANTIDOTE RESPONSE BETTER THERAPEUTIC COM " J ARole of Pharmacist in Poison Control sain " Development of adequate fegaa pole facilities for TreatmentTERTIARY ROLE OF PHARMACIST IN PCC Q To ensure treatment facilities Q Ensure Availability of ambulances Q Laboratory facilities Q Analytical facilities