21 Random Final Questions Part 2

Question 1

What is the Vulnerable Elders Survey?

Answer 1

Self-rating of health from poor to excellent

Question 2

What positive outcomes are you looking for in patients who have HTN/CHF?

Answer 2

Increased exercise tolerance. Reduced MI risk

Question 3

What positive outcomes are you looking for in patients who have Depression?

Answer 3

More independent. Greater activities. Better relationships

Question 4

What positive outcomes are you looking for in patients who have Arthritis?

Answer 4

Better conditioning. Improved mobility. More independent

Question 5

For Vital Sign Toxidromes, which drugs cause Bradycardia?

Answer 5

PACED. Propranolol. Anticholinesterases. Clonidine, CCBs. Ethanol. Digoxin

Question 6

For Vital Sign Toxidromes, which drugs cause Tachycardia?

Answer 6

FAST. Free base cocaine. Anticholin, Antihistamine, Amphetamines. Sympathomimetics. Theophylline

Question 7

For Vital Sign Toxidromes, which drugs cause Hypotension?

Answer 7

CRASH. Clonidine, CCBs. Reserpine and other anti-HTN. Antidepressants. Sedative/hypnotics. Heroin (opiates)

Question 8

For Vital Sign Toxidromes, which drugs cause Hypertension?

Answer 8

CT-SCAN. Cocaine. Theophylline. Sympathomimetics. Caffiene. Anticholinergics, Antihistamines. Nicotine

Question 9

What are some toxins with Delayed Absorption?

Answer 9

Carbamazepine. Concretions (Iron, ASA, Theophylline). Atropine

Question 10

What are some toxins with Delayed Mechanism?

Answer 10

Anticoagulants. MAO-I. Sulfonylureas. Thyroid hormones

Question 11

What are some toxins with Toxic Metabolites?

Answer 11

APAP. Methanol

Question 12

What are some common drugs not picked up during a drug screen?

Answer 12

Clonidine. Carbon monoxide. CCBs. B-blockers. Digoxin. B-agonists. Iron. Colchicine

Question 13

What are the ADRs with Ipecac?

Answer 13

Mallory-Weiss tear. Drowsiness, lethargy, and diarrhea in children

Question 14

What are some poorly bound substances that Activated Charcoal won’t work with?

Answer 14

Lithium, Iron, Cyanide, Ethanol

Question 15

When does Charcoal Fail?

Answer 15

PHAILS. Pesticides. Hydrocarbons, heavy metals, > 1 hour. Acids, Alkali, Alcohols, Aspiration risk. Iron, Intestinal obstruction. Lithium, Lack of gag reflex. Solvents, Seizures

Question 16

When can Whole Bowel Irrigation be used?

Answer 16

COINS. Carbamazepine, Cocaine body packers, Charcoal, CCBs. Opiates. Iron, Lead (heavy metals; useful b/c charcoal can’t). Antidepressants. Sustained-release/enteric-coated preparations

Question 17

What antidote is used for APAP?

Answer 17

N-Acetylcysteine

Question 18

What is considered a toxic dose of APAP?

Answer 18

> 140mg/kg (> 200mg/kg in kids < 6 yo)

Question 19

During APAP overdose, what time frame do you see the peak abnormalities including anorexia, nausea, confusion, coma, JAUNDICE, coagulopathies?

Answer 19

72-96 hours

Question 20

What are the indicators of poor outcome with APAP overdose?

Answer 20

Development of acute liver failure, PT > 100 seconds, Grade 3 or 4 encephalopathy, Cerebral edema, Renal failure (SCr > 3.4), and Metabolic acidosis (pH < 7.3)

Question 21

When looking at the nomogram chart for probable hepatic toxicity with APAP, what are the limitations?

Answer 21

Extended-release Tylenol. Chronic supratherapeutic ingestion. If charcoal administered prior to 4 hours

Question 22

When is N-Acetylcysteine indicated?

Answer 22

Serum APAP concentration following acute ingestion is above the “possible hepatic toxicity” line on the Rumack-Matthew nomogram. Estimated single ingestion > 150mg/kg or there is a delay in acquiring a serum APAP concentration. Time of ingestion is not known and serum APAP > 10mg/mL. Evidence of hepatotoxicity and history of supratherapeutic APAP ingestion

Question 23

When is IV N-Acetylcysteine indicated?

Answer 23

Patient vomiting. Continuous GI decontamination. GI bleed, obstruction. Encephalopathy or already existing acute liver failure. Neonatal/infant poisoning. Acetadote used (20 and 48 hour regimens (48 given if presenting late to clinic or possible increased enzymes already))

Question 24

What are the steps in ASA and Salicylate toxicology?

Answer 24

Stimulation of the respiratory center in the brainstem causes rapid and deep respiration –> Respiratory alkalosis –> decreased bicarbonate. Uncoupling of oxidative phosphorylation –> increases oxygen consumption, metabolic acidosis, less bicarbonate available to neutralize –> combined acidosis

Question 25

What are the treatment options for Iron Poisoning?

Answer 25

Whole Bowel Irrigation (+) abdominal x-rau. Lavage (use normal saline). Deferoxamine (make sure they have good renal function): forms complex with iron, renally eliminated. NO Ipecac or Charcoal (iron not bound)

Question 26

What endpoint do you want to reach with Deferoxamine?

Answer 26

Urine clear 24 hours, Fe < 100-150, no symptoms, UFe/Cr

Question 27

What can Isoniazid toxicity cause?

Answer 27

Profound lactic acidosis, Seizures, Hyperglycemia, Coma; rhabdomyolysis. NO toxicity screen, treat on suspicion

Question 28

What is used to treat Isoniazid?

Answer 28

Vitamin B6 (Pyridoxine) IV given as gram for gram equivalent (if unknown, give 5 grams). Effects reverse rapidly