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9) Toxic Flashcards

1
Q

antidote?

A

Neutralizes a specific toxin

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2
Q

cyanide) primary threat to life in a cyanide ingestion?

A

Cellular asphyxia

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3
Q

What should be your primary concern for a patient who ingested drain cleaner?

A

Potential airway compromise

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4
Q

Pt ingested fifty 325mg ASA tablets Med Rx

A

Activated charcoal

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5
Q

Rx for a narcotic OD n unresponsive patient?

A

2 mg of Naloxone

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6
Q

Lithium used to treat?

A

Bipolar disorder

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7
Q

Which class of drugs is commonly abused to produce hyperactivity and exhilaration?

A

Amphetamines

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8
Q

What are Versed Valium & Ativan examples of?

A

Benzodiazepines

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9
Q

What medication is not appropriate for a patient experiencing severe muscle spasms after a black widow spider bite?

A

Sodium bicarbonate

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10
Q

Continued use of a drug despite harmful effects?

A

Addiction

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11
Q

type of substances cause injury by inducing liquefaction necrosis?

A

Alkalis

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12
Q

What should you suspect in a Pt heating their home w/ wood & experiencing flu-like symptoms?

A

Carbon monoxide poisoning

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13
Q

med combination is beneficial for a lithium OD

A

Mannitol and Sodium Bicarb

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14
Q

Which class of mushrooms is responsible for over 90% of deaths from mushroom toxicity?

A

Amanita

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15
Q

S/S would you least expect in a patient who took too many Cardizem tablets?

A

Warm, dry skin and tachycardia.

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16
Q

How does a substance enter the body through the gastrointestinal tract?

A

Ingestion

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17
Q

What best describes the MOA of activated charcoal?

A

It adsorbs toxins in the stomach

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18
Q

How is alcohol classified?

A

CNS Depressant

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19
Q

primary goal in prehospital care for a pit viper bite?

A

Slow absorption of the venom

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20
Q

Med class would likely cause hypertension after eating cheese and drinking red wine?

A

Monoamine Oxidase Inhibitors

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21
Q

What S/S suggest ingestion of Amanita mushrooms?

A

Abdominal cramping, watering eyes, vomiting, diarrhea, and sweating.

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22
Q

What reduces the half-life of carboxyhemoglobin to approximately 22 minutes?

A

Hyperbaric oxygen therapy

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23
Q

a pharmaceutical agent is used for something other than its intended use?

A

Substance abuse

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24
Q

What do copious secretions, lacrimation, vomiting, and evidence of urination and defecation suggest?

A

Cholinergic exposure

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25
Q

What statement indicates possible cyanide exposure?

A

“I have been burning carpets and old furniture all day.”

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26
Q

What is a highly toxic, odorless, tasteless gas from incomplete combustion?

A

Carbon monoxide

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27
Q

Narcan act as an antagonist to?

A

Opiate meds; Heroin, Morphine, fentynl

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28
Q

most important question to ask a pt who ingested 30 tabs of Lexapro & 24 tablets of Tylenol PM?

A

“How long ago did you take these medications?”

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29
Q

poison def

A

Any substance that damages body function

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30
Q

toxin def

A

Poisonous substance from bacteria, animals, plants

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31
Q

substance abuse def

A

Misuse of substances for effect

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32
Q

overdose def

A

Toxic dose of a drug

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33
Q

routes of poison entry?

A

Ingestion, inhalation, absorption, injection

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34
Q

rx for ingested poisons?

A

Gastric lavage (within 1hr), activated charcoal (1-2 g/kg)

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35
Q

rx for inhaled poisons?

A

Move PT to fresh air, call HazMat for toxic gases, consider CPAP/advanced airway

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36
Q

rx for carbon monoxide poisoning?

A

100% O2, CPAP, monitor for arrhythmias

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37
Q

rx for beta blocker overdose?

A

Glucagon (3-10 mg IVP, then 3-5 mg/hr infusion)

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38
Q

rx for calcium channel blocker overdose?

A

Calcium chloride (1-2 g IV), glucagon (3-10 mg IVP, then 3-5 mg/hr infusion)

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39
Q

S/S of tricyclic antidepressant overdose?

A

Wide QRS, seizures, tachycardia

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40
Q

med Rx for tricyclic antidepressant overdose?

A

Sodium bicarb

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41
Q

SSRI OD serotonin syndrome

A

Mild: Tachycardia, diaphoresis, mydriasis; Severe: Hypertension, acidosis, seizures

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42
Q

SSRI OD Rx

A

Benzodiazepines, fluids

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43
Q

What are the signs and symptoms of opiate overdose?

