Bioterrorism and Emergency Preparedness
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What does CBRNe stand for?
What are the 6 category A biologic agents?
- viral hemorrhagic fever
Why are category A agents considered such?
- relatively easy to disseminate
- high mortality rate
- high infectivity
- little to no treatment
Is anthrax contagious?
What is the key identifier for anthrax?
widening of the mediastinum
How do we prevent anthrax?
- 5 shot series
- ABThrax (still not approved, but in the SNS stock)
How do we treat anthrax?
- Doxycycline x 60d (prophylaxis)
- Ciprofloxacin x 60d (prophylaxis & tx)
- Amoxicillin (susceptible bugs only)
- usually add 1-2 more AB's to this regimen (rifampin, vanco, chlorampenicol, clindamycin, clarithromycin, imipenem, PCN, ampicillin)
- STILL TREAT PREGNANT WOMEN - death if we don't
What is the mortality rate of anthrax?
100% if untreated
How does anthrax kill you?
- lethal factor toxin
- protective factor toxin
- edema factor toxin
- (any one of these gets to high enough level means no tx will work)
What is the time-frame of anthrax sx?
- incubation period of 2-60d
- symptom initiation to death as short as 3d
How is anthrax used as a weapon?
most likely aerosolized
Is smallpox contagious?
What is the key identifier of smallpox?
- spreads centrifugally and uniformly
- scabs contain the virus
- starts in mouth and on palms
What do we do to treat smallpox?
- ACAM2000 (bifurcated needle,
- in SNS stock only)
- Vaccine ImmunoGlobulin (VIG)
- CI in pregnancy
- supportive care (nutrition, fluids, eye care)
- Imvamune (in Phase III now)
What is the mortality rate for smallpox?
What is the time-frame for smallpox sx?
7-17d incubation period
Is plague contagious?
What is the key identifier of plague?
swollen lymph nodes or "bubo" (bubonic type)
What is the treatment of plague?
- STILL TREAT PREGNANT
What is the mortality rate for plague?
- 50-90% untreated
- 15% treated
What are the 3 types of plague?
How is plague used as a weapon?
can be aerosolized
What are is the key identifier of botulism?
- The 4 D's:
How do we treat botulism?
- Anti-toxin (heptavalent):
- prevents further paralysis (existing paralysis is permanent unless new nerve grows to area)
- must call CDC to get it
How toxic is botulinum toxin?
1g can kill 1 million people (most toxic substance known)
What is the time-frame for botulism?
probably >72h incubation period
Is tularemia contagious?
not usually person to person
What is the key identifier of tularemia?
ulcers of the skin or mouth
How is tularemia used as a weapon?
- can be aerosolized
- can be engineered to resist AB's
What is the mortality of tularemia?
What is the tx for tularemia?
- doxycycline x 14d
- ciprofloxacin x 14d
What are the viruses that can cause Hemorrhagic Fever?
- rift valley fever
- yellow fever
What is the key identifier of Viral Hemorrhagic Fever?
- hemorrhagic state:
- mucous membrane and conjunctival involvement
- Frank ecchymosis
What is the mortality rate for Viral Hemorrhagic Fever?
How do we prevent Hemorrhagic Fever?
- vaccine (yellow fever only)
- ribavirin for contained or mass prophylaxis (not for pregnant)
How is Viral Hemorrhagic Fever used as a weapon?
aerosolized (ebola, marburg, lassa, hantavirus)
How do we treat Viral Hemorrhagic Fever?
supportive care only
What are the nerve agents commonly used?
How do nerve agents work?
How do we treat nerve agent exposure?
- diazepam (seizures)
What are the blood agents (asphyxiants) commonly used?
- methane (simple)
- nitrogen (simple)
- CO (chemical)
- cyanide (chemical)
- hydrogen sulfide (chemical)
How do simple blood agents (asphyxiants) work?
interfere with inhalation
How do chemical blood agents (asphyxiants) work?
interfere with cellular respiration
What are the sx of cyanide poisoning?
- loss of consciousness
- respiratory failure
How do you treat cyanide poisoning?
- amyl nitrate (1 amp over 30s q 3min)
- sodium nitrite (IV, no < 5min)
- sodium thiosulfate (50ml IV over 10-20 min)
- cyanokit - complexes w/ CN to form B12 (turns urine red)
What are the responsibilities of the pharmacist in a crisis?
- mass dispensing
- pharmaceutical caches
- SNS request
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