ER pharm week 2

Term
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antivenom
CI: known hypersensitivity to sheep or sheep serum or to papain or papayas
SE: mild flushing and wheezing
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Terms in this set (43)
antivenom
CI: known hypersensitivity to sheep or sheep serum or to papain or papayas
SE: mild flushing and wheezing
Fab fragment antivenom- rattlesnake
hastens acclimatization and helps prevent high altitude disorders
Inhibition of the carbonic anhydrase enzyme counteracts the respiratory alkalosis that occurs during ascent
Facilitates the excretion of bicarbonate in the urine
- prevention: 125 mg BID
- tx: 250 mg BID
acetazolamide
for acute mountain sickness (AMS)/ high altitude cerebral edema (HACE)
prevention: 2mg q6h or 4 mg q 12 hours
tx:
- AMS: 4 mg q 6 h
- HACE: 8 mg single dose; maintenance 4 mg q 6 h until symptom resolve
dexamethasone
this is the leading cause of death from high-altitude illness - the hallmark is markedly elevated pulmonary artery pressure followed by pulmonary edema
HAPE
can be used to tx or prevent high altitude pulmonary edema
prevention: adjunct to gradual ascent in higher-risk individuals)
tx: (adjunctive therapy to nonpharmacologic measures, oxygen supplementation, portable hyerbaric chamber, gradual descent to lower atltidue) or as monotherapy if nonpharm measures are not possible
nifedipine (safe in pregnancy)
has been shown to improve exercise capacity in adults w/ high altitude pulmonary vasoconstriction
may be used for HAPE prevention
DO NOT give with nifedipine since may lower the MAP and dec cerebral perfusion
phosphodiesterase inhibitors: tadalafil 10 mg BID or sildenafil 50mg q 8 hours)
contains factors II, VII, IX, X, and proteins C&S (reversal agent for anti-coagulants - especially warfarin, can be used for DOACs)
contains heparin; CI if hx of HIT
BBW: arterial and venous thromboembolic complications
4 factor PCC (Kcentra)
contains inactive II, IX, I, and ACTIVATED factor VII (used for hemophilia or for DOAC reversal if Kcentra unavailable
SE: biggest risk: thrombosis, anaphylaxis
4 factor activated PCC (feiba)
Synthetic analogue of vasopressin (anti-diuretic hormone)
Usual use: Diabetes Insipidus; pressor in shock
Can help reverse the DOACs and treat intracranial hemorrhage associated w/ antiplatelet agents (0.4 mcg/kg)
plasma levels of von Willebrand factor, factor VIII leading to shortened bleeding time
SE: Biggest risk: hyponatremia! Fluid retention, HOTN, thrombotic events
desmopression (DDAVP)
Antidote for dabigatran
Monoclonal antibody binds specifically to dabigatran and metabolites (350 x greater affinity for dabigatran over thrombin), neutralizes anticoag effect within minutes and drug is eliminated w/ the monoclonal antibody

Duration of effect ~ 24 hrs

SE: Risk of thrombosis, hypersensitivity rxn
idarucizumab (praxbind)
BRAND NEW agent w/ rushed FDA approval for reversal of apixaban and rivaroxaban (limited availability right now) Recombinant modified version of factor Xa Xa inhibitors bind to this w/ same affinity as the natural Xa factor, making it unavailable to bind to the real factor Xa SE: thrombotic events occured in 18%andexanet (andexxa)Contraindicated with gastrointestinal ileus or obstruction, altered mental status, or acid or alkali ingestions, unless other drugs have also been ingested (charcoal makes endoscopic evaluation more difficult) SE: Pneumonitis and bronchiolitis obliterans; constipationactivated charcoalbuffering agent that reacts with hydrogen ions to correct acidemia and produce alkalemia Urinary alkalinization from renally excreted bicarbonate ions enhances the renal elimination of certain acidic drugs Alkalinization causes an intracellular shift of potassium and is used for the acute treatment of hyperkalemiasodium bicarbonateContraindicated in allergy to soy or eggs Relative contraindications include pulmonary disease, pancreatitis, and fat metabolism disorders SE: fat emboli syndrome, pancreatitis, phlebitislipid emulsion (ILE)competitively blocks the action of acetylcholine at muscarinic receptors does NOT reverse the effects of escess acetylcholine at nicotnitc recptors of the neuromuscular junctions, ganglia of the parasympathetic