A

Respiratory depression, miosis

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44
Q

opiate OD Rx

A

Naloxone (0.4-2 mg IV/IM/IN)

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45
Q

What are cholinergic agents associated with?

A

SLUDGEM/DUMBELS

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46
Q

What is the treatment for cholinergic agents?

A

Atropine + Pralidoxime (DuoDote)

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47
Q

What is the treatment for snakebite?

A

Keep PT calm/supine, no ice/tourniquet, transport ASAP

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48
Q

activated charcoal contraindications

A

Altered mental status, ingestion of caustics, acids, or hydrocarbons, late presentation (>1 hour post-ingestion)

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49
Q

What are the late signs of carbon monoxide poisoning?

A

Cherry-red skin

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50
Q

What are the symptoms of chlorine gas exposure?

A

Pulmonary edema, bronchospasm

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51
Q

S/S of beta blocker overdose?

A

Profound bradycardia, heart blocks, hypoglycemia (especially in pediatrics), mental status depression

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52
Q

What advanced treatment is considered for calcium channel blocker overdose?

A

Consider high-dose insulin euglycemia therapy (HIET), vasopressors (dopamine, norepinephrine) if refractory shock

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53
Q

What are the advanced signs and symptoms of tricyclic antidepressant overdose?

A

QRS >100ms = seizure risk, QRS >160ms = ventricular dysrhythmias, terminal R wave in aVR >3mm = severe toxicity

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54
Q

What is the first-line treatment for tricyclic antidepressant overdose?

A

Sodium Bicarb (1-2 mEq/kg IV push)

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55
Q

What are the early signs of serotonin syndrome in SSRI overdose?

A

Diaphoresis, tremors, tachycardia, mydriasis

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56
Q

What are the severe cases of serotonin syndrome in SSRI overdose?

A

Hyperthermia (>106°F), DIC, multi-organ failure

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57
Q

What is the treatment for serotonin syndrome?

A

Cooling measures, benzodiazepines for agitation, cyproheptadine (serotonin antagonist)

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58
Q

What are the signs and symptoms of cyanide poisoning?

A

Hypoxia with normal SpO2, metabolic acidosis

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59
Q

What is the treatment for cyanide poisoning?

A

Hydroxocobalamin (Cyanokit) - 5g IV over 15 min, sodium thiosulfate if kit unavailable

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60
Q

What are the early signs of salicylate poisoning?

A

Tinnitus, nausea, vomiting

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61
Q

What are the late signs of salicylate poisoning?

A

Metabolic acidosis, respiratory alkalosis, hyperthermia

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62
Q

What is the treatment for salicylate poisoning?

A

Sodium bicarbonate drip (urine alkalinization), hemodialysis for severe toxicity (>100 mg/dL level)

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63
Q

What is indicated if acetaminophen level is >150 mcg/mL at 4 hours post-ingestion?

A

NAC is indicated

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64
Q

What is the IV NAC dosing for acetaminophen poisoning?

A

150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours

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65
Q

What should be monitored after Narcan administration in opiate overdose?

A

Monitor for re-sedation after Narcan wears off (~30-90 min half-life)

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66
Q

What is the starting dose of Narcan for chronic opiate users?

A

Start with low-dose Narcan (0.1-0.2 mg IV) to avoid withdrawal

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67
Q

What is required for nerve agents in cholinergic poisoning?

A

Atropine + 2-PAM ASAP

68
Q

What is required for organophosphate poisoning?

A

Requires large doses of Atropine (2-4 mg IV q5 min)

69
Q

What are the symptoms of anticholinergic overdose?

A

“Hot as a hare” (hyperthermia),
“Red as a beet” (flushed skin),
“Dry as a bone” (dry mucosa, no sweating),
“Blind as a bat” (mydriasis, blurry vision),
“Mad as a hatter” (delirium, hallucinations)

70
Q

What is the treatment for anticholinergic overdose?

A

Benzodiazepines for agitation, physostigmine (if severe delirium & no QRS widening)

71
Q

What are the symptoms of snakebite envenomation?

A

Local swelling, ecchymosis, DIC, shock

72
Q

What is the treatment for snakebite envenomation?

A

Keep limb neutral position, no ice, no tourniquet, CroFab antivenom for rattlesnake/cottonmouth bites

73
Q

What are the symptoms of a black widow spider bite?

A

Muscle spasms + neurotoxin symptoms

74
Q

What is the treatment for black widow spider bite?

