Aspirin Development, Use, and Toxicity
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Questions and Answers

What is the primary mechanism of action of non-selective NSAIDs?

  • Inhibition of COX 1 and COX 2 enzymes (correct)
  • Stimulation of COX 2 enzymes
  • Stimulation of prostaglandin production
  • Inhibition of leukotriene production

    • What is the purpose of plotting salicylate levels on a nomogram?

  • To determine the severity of dehydration
  • To diagnose NSAID overdose
  • To monitor liver transaminases
  • To estimate the toxicity of salicylate ingestion (correct)

    • What is the common effect of most NSAID overdoses?

  • Respiratory depression
  • Cardiac arrhythmias
  • Mild gastrointestinal upset (correct)
  • Severe gastrointestinal bleeding

    • What is the likely effect of altered capillary integrity in cerebral and pulmonary edema?

    <p>Prolonged prothrombin time</p> Signup and view all the answers

    What is the initial step in managing salicylate intoxication?

    <p>Maintain the airway and assist ventilation if necessary</p> Signup and view all the answers

    What is the benefit of using antacids in NSAID overdose?

    <p>To treat mild GIT upset</p> Signup and view all the answers

    What is the primary use of COX 2 inhibitors?

    <p>To relieve ulcer pain</p> Signup and view all the answers

    What is the treatment for metabolic acidosis in salicylate intoxication?

    <p>Intravenous administration of sodium bicarbonate</p> Signup and view all the answers

    What laboratory tests are useful in NSAID overdose?

    <p>CBC, electrolytes, glucose, BUN, creatinine, liver transaminases, and urinalysis</p> Signup and view all the answers

    What is the therapeutic dose of aspirin for treatment?

    <p>40-60 mg/kg/d</p> Signup and view all the answers

    What is the likely outcome of acute ingestion of 150-200 mg/kg of aspirin?

    <p>Mild intoxication</p> Signup and view all the answers

    What is the purpose of replacing fluid losses with intravenous crystalloid solutions?

    <p>To replace fluid losses due to dehydration</p> Signup and view all the answers

    What is the minimum duration for monitoring asymptomatic patients?

    <p>6 hours</p> Signup and view all the answers

    Is there a specific antidote for most NSAID overdoses?

    <p>No, there is no specific antidote for most NSAID overdoses</p> Signup and view all the answers

    What is the effect of COX 1 inhibition?

    <p>Decreased prostaglandin production</p> Signup and view all the answers

    What is the effect of sodium bicarbonate in salicylate intoxication?

    <p>It promotes salicylate elimination by the kidneys</p> Signup and view all the answers

    What is the characteristic of pulmonary edema in salicylate intoxication?

    <p>It is related to alteration in capillary integrity</p> Signup and view all the answers

    What is the likely outcome of chronic ingestion of more than 100 mg/kg/d of aspirin for 2 or more days?

    <p>Chronic intoxication</p> Signup and view all the answers

    What is the mechanism of toxicity for salicylates?

    <p>All of the above.</p> Signup and view all the answers

    What is the primary cause of respiratory alkalosis in salicylate toxicity?

    <p>Decreased carbon dioxide retention in the lungs.</p> Signup and view all the answers

    What is the typical range of therapeutic salicylate concentrations in patients with arthritis?

    <p>100-300 mg/dL</p> Signup and view all the answers

    What salicylate concentration is considered very dangerous, often accompanied by acidosis and altered mental status?

    <p>600 mg/L</p> Signup and view all the answers

    Which of the following laboratory studies is NOT recommended for evaluating salicylate toxicity?

    <p>Complete blood count</p> Signup and view all the answers

    What is the primary mechanism by which salicylate toxicity contributes to dehydration?

    <p>All of the above.</p> Signup and view all the answers

    What is the primary clinical manifestation of salicylate toxicity that leads to respiratory alkalosis?

    <p>Hyperventilation</p> Signup and view all the answers

    What is the primary mechanism by which salicylate toxicity interrupts glucose and fatty acid metabolism?

    <p>Uncoupling of oxidative phosphorylation.</p> Signup and view all the answers

    What is the primary treatment for salicylate toxicity?

    <p>Supportive care</p> Signup and view all the answers

    Which of the following drugs can cause methemoglobinemia and hemolytic anemia?

    <p>Primaquine phosphate</p> Signup and view all the answers

    What is the primary mechanism of toxicity for chloroquine?

    <p>Inhibition of DNA and RNA synthesis</p> Signup and view all the answers

    Which of the following is a potential cardiotoxic effect of chloroquine overdose?

