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NAPLEX 2024 > 81. Toxicology > Flashcards

81. Toxicology Flashcards

1
Q

eWhat are some common C-R packaging?

A

Screw caps
Unit-dose packaging
Card adherence
Safety packaging

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2
Q

Initial overdose management for topical exposure

A

Removed contaminated clothing and wash skin with soap and water for 10 min to remove poison from skin

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3
Q

Initial overdose management for ocular exposure

A

Remove contact lenses and rinse eye(s) with gentle stream of water for at least 15 min

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4
Q

When should 911 be called for overdose?

A

It pt is unconscious, having difficulty breathing, appears agitated or having seizure

If pulseless, do CPR

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5
Q

Activated charcoal is most effective when used within ___

A

1 hr of ingestion

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6
Q

How does activated charcoal work?

A

Adsorbs drug, which prevents GI absorption and systemic tox

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7
Q

What is typical dosing for activated charcoal?

A

1g/kg

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8
Q

Prior to using activated charcoal, the air way should be. ___

A

protected (with intubation if needed) to prevent aspiration

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9
Q

When is activated charcoal contraindicated?

A

When airway is unprotected - unconscious, cannot clear throat, cannot hold head upright
Intestional obstruction
GI tract not intact or when there is decreased peristalsis

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10
Q

Hydrocarbons such as ____ can increase risk of aspirations

A

petroleum products including gasoline and paint thinner

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11
Q

Hepatotoxicity is dose-dependent adverse effect caused by increased metabolism of acetaminophen by CYP___ to ____

A

CYP2E1
NAPQI

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12
Q

How does NAPQI cause liver injury/failure

A

Covalently binds to liver cell proteins and cause liver injury&raquo_space; liver failure

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13
Q

Describe Phase 1 of APAP tox

A

1-24 hrs
commonly asymptomatic or non-specific symptoms, such as N/V

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14
Q

Describe Phase 2 of APAP tox

A

24-48hrs
Labs elevated INR, AST/ALT
Any symptoms from phase 1 usually subside

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15
Q

Describe Phase 3 of APAP tox

A

48-96hrs
Fulminant hepatic failure (e.g. jaundice, coagulopathy, renal failure, and/or death)

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16
Q

Describe Phase 4 of APAP tox

A

> 96 hrs
Pt recovers or receives a liver transplant

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17
Q

How does NAC work for APAP tox?

A

NAC (Acetadote) is free radical scavenger and precursor to glutathione (GSH), ultimately increasing GSH&raquo_space; GSH converts NAPQI to mercapturic acid&raquo_space; safely excreted

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18
Q

NAC formulations

A

PO and IV

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19
Q

Typical dosing for oral NAC vs IV NAC

A

Oral: high dose given once, then lower dose for 17 doses, repeat if emesis occurs within 1 hr of admin

IV: 3 infusions over total of 21 hrs

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20
Q

Symptoms of anticholinergic overdose (atropine, diphenhydramine, dimenhydrinate, scopolamine, Atropa belladonna (Deadly nightshade), jimson weed)

A

Flushing - red as a beet
Dry skin and mucous membranes - dry as a bone
Mydriasis with double/blurry vision - blind as a bat
Altered mental status - mad as a hatter
Fever - hot as a hare

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21
Q

Andexanet alfa (Andexxa) can reverse which anticoags?

A

Apixaban, rivaroxaban

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22
Q

Treatment for anticholinergic overdose

A

Primarily supportive care
Rarely physostigmine is given - inhibits enzyme that breaks down ACh, acetylcholinesterase, which increase ACh and decrease anticholinergic toxicity

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23
Q

Idarucizumab (Praxbind) can reverse which anticoags?

A

Dabigatran

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24
Q

Phytonadione (Vit K) can reverse which anticoags?

A

Warfafrin

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25
Q

Protamine can reverse which anticoags?

A

Heparin, LMWH

26
Q

Prothrombin complex concentrate (Kcentra) can reverse which anticoags?

A

warfarin, factor Xa inhibitors

27
Q

Treatment for antipsychotic overdose

A

Primarily supportive care
Bezntropine can be given for dystonias and bicarbonate can be given if QRS-interval widening

28
Q

Treatment for BZD overdose

A

Flumazenil - can cause seizures when used in pts on BZD chronically
Sometimes used off label for non-BZD hypnotic overdose (e.g. zolpidem) but not routinely recommended

29
Q

Treatment for beta-blocker overdose

A

Glucagon (if unresponsive to symptomatic treatment)
High dose insulin with glucose may be used in pts refractory to glucagon
Lipid emulsion to enhance elimination of some lipophilic drugs

30
Q

Treatment for CCB overdose

A

Same as beta-blockers:
Glucagon (if unresponsive to symptomatic treatment)
High dose insulin with glucose may be used in pts refractory to glucagon
Lipid emulsion to enhance elimination of some lipophilic drugs

PLUS calcium (chloride or gluconate): IV only, avoid fast infusion, monitor ECG, do not infuse calcium in same line as phosphate-containing solutions

31
Q

Treatment for cyanide (smoke inhalation, nitroprusside in high doses/long durations/renal impairment) overdose

A

hydroxocobalamin (Cyanokit)
Sodium thiosulfate + sodium nitrite (Nithiodote)

32
Q

Treatment for digoxin, oleander, foxglove overdose

A

Digoxin immune fab (DigiFab)
Each DigiFab 40mg vials binds ~0.5mg digoxin; when amt ingested or digoxin level is unknown, max adult dose is 20 vials
Interferes with digoxin levels drawn after it has been given

33
Q

Treatment for ethanol (alcoholic drinks) toxicity

A

If suspected chronic alcohol user, administer thiamine (vit B1) to prevent Wernicke’s encephalopathy (neurological damage)
Can cause increase anion gap