A

Benzodiazepines (Diazepam 2.5-10 mg IV for spasms), calcium gluconate (0.1-0.2 mg/kg IV)

75
Q

What are the symptoms of a brown recluse spider bite?

A

Necrotic ulcer, hemolysis, DIC

76
Q

What is the treatment for brown recluse spider bite?

A

Supportive wound care, antibiotics if infected

77
Q

What are the advanced details of scorpion sting?

A

Bark scorpion venom: Neurotoxic, leads to cholinergic crisis

78
Q

What is the treatment for scorpion sting?

A

Benzodiazepines for muscle spasms, scorpion-specific antivenom

79
Q

What are some neurotoxins that cause excessive neurotransmitter release?

A

Black widow venom, scorpion venom, organophosphates cause overstimulation of the nervous system.

80
Q

What is the treatment for neurotoxin-induced overstimulation?

A

Benzodiazepines (Midazolam, Diazepam) increase GABA, which inhibits excitatory pathways.

81
Q

What is an example of a neurotoxin that induces hyperpolarization?

A

Tetrodotoxin (pufferfish poison) blocks voltage-gated Na+ channels, leading to paralysis.

82
Q

What is the treatment for tetrodotoxin poisoning?

A

Supportive care (mechanical ventilation), no antidote.

83
Q

What does black widow spider venom cause?

A

Massive acetylcholine & catecholamine release leading to severe muscle spasms, cramping, tachycardia, hypertension.

84
Q

What is the treatment for black widow spider envenomation?

A

Benzodiazepines (Diazepam 2.5-10 mg IV) to relax muscles and Calcium Gluconate to reduce excessive neurotransmitter release.

85
Q

What are organophosphates and their effects?

A

They block AChE, causing excess acetylcholine at synapses and cholinergic crisis (SLUDGEM).

86
Q

What is the treatment for organophosphate poisoning?

A

Atropine (blocks muscarinic ACh receptors) and Pralidoxime (2-PAM) to reactivate AChE.

87
Q

What is the effect of tetanus toxin on the CNS?

A

Blocks GABA & Glycine release, leading to uncontrollable muscle contractions (spastic paralysis).

88
Q

What are the signs and symptoms of tetanus toxin effect?

A

Trismus (lockjaw), risus sardonicus, opisthotonos.

89
Q

What is the treatment for tetanus toxin effect?

A

Benzodiazepines (Midazolam, Diazepam) for muscle relaxation and Tetanus Immunoglobulin (TIG).

90
Q

What causes hypokalemia and its effects?

A

Low extracellular K+ makes it harder to reach threshold potential, leading to muscle weakness and paralysis.

91
Q

What are common causes of hypokalemia?

A

Diuretics, alkalosis, diarrhea.

92
Q

What is the treatment for hypokalemia?

A

Potassium replacement (KCl IV if severe, PO if mild) and monitor ECG for U waves, prolonged QT.

93
Q

What is hyperkalemia and its effects?

A

Increased extracellular K+ makes depolarization easier, leading to prolonged action potentials and dysrhythmias.

94
Q

What does the ECG show in hyperkalemia?

A

Peaked T waves, widened QRS, eventual sine wave pattern.

95
Q

What is the treatment for hyperkalemia?

A

Calcium Gluconate (stabilizes cardiac membrane), Insulin + Dextrose (shifts K+ into cells), Sodium Bicarbonate (if acidosis is present).

96
Q

What is the pharmacodynamics of benzodiazepines?

A

They bind to GABA-A receptors, increasing chloride influx, resulting in neuronal hyperpolarization and CNS depression.

97
Q

What are the uses of benzodiazepines?

A

Organophosphate toxicity (seizures), alcohol withdrawal, black widow spider envenomation.

98
Q

What is naloxone (Narcan) used for?

A

It is a competitive antagonist at opioid (mu) receptors, reversing opioid-induced respiratory depression.

99
Q

What is the half-life of naloxone?

A

Approximately 30-90 minutes, which may necessitate repeat doses.

100
Q

What is flumazenil used for?

A

It is a competitive antagonist at GABA-A receptors, used for benzodiazepine overdose, but carries a risk of seizure in chronic users.

101
Q

What is the role of sodium bicarbonate in TCA overdose?

A

It increases serum pH, shifting the drug off cardiac sodium channels and narrowing the QRS complex.

102
Q

What does glucagon do in beta blocker and CCB overdose?

