Busy. Please wait.

show password
Forgot Password?

Don't have an account?  Sign up 

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Don't know
remaining cards
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

APAP OD Treatment

Lecture 6

Treatment Plan Emergency stabilization , Decontamination (don’t worry about it b/c of antidote) , Antidote , Enhancing elimination , Liver transplant
APAP Treatments (3) Emergency stabilization , Decontamination , Acetylcysteine (^-acetylcysteine, NAC, Mucomyst , Acetadote )
Acetylcysteine (NAC) Available Forms Acetadote – IV , Mucomyst – Inhalation/Oral (generic)
Muco myst Inhalation/Oral (generic)
Acetadote IV
NAC MOA My notes Precursor for glutathione synthesis , Substitute for glutathione , Substrate for sulfation , Direct hepato protective
When NAC most effective within first 8 hours
Acetylcysteine Effectiveness Equally effective if given within the first 8 hours , Effectiveness decreases after 8 hours , ? Effective > 24 hours , Some benefit late in fulminant hepatic fail
NAC Indications Acute overdose [APAP] above treatment line Elevated AST/ALT or [APAP] if time unknown , Chronic overdose High risk based on symptoms and/or [APAP], AST/ALT
NAC Indications Acute OD - time known [APAP]
NAC Indications Acute OD - time unknown Increased AST/ALT (>50IU/L) Increased (APAP] (> lOmcg/mL)
NAC Indications Chronic OD High-risk , Symptoms , [APAP] . AST/ALT
NAC Oral dose Load followed by maintenance
NAC Oral dose Load 140 mg/kg load
NAC Oral dose Maintenance 70 mg/kg q4 hours for 17 doses
NAC Oral administration Dilute to 5% solution to avoid gastric irritation
Oral Acetylcysteine (NAC) Notes Dose 140 mg/kg load M 70 mg/kg q4 hours X 17 Shorter course may be used
Oral Acetylcysteine (NAC) Notes Administration Dilute to 5% solution to avoid gastric irritation Cold, sweet, acidic beverage to disguise taste - FRESCA™ NG/NJ Smaller more frequent doses
NAC Oral SEs Primarily GI
IV Acetylcysteine (NAC) Adults Loading Dose 150 mg/kg in 200mL D5W over 60 min
IV Acetylcysteine (NAC) Adults Loading Dose J Maintenance Dose 50 mg/kg in 500mL D5W over 4 hours 4 , 100 mg/kg in 100mL D5W over 16 hours
IV Acetylcysteine (NAC) Children 20kg, < 40 kg Decrease fluid volume by 50% < 20 kg Fluid adjusted by body weight (see ???)
NAC Pediatric considerations Risk for anaphylactoid reactions , Higher risk in asthamtics , Hyponatremia in children if pediatric fluid guidelines not adhered
NAC Monitoring therapy Check AST/ALT and [APAP] at end of infusion or oral therapy Continue therapy if detectable APAP or AST/AST increasing
Ensuring Optimal NAC Therapy Obtain APAP, AST & ALT concentrations at end of infusion
Ensuring Optimal NAC Therapy Continue NAC if detectable APAP or rising AST/ALT (16-hour bag)
Ensuring Optimal NAC Therapy At risk for longer duration of therapy: Late presenters , , Supra-therapeutic or unknown ingestion , , Diphenhydramine
APAP Liver transplant Kings College criteria pH < 7.3
APAP Liver transplant Kings College criteria lactate > 3 mmol/L
APAP Liver transplant Kings College criteria INR >6.5
APAP Liver transplant Kings College criteria Scr >3.39mg/dL
APAP Liver transplant Kings College criteria encephalopathy Grade III or higher
Created by: pberriochoa