04-15 L3 ANS toxicology

Question 1

What is toxicology?

Answer 1

• Toxicology: the study of posisons (xenobiotics)
  
  • clinicial toxicology
  • toxinology
  • Environmental toxicology
  • Adverse drug reactions

Question 2

What is the hazard to health?

Answer 2

• Human health hazard
  
  • Inherent toxicity x Exposure (dose x time)
    
    • time: the greater the inherent toxicity the greater the hazard
    • dose: the larger the exposure the greatern the hazard

Question 3

What are the methods of getting poisoned?

Answer 3

• Inhalation
• Ingestion
• Absorption
• Injection

Question 4

What should you suspect in a 1 yo child that comes poisoned?

Answer 4

• the child should be evaluated for teh possibility of child abuse or neglect.

Question 5

What should you suspect in adolescents and young adults that are posioned?

Answer 5

• Overdose usually suicidal but may be drug abuse or experimentation
• consider underlying reasons, pregnancy sexual/physical/mental abuse, school/peer failure, sexual orientation

Question 6

What is your approach to someone that is OD?

Answer 6

• A: airway is primary improtance
• B: breathing, C ciruculation D disabilyt (dextrostix)
• D= don’t coma cocktail

Question 7

What are the two things a brain needs to operate?

Answer 7

• O2 and glucose
• hypoglycemia: is the great pretender in toxicology
• Hypo/hyperthermia is the runner up get core temp.

Question 8

What are the 4 classes of toxidromes?

O-CAS

Answer 8

• Opioid (CNS, PNS and GI tract)
• Cholinergic (parasympathetic NS)
• **Anticholinergic **( parsympethic CNS, PNS)
• Sympathomimetic (sympethetic NS (NE, Epi, dopa)

Question 9

What are toxic syndormes?

Answer 9

Toxic syndromes: group of s/s that point to a particular class of toxins.

Question 10

Which autonomic sydrome do you see

an increase in all of the following

a decrease in all of the following

BP, PR, Pupil size, Sweating

Answer 10

• Sympatholytic inhibition
  
  • Decrease in
    
    • BP
    • PR
    • Pupil size
    • sweating
    • peristalsis
• Nicotinic inhibition
  
  • increase in
    
    • BP
    • PR
    • Pupil size
    • sweating
    • peristalsis

Question 11

Opioid toxidrome

name the classic triad

what are the effects on the heart and BP

Answer 11

Opioid toxidrome

• Miosis
• Respiratory depression
• coma
• hypotension and bradycardia

Question 12

Cholinergic toxidrome

DUMB-BELS

what can come out of the body and the heart + lungs

What are the agents

Answer 12

Cholinergic toxidrome

• DUMB-BELS
  
  • Defecation, Urinartion, Miosis, Bradycardia, Bronchorrhea, Emesis, Lacrimation, Salivation
• Agents
  
  • Insecticides: (ACh-ase inhbitor) carbamates, organophosphates
  • Nerve agents: sarin (GB), VX
  • Myasthenia agnets: (revesible ACh-ase inhibitor) Edrophonium, pyridostigmine

Question 13

Anticholinergic toxidrome

causes

effects

Answer 13

Anticholinergic toxidrome

• causes (DAAT)
  
  • Datura Inoxium, Atropine, Antihistamines, TCAs
• effects
  
  • red, hot, blind, dry, mad, bowels and bladder loss tone
  • red as a beet, hot as a stone, blind as a bat, dry as a bone, mad as a hatter, and the heart runs alone. bowel and bladder have lost their tone.

Question 14

Sympathomimetic toxidrome

think withdrawal (alcohol, benzos)

• Causes
• Effects

Answer 14

Sympathomimetic toxidrome

• Causes (RACCE)
  
  • Ritalin,amphetamines, Caffeine, cocaine, ephedrine, (methylphenidate: or a nun keeps the kid in check)
• Effects (DT-HHAM)
  
  • diaphroesis, tacycardia, Hypertension, , hyperpyrexia, anxiety/delirium, mydriasis