A

It increases cAMP in cardiac cells, bypassing β-receptor blockade, improving inotropy and heart rate.

103
Q

What is hydroxocobalamin (Cyanokit) used for?

A

It binds cyanide, forming B12, which is excreted in urine.

104
Q

What is high-dose insulin euglycemia therapy (HIET) used for?

A

It enhances myocardial metabolism, restoring contractility in CCB overdose.

105
Q

What does magnesium do in torsades de pointes?

A

It blocks calcium influx at cardiac channels, stabilizing rhythm.

106
Q

What is the pathophysiology of hyperglycemia and DKA?

A

No insulin leads to cells not using glucose, resulting in ketone production and metabolic acidosis.

107
Q

What is the treatment for hyperglycemia and DKA?

A

IV Fluids (NS → D5 1/2 NS when BG <250 mg/dL) and IV Insulin Drip (0.1 U/kg/hr, no bolus in pediatrics).

108
Q

What is hypoglycemia and its effects?

A

Low glucose causes catecholamine release (epinephrine, glucagon), leading to altered mental status, tachycardia, diaphoresis.

109
Q

What is the treatment for hypoglycemia?

A

Dextrose (D10 in neonates, D25 in pediatrics, D50 in adults) and glucagon IM if no IV access.

110
Q

What is the mechanism of action of depolarizing neuromuscular blockers?

A

They bind to nicotinic receptors, keeping Na+ channels open, resulting in flaccid paralysis.

111
Q

What is succinylcholine used for?

A

Rapid sequence intubation (RSI).

112
Q

What are the cautions for using succinylcholine?

A

Avoid in hyperkalemia, burns, crush injuries.

113
Q

What are non-depolarizing neuromuscular blockers?

A

Competitive antagonists at nicotinic receptors that prevent depolarization, with slower onset and longer duration than succinylcholine.

114
Q

What is lead poisoning and its effects?

A

It binds sulfhydryl groups, inhibits heme synthesis, leading to anemia and cognitive decline.

115
Q

What is the treatment for lead poisoning?

A

EDTA or Succimer (chelators).

116
Q

What is iron poisoning and its effects?

A

It has a direct corrosive effect and causes free radical damage, leading to GI distress and metabolic acidosis.

117
Q

What is the treatment for iron poisoning?

A

Deferoxamine (binds free iron).

118
Q

What is mercury poisoning and its effects?

A

It is neurotoxic and inhibits cellular metabolism, causing tremors, ataxia, and personality changes (Mad Hatter syndrome).

119
Q

What is the treatment for mercury poisoning?

A

Chelation (Dimercaprol, Succimer).

120
Q

Poison/Toxin National Hotline Phone#

A

1-800-222-1222

121
Q

How can someone be exposed to a toxic substance?

A

Inhalation, ingestion, injection, absorption

122
Q

What are the four portals of entry?

A

Inhalation, ingestion, injection, absorption

123
Q

What is the most common way to be exposed to a toxic substance?

124
Q

What is the difference between poisoning and overdose?

A

Poisoning: exposure to toxic substance (accidental or intentional)
Overdose: excessive amount of a drug or substance taken (usually intentional or recreational)

125
Q

What key information should you obtain from someone who ingested a toxin or poison?

A

How long ago since your exposure

126
Q

What medication do we administer to a patient who suffers from chronic alcoholism?

A

Thiamine 100mg

127
Q

What is delirium tremens?

A

Life-threatening withdrawal syndrome in chronic alcoholics

128
Q

What is the medical treatment for patients who ingest or inhale a toxin?

A

Support ABCs first, remove from source, administer O2, consider activated charcoal if ingestion was recent, consider antidotes if known toxin, IV access, cardiac monitor, vitals, transport

129
Q

Rx of pt w/ surface-absorbed toxin
) Dry powder toxin Rx: brush off 1st, then flush w/ water; Liquid toxin Rx: flush thoroughly w/ water or saline

130
Q

How does carbon monoxide kill us?

A

CO binds to hemoglobin w/ 200× the affinity of O2 → prevents O2 from binding → cellular hypoxia despite normal SpO2

131
Q

What is hemoglobin bound with carbon monoxide called?

A

Carboxyhemoglobin (COHb)

132
Q

What different things does a CO-Oximeter detect?

A

O2Hb (oxygen-bound hemoglobin),
COHb (carbon monoxide),
MetHb (methemoglobin)

133
Q

What is the treatment for a patient that presents with CO poisoning?

A

Oxygen therapy and supportive care

134
Q

How does cyanide kill us?

