Pharmacology

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Pharmacology

• Chapter 10
• Poison Control

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A Poison

• A substance taken into the body by ingestion,
  inhalation, injection, or absorption that
  interferes with normal physiological functions
• In some cases, only a small amount of a substance
  can cause severe tissue damage directly such as
  corrosives like Drano if swallowed

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If you suspect poisoning

• ALWAYS CHECK ABCscannot do anything else
  without ABCs
• Contact poison control for further directions on
  how to handle the ingestion or inhalation of a
  poisoning

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The most common type of poisoning is

• INGESTION or swallowing

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Who is at the most risk of poisoning?

• Children between the ages of 1-5 years old

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What to do if someone swallows a poison?

• We used to immediately recommend syrup of
  ipecacnot always the case now
• Too much vomiting can interfere with other
  treatment
• There has been evidence that bulimics and
  anorexics are abusing ipecac

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The American Academy of Pediatrics, 2004

• Recommends that ipecac NOT be kept in the home in
  case of accidental poisoning
• This is because homeowners misuse ipecac. They
  have administered ipecac to someone who drinks
  corrosives, vomiting can cause more damage to
  esophagus
• The AAP recommends that homeowners MUST dispose
  of the ipecac safely and to not use it

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Poison Control Phone Number

• There is a national toll-free hotline you can
  call regarding poisoning
• Callers should be ready to give the following
  information regarding the poisoning
• Age weight health status of pt
• Type of poison if known pts allergies
• Whether the pt has asthma or not

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When NOT TO induce vomiting

• Ingestion of corrosives
• Ingestion of volatile petroleums such as gas,
  kerosene, lighter fluids. Vomiting can cause
  aspiration or asphyxiation.
• Ingestion of convulsants such as strychnine or
  iodine. Vomiting can precipitate seizures
• If pt is semiconscious, severely inebriated, in
  shock, or has no gag reflex. Vomiting can cause
  choking, aspiration or asphyxiation
• If pt is lt 1 y.o.
• Pts with cardiac conditions should not induce
  vomiting, can cause HTN, stroke, arrhythmias

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• If any of the previously mentioned situations
  happen, call 911 IMMEDIATELY
• Trained personal can lavage the stomach contents
• Sometimes, anecdotes can be effective if
  ingestion happened only a short time ago

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Activated Charcoal

• It helps minimize systemic absorption
• It is ONLY given after emesis or gastric lavage
• It is recommended that you do not mix charcoal
  with milk, only water or fruit juice
• Activated charcoal is excreted in the feces and
  stool is black in color

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Personnel caring for poisoning victims should
observe the following

• Save the emesis it may help in determining the
  type of poisoning taken
• VS
• Observe closely for tremors, confusion,
  convulsions, resp. distress or cardiac arrhythmias

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Treatment for Poisoning by inhalation

• Treat the symptoms
• Provide fresh air and oxygen
• Perform CPR if indicated
• The inhalation of insect spray may require
  administration of an anecdote

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Treatment for external poisoning of skin or eyes

• These should be flushed from the eyes or skin
  with a continuous stream of water for at least 15
  minutes
• The person should be transported to an emergency
  care facility for further treatment
• Systemic absorption of poisons through the skin
  may require administration of an anecdote

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Poisoning by Sting

• Insect sting (stings include by bee, wasp,
  scorpion or fire ant)
• treat with the immediate application of household
  ammonia to the site or with a paste made of
  bicarbonate of soda (baking soda) and water,
  after removing the stinger of a bee or wasp
• Ice can also be applied to the site
• If pt tells you they are allergic to stings,
  watch pt for anaphylaxis

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Anaphylaxis of a sting

• CALL 911 IMMEDIATELY
• Watch ABCs
• Pt may receive adrenalin, corticosteroids and
  histamine blocker such as benadryl
• Pt needs to be transported to an emergency
  facility immediately after the administration of
  the above meds

