Risk of Using APAP in Alcoholics 2 +salicylates
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Questions and Answers

What is the main risk of using acetaminophen (APAP) in alcoholics?

  • Reduced risk for drug toxicity
  • No change in risk for drug toxicity
  • Increased effectiveness of acetaminophen
  • Increased risk for drug toxicity (correct)

    • How does alcohol contribute to the increased risk of drug toxicity when using acetaminophen?

  • Alcohol reduces the effectiveness of acetaminophen
  • Alcohol increases the detoxification of NAPQI
  • Alcohol has no impact on NAPQI detoxification
  • Alcohol depletes glutathione, reducing the ability to detoxify NAPQI (correct)

    • What effect does alcohol have on the toxic metabolite (NAPQI) formed in the body?

  • Decreases the formation of NAPQI
  • Converts NAPQI into a non-toxic substance
  • Has no effect on the formation of NAPQI
  • Increases the formation of NAPQI (correct)

    • What is the impact of alcohol on the rate at which the toxic metabolite (NAPQI) is detoxified?

    <p>Slows down the detoxification of NAPQI</p> Signup and view all the answers

    What is the primary reason for synthesizing esters of salicylic acid?

    <p>To reduce the irritant effect of salicylic acid when taken orally</p> Signup and view all the answers

    Where are the substances converted to salicylate mainly?

    <p>In the gastrointestinal mucosa, red cells, and synovial fluid</p> Signup and view all the answers

    What is responsible for most of the activity of aspirin and other salicylates?

    <p>The salicylic acid moiety</p> Signup and view all the answers

    In what way do various derivatives of salicylic acid differ?

    <p>In their potency and toxicity</p> Signup and view all the answers

    What is the toxic dose of salicylates that may cause serious poisoning?

    <p>More than 300 mg/kg</p> Signup and view all the answers

    Which of the following is considered a salicylate medicine?

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

    Which form of salicylate is commonly found in liniments and ointments?

    <p>Methyl salicylate</p> Signup and view all the answers

    What is the potential consequence of consuming over 500 mg/kg of salicylates?

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

    What are the primary types of biochemical abnormalities that appear in salicylate toxicity?

    <p>Respiratory and metabolic effects</p> Signup and view all the answers

    Which body system is most affected by aspirin overdose?

    <p>Respiratory system</p> Signup and view all the answers

    What type of acid-base imbalance is associated with salicylate toxicity?

    <p>Respiratory alkalosis &amp; metabolic acidosis</p> Signup and view all the answers

    What is the primary cause of respiratory alkalosis of salicylate stimulation?

    <p>Increased oxygen consumption and breathing rate</p> Signup and view all the answers

    How does the bicarbonate buffer system respond to the effect of excessive CO2 loss in respiratory alkalosis?

    <p>It decreases hydrogen ion concentration</p> Signup and view all the answers

    What is the renal compensation for respiratory alkalosis of salicylate stimulation?

    <p>Increased bicarbonate excretion</p> Signup and view all the answers

    What is the likely consequence for a patient experiencing delayed renal compensation for respiratory alkalosis caused by salicylate stimulation?

    <p>Increased risk of not surviving long enough for intervention</p> Signup and view all the answers

    What is the primary impact of salicylates on oxidative phosphorylation?

    <p>Prevention of ATP formation during the oxidation of NADH</p> Signup and view all the answers

    How does a cell respond to the uncoupling of ATP production from electron transport caused by salicylates?

    <p>By increasing the rate of glycolysis</p> Signup and view all the answers

    What is the consequence of significant and prolonged obstruction of oxidative phosphorylation by salicylates?

    <p>Fatal interference with energy production</p> Signup and view all the answers

    What is the major pathway for energy production in a cell affected by salicylates?

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

    What is the consequence of faster glycolysis due to salicylate overdose?

    <p>Metabolic acidosis due to increased production of lactic and pyruvic acids</p> Signup and view all the answers

    Which acid is produced in large quantities due to energy depletion by fat oxidation in salicylate overdose?

    <p>Acetoacetic acid</p> Signup and view all the answers

    What effect does salicylate overdose have on the body's response to energy depletion?

    <p>Increased glycolysis and hypoglycemia</p> Signup and view all the answers

    What is the end result of the acid load in the blood due to salicylate overdose?

    <p>Severe acidosis</p> Signup and view all the answers

    What type of acid-base disorder may the patient have?

    <p>Metabolic acidosis superimposed on respiratory alkalosis</p> Signup and view all the answers

    In which age group does metabolic acidosis develop rapidly ?

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

    What is the presentation often thought to be in children due to brief respiratory alkalosis?

    <p>Pure metabolic acidosis</p> Signup and view all the answers

    What factor determines the direction of pH change in patients with mixed acid-base disorder?

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

    What mechanism contributes to lactic acidosis in salicylate overdose?

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

    What is the consequence of increased fatty acid metabolism in salicylate overdose?