34
Q

Treatment for heavy metal (arsenic, copper, gold, lead, mercury, thallium) toxicity

A

Dimercaprol: aresenic, gold, mercury
Dimercaprol + CaNa2 EDTA OR Succimer (Chemet) + DMSA: Lead
Penicillamine: copper
Ferric hexacyanoferrate (“Prussian blue” (Radiogardase)): Thallium

35
Q

Treatment for hydrocarbon (petroleum products) toxicity

A

Do not induce vomiting
Keep pt NPO d/t aspiration risk

36
Q

Treatment for insulin or other hypoglycemic toxicity

A

Dextrose injection or infusion (drip), oral glucose (do not administer if unconscious)
Glucagon (when IV or PO dextrose cannot be administered)
SU-induced hypoglycemia: octreotide (Sandostatin)

37
Q

Teratment for isoniazid toxicity

A

Pyridoxine (Vit B6), BZD and/or barbituates
For acute neurotox (seizure, coma), administer IV pyridoxine
PO pyridoxine 10-50mg used daily with isoniazid to prevent neuropathies

38
Q

Treatment for iron and aluminum toxicity

A

Deferoxamine (Desferal): iron and aluminum

39
Q

Treatment for organophosphates (OPs) including industrial insecticides) toxicity

A

OPs block ACE which increase ACh levels and causes cholinergic “SLUDD” symptoms salivation, lacrimation, urination, diarrhea/defecation

Atropine - anticholinergic which blocks effect of ACh to reduce SLUDD symptoms
Pralidoxime (Protopam) - treats muscle weakness and relieves paralysis or respiratory muscles by reactivating cholinesterase that was inactivated by exposure to OPs

Atropine and pralidoxime combo can be used (DuoDote)

40
Q

Treatment for methotrexate toxicity

A

Leucovorin (folinic acid), levoleucovorin (Fusilev), glucarpidase (Voraxaze) - rescue after high dose in cancer treatment, after accidental overdose or to reduce tox wand counteract effects of impaired elimination

41
Q

Treatment for methemoglobinemia from topical benzocaine (in OraGel or teething products), dapsone, nitrates, or sulfonamides

A

Methylene blue (ProvayBlue)

Note: contraindicated in pts with G6PD deficiency; avoid admin with SSRIs and SNRIs

42
Q

Treatment for neostigmine, pyridostigmine toxicity

A

Pralidoxime (Protopam) - counteracts muscle weakness and/or respiratory depression secondary to overdose of ACE meds used to treat myasthenia gravis

Atropine or glycopyrrolate can be given to prevent bradycardia from neostigmine

43
Q

Early symptoms of nicotine (including e-cig) toxicity

A

Abd pain, nausea, diaphoresis, tachycardia, tremors

44
Q

Later symptoms of nicotine (including e-cig) toxicity

A

Bradycardia, dyspnea, lethargy, coma, seizures

45
Q

Treatment for nicotine (including e-cig) toxicity

A

Supportive care (e.g. atropine for symptomatic bradycardia, BZDs used for seizures)

46
Q

what can be used to reveres paralytics (e.g. rocuronium, vecuronium, pancuronium)

A

Neostigmine methylsulfate (Bloxiverz): rocuronium, vecuronium, pancuronium
Sugammadex (Bridion): rocuronium, vecuronium

47
Q

Treatment of salicylate toxicity

A

Salicylates are acidic.
Sodium bicarbonate is alkalinizing agent, can alkalinize urine&raquo_space; decrease drug reabsorption and increase excretion of salicylates and other weak acids

48
Q

Treatment of stimulant overdose (amphetamines including ADHD and weight loss drugs, cocaine, ephedrine, caffeine, theophylline, MDMA (ecstasy))

A

Supportive care for agitation or seizures (BZD)

49
Q

Treatment of toxic alcohols (ethylene glycol (antifreeze), diethylene glycol, ethanol) toxicity

A

Can cause increase anion gap
Fomepizole is preferred; ethanol (2nd line)

50
Q

Treatment of TCA overdose

A

Overdose can quickly cause fatal arrhythmias
Sodium bicarbonate - to decrease widened QRS complex
Supportive care for agitation/seizures (BZD) if present
Vasopressors may be needed for hypotension

51
Q

Treatment for valproic acid or topiramite-induced hypoammonemia

A

Levocarnitine (Carnitor)

52
Q

If opioids and acetaminophen were both ingested, ___ should be given first

A

naloxone

53
Q

What can be signs of opioid overdose?

A

Somnolence, shallow labored breathing, pinpoint pupils

Naloxone should be administered

54
Q

What can be used to determine if NAC should be given in APAP toxicity?

A

Rumack-Matthew nomogram

55
Q

Tachycardia, seizures or severe agitation can be from multiple causes. Give ___

A

BZD

56
Q

QT prolongation can be caused by ___. Check ECG and give ___ if QRS is widened.

A

TCAs
sodium bicarbonate

57
Q

Antidote for animal bites

A

Rabies vaccine (RabAvert, Imovax Rabies)
+ human rabies immune globulin (HyperRAB S/D, Imogam Rabies HT)

58
Q

Antidote for black widow spider bites

A

Antivenin for Latrodectus mactans

59
Q

Antidote for scorpion stings

A

Antivenin immune FAB Centruroides (Anascorp)

60
Q

Antidote for snake bites (eastern coral snake, Texas coral snake, copperhead, rattlesnake)

A

Crotalidae polyvalent immune FAB (CroFab) for copperhead and rattlesnake bites

Crotalidae Immune F(ab’)2 (Anavip) for rattlesnake bites)

NAPLEX 2024 (74 decks)

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