    <p>Ventricular fibrillation</p> Signup and view all the answers

    Which of the following drugs is associated with fatal neutropenia?

    <p>Amodiaquine HCl</p> Signup and view all the answers

    What is the therapeutic dose of chloroquine phosphate for malaria prophylaxis?

    <p>500 mg once a week</p> Signup and view all the answers

    Which of the following is NOT a potential side effect of mefloquine?

    <p>Hypotension</p> Signup and view all the answers

    What is the role of G6PD in red blood cells?

    <p>Protection from harmful substances</p> Signup and view all the answers

    Which of the following is NOT a sign of severe chloroquine overdose?

    <p>Hepatitis</p> Signup and view all the answers

    Which of the following drugs is most likely to cause ototoxicity?

    <p>Primaquine phosphate</p> Signup and view all the answers

    What is a common clinical presentation associated with quinidine toxicity?

    <p>Confusion</p> Signup and view all the answers

    Which of the following drugs has ganglionic and neuromuscular blocking activity?

    <p>Procainamide</p> Signup and view all the answers

    What is the toxic dose for procainamide?

    <p>5 g</p> Signup and view all the answers

    Which of these statements about lidocaine is correct?

    <p>It is also an anti-dysrhythmic agent.</p> Signup and view all the answers

    What is one potential consequence of quinidine toxicity?

    <p>Coma</p> Signup and view all the answers

    Which of the following is a metabolite of lidocaine that may contribute to toxicity?

    <p>Monoethylglycinexylidide</p> Signup and view all the answers

    Encainide was withdrawn from the market primarily due to its association with which issue?

    <p>Increased cardiovascular events</p> Signup and view all the answers

    What cardiac effect is NOT associated with high doses of anti-dysrhythmic drugs?

    <p>Tachycardia</p> Signup and view all the answers

    Which condition may arise from an overdose of lidocaine?

    <p>Seizures</p> Signup and view all the answers

    Study Notes

    Aspirin Development and Use

    • Developed in 1897, aspirin became widely distributed to doctors by 1915, becoming the top drug globally.
    • Therapeutic concentration for chronic use in arthritis patients is 100-300 mg/L.
    • Toxic levels exceed 600 mg/L and can cause severe acidosis and altered mental status.

    Mechanism of Toxicity

    • Salicylate toxicity leads to hyperventilation and respiratory alkalosis, increasing blood pH.
    • Metabolic acidosis can occur from acid buildup (lactate, ketones), leading to dehydration.
    • Uncoupling of oxidative phosphorylation affects glucose and fatty acid metabolism.
    • Can cause cerebral and pulmonary edema due to capillary integrity alteration.
    • Prolonged prothrombin time and altered platelet function are noted.

    Treatment for Salicylate Toxicity

    • Maintain airway and ventilation; supplemental oxygen may be given.
    • Treat acute manifestations: coma, seizures, hyperthermia, and pulmonary edema.
    • Administer intravenous sodium bicarbonate to manage metabolic acidosis; prevent pH from falling below 7.4.
    • Replace fluid and electrolytes lost through vomiting and hyperventilation.
    • No specific antidote; sodium bicarbonate aids in salicylate elimination.

    NSAIDs Overview

    • NSAIDs are diverse agents used for pain and inflammation management.
    • Most overdose cases lead to mild gastrointestinal upset.
    • Non-selective NSAIDs inhibit COX-1 and COX-2, affecting prosaglandin and leukotriene production.
    • Selective COX-2 inhibitors primarily relieve ulcer pain.
    • Chloroquine inhibits DNA and RNA synthesis; can cause cardiotoxicity similar to quinidine.
    • Overdose may lead to severe cardiotoxicity symptoms: sinoatrial arrest, ventricular arrhythmias.
    • Primaquine and quinacrine can cause hemolytic anemia and methemoglobinemia, especially in patients with G6PD deficiency.
    • Therapeutic dose for chloroquine in malaria prevention is 500 mg weekly; treatment dose is 2.5 g over 2 days.

    Specific Drug Toxicity

    • Quinidine: 1 g toxic dose, can lead to confusion, sedation, and asystole.
    • Procainamide: Toxic at 5 g; can cause respiratory arrest and cardiac complications.
    • Lidocaine: Antidysrhythmic agent; potential toxicity from metabolites.
    • Encainide withdrawn due to mortality concerns in cardiac dysrhythmia trials.

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    Description

    Learn about the development and use of aspirin, including its therapeutic concentration and toxic levels, as well as the mechanism of toxicity and its effects on the body.

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