Toxicity

measurement of the rate at which creatinine is cleared from the blood by the kidney

*normal = 125 ml/min*

[(140-age) x lean body mass (kg)]:[serum reatinine x 72] 1.2(140-age))(weight)/serum creatinine

*if patient is female, multiple by 0.85*

The condition of producing adverse bodily effects due to poisonous qualities.

-receptor desensitized or there's a decreased number of viable receptors to a substance
-more drug is required for the same response

an adaptive response in which microorganisms begin to tolerate an amount of drug that would ordinarily be inhibitory

eg: an increased drug metabolism d/t increased demand for it= drug metabolized too fast and not effective

-Acetylsalicylic acid (aspirin)

-Acetaminophen (tylenol)

-fentany
-cocaine
-benzodiazepines
-alcohol
-antidepressants

-dose
-crushing of enteric coating tablets
-crushing of sustained-release tablets

Drug, patient, dose, time, reasons

DPDTR

-Stabilize patient (ABCDE)
-Identify Agent
-Decontaminate (wash, rinse, gastric emptying)
-Treat (use K& D)

airway- patency

Breathing: oxygenation and ventilation

Circulation (organ perfusion, BP)

Disability- assess for dysfunction

eg: CNS: agitation, coma, PEARL, temp, Cardiac

Exposure: LIMIT

-use kinetics and dynamics
-absorption
-distribution
-metabolism
-antagonism

signs and symptoms

-confusion
-tachycardia
-tachypnea
-hyperthermia
-diaphoresis (sweating)
-vomiting

-abdominal pain
-loss of appetite
-nausea/vomiting
-diaphoresis
-somnolence

-Bradypnea/apnea
-Bradicardia
-everything slower
-somnolence/coma
-pupils constricted

-agitation, tremors
-tachycarida
-tachypnea
-hyperthermia
-diaphoresis
-pupils dilated

adsorption: prevention of absorption
-binding of drug to decrease its absorption
-activated charcoal

-increase glutathione in Tylenol OD
-increased metabolism in alcohol/ethanol

*1. Activated Charcoal (effects elimination*
-intestinal elimination of charcoal-bound drug

*2. Urinary alkalization*
-acid-base neutralization
-charged molecules excreted= acidic drugs, elimination enhanced via alkalization of urine
-Iv dose: 100-150 mEq sodium bicarbonate

*3. Hemodialysis*
-active removal of drug via blood filtration system

antagonism of a specific receptor: cessation of drug action

-activated charcoal
-antidote: acetylcysteine
-close monitoring

Antidote: Baloxone
-Close monitoring (RR!!!)

-benzodiazepines: Lorazepam
-no antidote
-close monitoring.