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Mark Klimek Lecture Notes

Lecture 6 Drug Toxicities

1) Lithium- antimania- bipolar mania- therapeutic level is -0.6-1.2- toxic level is greater than or equal to 2, gray area in between where no books agree on- and is not tested on 2) Lanoxin (digoxin)- treats Atrial fibrillation (adena beta calcium dig) and congestive heart failure- 1-2 is therapeutic, toxic Is greater than or equal to 2- value of 2 is toxic because its safer to call something toxic when it may not be- 3) Aminofilin- relieves spasms in your airway- (technically not a bronchodilator- doesn’t stimulate your beta 2 agonist cell just relaxes a spasm,.. epinephrine is a bronchodilator)- inflammation- theyre in a spasm, acute lock down spasm, need to relieve spasm before giving bronchodilator so that it works better, 10-20 is the therapeutic level, under 10 is not enough, 21=toxic, 20=either way so call it toxic 4) Dilatin (phenytoin)- seizure, therapeutic level is 10-20 toxicity is greater than or equal to 20.5) Billirubin- waste product from the break down of the red blood cells, when boards test bilirubin they only test it in newborns not in adult- babies are breaking down moms red blood cells so they are usually high- 8 = no big deal… elevated level= 10-20.. 9.9 and less= normal for newborn but high for an adult, toxicity= greater than or equal to 20- a child with what bilirubin and above needs to come to the hospital? 14-15 doctors start thinking about hospitalization because 15 means you are half way to toxic which will lead to death

**Toxic levels: 2’s and 20’s

2’s -lithium and lanoxin- pick lower number for L’s 20’s- bilirubin, phenytoin, and aminofilin– go high

Kernicterus- bilirubin in the brain – when your bilirubin crosses your blood brain barrier and crosses your spinal fluid- bilirubin in the brain – usually occurs when you get up around 20- and causes aspetic (no germs) meningitis/encephalitis (baby can die) Jaundice- bilirubin in the skin Opisthotonos- position baby assumes when they have bilirubin on the brain- hyperextend due to the irritation of the meninges- babies usually are very flexible but with this, their heels will touch their ears and they are very rigid/extending neck- need to catch it right away- IN what position do you place an opisthotonos child? On their side

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Pathologic jaundice vs physiologic jaundice Physiologic- bilirubin is normal at birth and kid turns yellow over the next two days Pathologic jaundice- high at birth and kid yellow at birth

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