A

Blocks cellular respiration → cells can’t use O2 even if plenty is available → rapid death

135
Q

What does cyanide smell like?

136
Q

How do we treat a patient with suspected cyanide poisoning?

A

Rx: O2 Cyanokit
Meds: Old school: amyl nitrite, sodium nitrite, sodium thiosulfate; New: Hydroxocobalamin (Cyanokit) → turns urine red

137
Q

What is the pathophysiology of cholinergic exposure?

A

Overstimulation of PSNS due to excessive acetylcholine (ACh) seen with organophosphates, nerve agents

138
Q

How do we treat cholinergic exposure?

A

Atropine, Pralidoxime (2-PAM), airway support

139
Q

How do we treat patients suspected of overdosing on beta blockers?

A

If unstable, administer Glucagon 3-10 mg IVP followed by 3-5 mg per hour infusion

140
Q

What are the signs and symptoms of beta blocker overdose?

A

Bradycardia, hypotension, bronchospasm, AMS

141
Q

How do we treat patients suspected of overdosing on calcium channel blockers?

A

1st Calcium Chloride 1-2Gs followed by IV infusion of the same dose per hour; 2nd Glucagon: 3-10 mg IVP followed by 3-5mg/Hr infusion

142
Q

What are the signs and symptoms of calcium channel blocker overdose?

A

N/V, H/A & AMS, cardiac arrhythmias, bradycardia, heart blocks, profound hypotension

143
Q

What are the signs and symptoms of cardiac glycoside (Digoxin) overdose?

A

N/V, visual disturbances (halos), bradycardia, arrhythmias

144
Q

What are the signs and symptoms of ace inhibitor overdose?

A

Hypotension, hyperkalemia, angioedema

145
Q

What is the treatment for tricyclic antidepressant overdose?

A

Na-Bicarb 1 ampule/50meq; if not working give another, beware of precipitation, influx of Na

146
Q

What are the signs and symptoms of tricyclic antidepressant overdose?

A

Dry mouth, urinary retention and constipation, respiratory depression, seizures, tachycardia & arrhythmias (wide QRS complexes)

147
Q

What are the signs and symptoms of MAO inhibitor overdose?

A

Tachycardia & palpitations, hypertension, hyperthermia, seizures

148
Q

What is serotonin syndrome?

A

Mild: Tachycardia, shivering, diaphoresis and mydriasis; Moderate: Mild symptoms plus hypertension and hyperthermia; Severe: Severe hypertension & tachycardia, acidosis, rhabdomyolysis, & seizures

149
Q

What is the treatment for lithium overdose?

A

Supportive care and possible dialysis

150
Q

What are the most common salicylates?

A

Aspirin, Oil of Wintergreen, Pepto Bismol, other Rx meds with codeine

151
Q

What does salicylate toxicity interrupt?

A

The normal function of the Kreb’s Cycle leading to anaerobic metabolic acidosis

152
Q

What is the treatment for salicylate toxicity?

153
Q

What is a common symptom of salicylate toxicity?

154
Q

What is the most lethal mushroom?

A

Amanita phalloides (death cap) → liver failure

155
Q

What does foxglove contain and what are its effects?

A

Contains digitalis-like compounds → bradycardia, arrhythmias

156
Q

What does nightshade contain and what are its effects?

A

Contains atropine-like alkaloids → anticholinergic toxicity (dry mouth, tachycardia, hallucinations)

157
Q

What are the identifying marks of a brown recluse spider?

A

Violin-shaped mark on back

158
Q

What type of toxin does a brown recluse spider have and what is the treatment?

A

Cytotoxic venom Painless bite → necrotic ulcer over hours to days

159
Q

What type of toxin does a black widow spider have and what is the treatment?

A

Neurotoxic venomCauses severe muscle cramps/spasms, abdominal rigidity, HTN, tachycardia

160
Q

What is the most lethal scorpion?

A

Arizona bark scorpion

161
Q

What type of toxin do pit viper snakes have and what are the effects?

A

Hemotoxic (damages blood vessels/tissues → swelling, bruising, coagulopathy)

162
Q

What is a dry bite?

A

Defensive bite without venom

163
Q

What are the identifying marks of a coral snake?

A

“Red on yellow, kill a fellow. Red on black, friend of Jack”

164
Q

What type of toxin does a coral snake have and what are its effects?

A

Neurotoxic (affects nervous system → paralysis, respiratory depression)

165
Q

How do coral snakes envenomate a person?

A

Little teeth saw

Med EMRG (15 decks)

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