Bioterrorism and Emergency Preparedness

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  1. What does CBRNe stand for?
    • Chemical
    • Biological
    • Radiation
    • Nuclear
    • explosive
  2. What are the 6 category A biologic agents?
    • anthrax
    • smallpox
    • plague
    • botulism
    • tularemia
    • viral hemorrhagic fever
  3. Why are category A agents considered such?
    • available
    • relatively easy to disseminate
    • high mortality rate
    • high infectivity
    • little to no treatment
  4. Is anthrax contagious?
  5. What is the key identifier for anthrax?
    widening of the mediastinum
  6. How do we prevent anthrax?
    • 5 shot series
    • ABThrax (still not approved, but in the SNS stock)
  7. 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
  8. What is the mortality rate of anthrax?
    100% if untreated
  9. 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)
  10. What is the time-frame of anthrax sx?
    • incubation period of 2-60d
    • symptom initiation to death as short as 3d
  11. How is anthrax used as a weapon?
    most likely aerosolized
  12. Is smallpox contagious?
  13. What is the key identifier of smallpox?
    • rash:
    • spreads centrifugally and uniformly
    • scabs contain the virus
    • starts in mouth and on palms
  14. 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)
    • isolation
    • Imvamune (in Phase III now)
  15. What is the mortality rate for smallpox?
  16. What is the time-frame for smallpox sx?
    7-17d incubation period
  17. Is plague contagious?
  18. What is the key identifier of plague?
    swollen lymph nodes or "bubo" (bubonic type)
  19. What is the treatment of plague?
    • Doxycycline
    • Ciprofloxacin
  20. What is the mortality rate for plague?
    • 50-90% untreated
    • 15% treated
  21. What are the 3 types of plague?
    • bubonic
    • pneumonic
    • septicemic
  22. How is plague used as a weapon?
    can be aerosolized
  23. What are is the key identifier of botulism?
    • The 4 D's:
    • diplopia
    • dysarthria
    • dysphonia
    • dysphagia
  24. 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
  25. How toxic is botulinum toxin?
    1g can kill 1 million people (most toxic substance known)
  26. What is the time-frame for botulism?
    probably >72h incubation period
  27. Is tularemia contagious?
    not usually person to person
  28. What is the key identifier of tularemia?
    ulcers of the skin or mouth
  29. How is tularemia used as a weapon?
    • can be aerosolized
    • can be engineered to resist AB's
  30. What is the mortality of tularemia?
    • 50% untreated
    • 2% treated
  31. What is the tx for tularemia?
    • doxycycline x 14d
    • ciprofloxacin x 14d
  32. What are the viruses that can cause Hemorrhagic Fever?
    • ebola
    • marburg
    • lassa
    • rift valley fever
    • hantavirus
    • yellow fever
  33. What is the key identifier of Viral Hemorrhagic Fever?
    • hemorrhagic state:
    • petechiae
    • mucous membrane and conjunctival involvement
    • Frank ecchymosis
    • epistaxis
    • hematuria
    • hematemesis
    • melana
  34. What is the mortality rate for Viral Hemorrhagic Fever?
    • 90%
    • NO TX available
  35. How do we prevent Hemorrhagic Fever?
    • vaccine (yellow fever only)
    • ribavirin for contained or mass prophylaxis (not for pregnant)
  36. How is Viral Hemorrhagic Fever used as a weapon?
    aerosolized (ebola, marburg, lassa, hantavirus)
  37. How do we treat Viral Hemorrhagic Fever?
    supportive care only
  38. What are the nerve agents commonly used?
    • sarin
    • soman
    • tabun
    • VX
  39. How do nerve agents work?
    inhibit acetylcholinesterase
  40. How do we treat nerve agent exposure?
    • decontamination
    • antidotes:
    • atropine
    • 2-PAM
    • diazepam (seizures)
  41. What are the blood agents (asphyxiants) commonly used?
    • methane (simple)
    • nitrogen (simple)
    • CO (chemical)
    • cyanide (chemical)
    • hydrogen sulfide (chemical)
  42. How do simple blood agents (asphyxiants) work?
    interfere with inhalation
  43. How do chemical blood agents (asphyxiants) work?
    interfere with cellular respiration
  44. What are the sx of cyanide poisoning?
    • tachypnea
    • convulsions
    • hypotension
    • loss of consciousness
    • respiratory failure
  45. 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)
  46. What are the responsibilities of the pharmacist in a crisis?
    • mass dispensing
    • pharmaceutical caches
    • planning
    • SNS request
Card Set
Bioterrorism and Emergency Preparedness
Bioterrorism and Emergency Preparedness
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