and sympathetic nervous system, and CNS adverse effects: include dry mouth, blurred vision, cycloplegia and mydriasis, palpitations, tachycardia, aggravation of angina, congestive heart failure (CHF), and constipation Urinary retention is common, and a Foley catheter may be neededatropine for cholinergic exposurereverse acetylcholinesterase (AChE) inhibition (thus reversing cholinergic excess at both muscarinic and nicotinic receptors) by reactivating the phosphorylated AChE and protecting the enzyme from further inhibitionpralidoxime (2-PAM) - tx of cholinergic exposureInhibits the enzyme acetylcholinesterase and prolongs the central and peripheral effects of acetylcholine Can be given to patients with severe anticholinergic toxicity (eg, hyperthermia, severe delirium, or tachycardia) IM, IV: Initial: 0.5 to 2 mg; may repeat every 10 to 30 minutes until response occurs. Subsequent doses may be required to manage life-threatening anticholinergic effects Administer no faster than 1 mg/minute to prevent bradycardia, respiratory distress, and seizures from too rapid administration Caution: can cause atrioventricular (AV) block, asystole, and seizures, especially in patients with *tricyclic antidepressant overdose*physostigminePeripherally acting cholinesterase inhibitor, may be useful in treating anticholinergic-induced ileus Contraindications: peritonitis or mechanical obstruction of the intestinal or urinary tract SE: related to too much acetylcholine, bradycardia can occurneostigminethis should be suspected in any pt with lethargy, coma, or seizures accompanied by QRS interval prolongation or a terminal R wave in aVR of greater than 3 mmtricyclic antidepressant poisoningwhat should NOT be given for tricyclic antidepressant overdose?physostigminewhat is hallmark of aspirin overdose?ringing in earsaltered mental status sweating pulmonary edema irritability ringing in ears n/vsalicylate toxidromewhat are examples of salicylates?- aspirin - pepto-bismol - oil of wintergreen (methyl salicylate) - some analgesic ointments (methyl salicylate (bengay)) - alka-seltzerhow do you tx metabolic acidosis in salicylate toxicity?IV sodium bicarbonatewhat must be taken in account for salicylate poisoned pts, even with normal measured serum glucose?low brain glucose levels - MUST give glucose-containing IV fluidstylenol antidote replenishes glutathione stores scavenges free radicals mucolytic agent that acts as a sulfhydryl group donor, substituting for the usual sulfhydryl donor of the liver, glutathione. It rapidly binds (detoxifies) the highly reactive electrophilic intermediates of metabolism, or it may enhance the reduction of the toxic intermediate, NAPQI, to the parent, acetaminophenN-acetylcysteine (NAC)First few hours after ingestion there is transient excitation followed by CNS depression After a delay of 4-12 hours, severe metabolic acidosis develops from accumulation of acid metabolites and lactate Finally, deposition of oxalate crystals in renal tubules occurs, followed by delayed renal insufficiency3 stages of ethylene glycol overdosePotent competitive inhibitor of alcohol dehydrogenase, the first enzyme in the metabolism of ethanol and other alcohols Used for methanol and ethylene glycol overdosefomepizolethis can be used for isoniazide and some muschroom toxicity - correct lactic acidosis secondary to isoniazide-induced impaired lactate metabolism - ethylene glycol intoxication - cycloserine toxicitypyridoxineImidazobenzodiazepine derivative that competitively inhibits the activity of CNS benzodiazepine receptors and antagonizes the CNS effects of benzodiazepines May also reverse CNS depression from certain nonbenzodiazepine sedatives and hypnotics Used for rapid reversal of benzodiazepine overdose-induced coma and respiratory depression *Routine use in patients with coma of unknown etiology or with possible mixed drug overdose is not recommended*flumazenilwhat are the black box warnings of flumazenil?rapid reversal of benzodiazepine effect in high-tolerance pts may result in acute withdrawal state, including hyperexcitability, tachy, and seizures - seizures may be unmasked in pts with serious TCA or other proconvulsant overdose d/t loss of protective effect of benzoUsed