    <p>Ketone formation</p> Signup and view all the answers

    What is the primary impact of salicylates on oxidative phosphorylation?

    <p>Anaerobic metabolism</p> Signup and view all the answers

    Where are substances converted to salicylate mainly?

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

    What is the primary cause of metabolic acidosis of salicylate overdose?

    <p>Renal dysfunction leading to accumulation of sulfuric and phosphoric acids</p> Signup and view all the answers

    How does the body respond to the initial respiratory alkalosis caused by salicylate stimulation?

    <p>By excreting bicarbonate in the kidneys</p> Signup and view all the answers

    What contributes to hypokalemia in the context of salicylate overdose?

    <p>Renal bicarbonate diuresis accompanied by sodium and potassium</p> Signup and view all the answers

    What is the consequence of renal dysfunction in salicylate overdose?

    <p>Accumulation of sulfuric and phosphoric acids</p> Signup and view all the answers

    What is the early finding associated with salicylate poisoning?

    <p>Nausea, vomiting, hyperpnea, and headache</p> Signup and view all the answers

    What contributes to the hypokalemia of salicylate overdose?

    <p>Faster glycolysis</p> Signup and view all the answers

    What is the primary cause of metabolic acidosis of salicylate overdose?

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

    Which body system is most affected by aspirin overdose?

    <p>Central nervous system</p> Signup and view all the answers

    What acid-base abnormality is likely to be present during the initial phase (up to 12 hours) of salicylate overdose?

    <p>Alkalosis in blood and urine</p> Signup and view all the answers

    What characterizes the phase of salicylate overdose that occurs 12-24 hours post-ingestion?

    <p>Shift from alkaline to acid character in blood; presence of coagulation abnormalities</p> Signup and view all the answers

    What is the primary effect of salicylate overdose (>24 hours post-ingestion)?

    <p>Potassium and hydrogen ion excretion; increase in acidosis</p> Signup and view all the answers

    What contributes to the acid-base imbalance during the phase 12-24 hours post-ingestion of salicylates?

    <p>Shift from alkaline to acid character in blood; presence of coagulation abnormalities</p> Signup and view all the answers

    How is the presence of salicylates in urine tested?

    <p>By adding several drops of 10% ferric chloride to 1 mL of urine and observing for a purple color</p> Signup and view all the answers

    What does the Done nomogram relate the serum concentration of salicylates to?

    <p>Risk and time of ingestion</p> Signup and view all the answers

    What serum concentration of salicylate per deciliter is consistent with moderate overdose based on the Done nomogram?

    <p>60 mg</p> Signup and view all the answers

    What is the relationship between salicylate serum concentration and severity of poisoning?

    <p>The serum concentration is closely related to the severity of poisoning</p> Signup and view all the answers

    What is the initial step in therapy for aspirin overdose to prevent further absorption of salicylates from the stomach?

    <p>Administering ipecac for emesis</p> Signup and view all the answers

    In the case of an enteric-coated or sustained-release form of aspirin, what may affect the timeline for performing emesis or lavage?

    <p>Decreased absorption in the stomach</p> Signup and view all the answers

    What procedure is also helpful in preventing further absorption of salicylates from the stomach in addition to emesis with ipecac and administering activated charcoal?

    <p>Administering corticosteroids</p> Signup and view all the answers

    What is the primary purpose of gastric lavage in treating aspirin overdose?

    <p>To remove salicylates from the stomach</p> Signup and view all the answers

    What is the main treatment for dehydration in aspirin overdose?

    <p>IV fluids</p> Signup and view all the answers

    How is acidosis mainly treated of aspirin overdose?

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

    What is the primary purpose of giving enough bicarbonate to maintain the patient’s urine pH above 8?

    <p>To enhance elimination of salicylates</p> Signup and view all the answers

    What is the central method for controlling seizures in aspirin overdose?

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

    In which type of compartment would salicylic acid be more ionized?

    <p>Basic compartment with a relative lack of H+</p> Signup and view all the answers

    What happens to salicylic acid in an acidic compartment?

    <p>It becomes non-ionized due to its weak acid nature</p> Signup and view all the answers

    How is salicylic acid affected by the presence of stronger acids in a compartment?

    <p>It becomes more non-ionized due to the presence of stronger acids</p> Signup and view all the answers

    Why is salicylic acid described as being 'trapped' in a milieu?

    <p>It becomes more non-ionized in an acidic environment</p> Signup and view all the answers

    What is the impact of urine pH equal to 8 on the ionization of salicylic acid?

    <p>It increases the ionization of salicylic acid</p> Signup and view all the answers

    In which condition should hemodialysis be used ?

    <p>Liver failure with coagulopathy</p> Signup and view all the answers

    What is the impact of ionization on the entry of salicylic acid into the CNS?

    <p>It reduces the entry of salicylic acid into the CNS</p> Signup and view all the answers

    In what form is almost all salicylic acid present at urine pH equal to 8?

    <p>Ionized form</p> Signup and view all the answers

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