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Epi-pen

• Pts can administer an epi pen to themselves or
  another person can administer the epi-pen to
  another person if needed
• Epinephrine or adrenaline causes bronchodilation
  to open the bronchioles to get O2 in more
  effectively
• And vasoconstriction to allow the blood vessels
  to close and return BP

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Snakebites

• Do not apply ice or a tourniquet to a snakebite
  because venom is very irritating and may cause
  sloughing of the tissues
• Keep the pt quiet in order to slow circulation
• Transport the pt lying down to an ER for
  antivenom injections
• If possible, take the snake with you for
  identification

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Statistics on Poisonings

• Poisonings are the leading cause of health
  emergencies for children in the nation
• Poisonings are a major cause of death among
  children d/t their natural curiosity and active
  lifestyle
• Children like colored medicine with flavors

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CANDY

• DO NOT REFER TO MEDICINE AS CANDY
• This is very bad for children ?
• They love candy as do I, but children dont know
  the difference and will eat up pills mistakenly
  for the candy. I only eat candy ?
• Education is very important with children

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Child-proof your home

• Lock all cupboards containing meds and cleaning
  agents
• Keep meds in child-proof containers
• Watch children closely when they visit others,
  watch for homes NOT child-proofed

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Others precautions to take for prevention of
childhood poisoning

• Never transfer poisonous substances to unlabeled
  containers or to food containers such as milk
  cartons or soda bottles or cereal boxes. Keep
  chemicals in their original labeled containers
• Never store poisonous substances in the same are
  with food, confusion could be fatal
• Never reuse containers of chemical products

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• Always flush unused medication down the toilet,
  never discard meds in the garbage can
• Do not give or take meds in the dark, error can
  occur
• Never give or take meds that are discolored, have
  a strange odor or is outdated

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• Adults should NOT take medication in front of
  children
• Keep purses and pill boxes out of reach of
  children
• Rinse out medication containers thoroughly before
  disposing of them

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IRON

• The FDA reports that iron pills are the leading
  cause of poisoning deaths in children under 6
  y.o.
• In the last decade, 110,000 children were
  poisoned by eating adult pills and at least 33
  children have died
• Therefore

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• FDA proposed requiring iron supplements to be
  sold in special blister packs to prevent from
  childhood poisonings

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Mr. Yuck
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Mr. Yuk Stickers

• Mr. Yuck says NO stickers are for children who
  cannot read. These stickers were produced by the
  Childrens Hospital of Pittsburgh
• These stickers are encouraged to prevent
  accidental poisonings
• You place a Mr. Yuk sticker on items you dont
  want your child to taste or touch
• Do you think kids will want to at least touch
  something you tell them not to touch? Hmm

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Others at risk for poisons

• The older adult, especially the elderly person

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Overdoses of medication can result in toxicity
with the following symptoms

• Confusion Dizziness
• Weakness Lethargy
• Ataxia Tremors
• Cardiac irregularities

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What else can cause toxic reactions from meds
besides overdosing

• Slower metabolism, Impaired circulation, and
  Decreased excretion cause meds to remain in the
  body longer and then builds up dangerous levels
• Wrong dose taken d/t impaired vision or poor
  memory
• Multiple medication interactions
• Other medical conditions affecting absorption

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Other Measures For Prevention

• Obtain the number of your nearest Poison Control
  Center and place it near your telephone
• There are more than 70 Poison Control Centers
  throughout the U.S. and Canada
• Poison Control Centers have information regarding
  poisonous plants, snakes, reptiles, and marine
  organisms such as jelly fish and stingray

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CAUTION

• The wrong treatment can be often times, more
  dangerous than none
• Practice safety in your home and teach safety to
  your patients for their home
• ABCs is 1 once a poisonous substance has been
  taken CALL 911 IMMEDIATELY

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THE END

• CONGRATULATIONS!!!!!
• You have officially completed the Pharmacology
  course ?