for life-threatening arrhythmias, hyperkalemia (≥5 mEq/L), or hemodynamic instability caused by acute and chronic cardiac glycoside intoxication Produced in immunized sheep and have a high binding affinity for digoxin and, to a lesser extent, digitoxin and other cardiac glycosidesdigifab - digoxin-specific antibodiesDimercapto chelating agent that is a water-soluble analog of BAL Used in the treatment of poisoning by several heavy metals, principally mercury, arsenic, and lead caution is warranted in administering to patients with severe *renal insufficiency* Self-limited, reversible allergic dermatologic reactions such as exanthems and urticaria have been the most commonly reported adverse effectunithiolDithiol chelating agent that is used in the treatment of poisoning by the heavy metals arsenic, mercury, lead, and gold *avoid use in pts w/ peanut allergy*BAL (dimercaprol)Chelating agent to enhance elimination of certain toxic metals Most commonly used for lead, but also removes zinc, manganese, iron, and copper Mobilizes lead from soft tissues and from a fraction of the larger lead stores present in bone *anuria is a relative CI* BBW: rapid or high-volume infusions may exacerbate inc intracranial pressurecalcium EDTA (ethylernediaminetetraacetate)inadvertent use of sodium EDTA INSTEAD of calcium EDTA may cause?serious hypocalcemiaSpecific chelating agent for iron. It binds free iron and, to some extent, loosely bound iron (from ferritin or hemosiderin) may impart an organge-pink color to the urine has also been used for the tx of aluminum toxicity in pts with renal failure HoTN or an anaphylactoid-type reaction may occur from a very rapid IV administration promotes the growth of certain bacteria, such as Yersinia enterocolitica, and may predispose pts to Yersinia sepsisdeferoxaminepolypeptide hormone that stimulates the formation of adenyl cyclase, which in turn increases the intracellular concentration of cyclic adenosine monophosphate (cAMP) This results in enhanced glycogenolysis and an elevated serum glucose concentration, vascular smooth-muscle relaxation, and *positive inotropic, chronotropic, and dromotropic effects* SEEMS to be most effective at inc the HRglucagonUsed to treat hypotension, bradycardia, or conduction impairment caused by beta-adrenergic blocker intoxication Possibly effective for severe cardiac depression caused by intoxication with calcium antagonists, tricyclic antidepressants, quinidine, or other types la and lc antiarrhythmic drugs Contraindicated in pheochromocytoma (stimulates the release of catecholamines and may result in severe hypertension) or insulinoma (indirectly stimulates release of insulin and may result in hypoglycemia) SE: nausea, vomiting, hyperglycemia (usually transient), hypokalemiaglucagonmay improve cardiac output: In calcium antagonist and beta-adrenergic blocker overdose, myocardial metabolism shifts from free fatty acid to carbohydrate metabolism; insulin increases myocardial uptake of glucose, lactate, and oxygen High-dose insulin increases calcium-dependent inotropic effects High-dose insulin enhances nitric oxide synthase activity, which dilates coronary, pulmonary and systemic blood vessels, leading to improved cellular perfusion Onset of effect is often 15-45 minuteshigh-dose insulinSymptoms include headache, nausea, dyspnea, and confusion. Syncope, seizures, lactic acidosis, coma, agonal respirations, and cardiovascular collapse ensue rapidly after heavy exposurecyanide toxicityanalog of vitamin B12 that binds and detoxifies free cyanide Rapidly exchanges its hydroxyl group with free cyanide to produce nontoxic, stable cyanocobalamin Coloration of bodily fluids caused by cobalamins can interfere with colorimetric laboratory tests for periods ranging from 12 to 48 hours for blood and serum and up to 8 days for urine Red chromaturia and skin erythema are nearly universal with treatment; rash is also commonhydroxocobalamin (Cyanokit)older cyanide treatment based on two modalities, one of which produces cyanide-scavenging methemoglobinemia while the second serves as a sulfur donor for cyanide metabolism Contraindications: Significant preexisting methemoglobinemia (>40%)nithiodote (sodium nitrite and Thiosulfate sodium)