9 - Toxicology Flashcards
Approach to Poisoned Patient (ABCD)
Airways
Breathing
Circulation
Dextrose (especially if diabetic, 50% regains consciousness)
Approach to Poisoned Patient: Activated Charcoal prevents?
Toxin absorption
Approach to Poisoned Patient: Gastric Lavage
Removal of toxin from GIT
Approach to Poisoned Patient: Ionized diuresis
Facilitates excretion of toxin (Aspiring/Acidic drugs, give NaHCO3)
Opioids (Morphine) Poisoning
Give Naloxone
Benzos Poisoning
Give Flumazenil
Acetaminophen Poisoning
Give acetylcysteine
Fibrinolytics Poisoning
Give aminocaproic acid
Digoxin Poisoning (3)
K+
Atropine
Digoxin antibodies
Heparin Poisoning
Give Protamine sulfate
Warfarin Poisoning
Give Vitamin K
Methotrexate Poisoning
Give Leucovorin
Cyclophosphamide Poisoning
Give MESNA
Isoniazid Poisoning
Pyridoxine (B6)
Cholinergic (insecticides) Poisoning
Atropine and PAM
Anticholinergic Poisoning
Physostigmine
Beta Blockers Poisoning
Glucagon
Cyanide Poisoning (2)
Amyl nitrate + thiosulfate
Hydroxocobalamin
Methemoglobinemia Poisoning
Methylene blue
Methanol Poisoning
Ethanol
Ethylene Glycol Poisoning
Fomepizole
Arsenic, Gold, Mercury Poisoning
Dimercaprol (BAL)
Lead Poisoning (3)
CaEDTA
Dimercaprol
Succimer
Cooper Poisoning (2)
Penicillamine
Trientine
Iron Poisoning
Deferoxamine
Chelator Pharmacology Defined
To prevent or reverse the toxic effects of a heavy metal
Chelator Pharmacology: Dimercaprol (IM) Use (3)
AKA BAL
Aresenic, Lead, Mercury
Chelator Pharmacology: Succimer Use (DMSA Oral)
Water soluble of BAL
Arsenic, Lead, Mercury
Chelator Pharmacology: Unithiol (DMPS, oral) Use (3)
Mercury
Arsenic
Bismuth
Chelator Pharmacology: Edetate Calcium Disodium Use (5)
Lead
Zinc
Manganese
Plutonium
Curium
Chelator Pharmacology: Penicillamine (Oral) Use (3)
Copper
Wilson disease
Rheumatoid arthritis
Chelator Pharmacology: Deferoxamine (IM/IV) Use (2)
Iron
Aluminum
Chelator Pharmacology: Deferasirox (Oral) (1)
Iron
Chelator Pharmacology: Prussion Blue (Oral) Use (2)
Radiactive cesium
Thallium
Lead primarily affects the (3)
Nervous System
GIT
Hematopoietic system
Lead Poisoning X-Ray Clinical Presentation (2)
Lead lines on Gingivae (Buton’s Lines) and metaphyses
Lead lines metaphyses of long bones o x-ray
Acute Lead Poisoning Symptoms (3)
Tinnitus
Encephalopathy
Abdominal Colic
Chronic Lead Poisoning Symptoms (5)
Anemia (decrease heme)
Wrist drop
Proteinuria
Decrease fertility
Pica (leads to mental retardation)
Lead Poisoning in Children Rx
Succimer PO
Lead Poisoning in Adults Rx (3)
Dimercaprol
EDTA
Penicillamine
Arsenic is found in (3)
Pesticides
Wood preservatives
Ant Poisons
Acute Arsenic Poisoning Symptoms (3)
Rice watery stools
Garlic breath
Seizures
Chronic Arsenic Poisoning Symptoms (2)
Stocking glove neuropathy
Alopecia
Arsenic Poisoning Buzzword (3)
Dimercaprol
Unithiol
Succimer
Acute Iron Poisoning in Children Presentation (3)
Necrotizing Gastroenteritis
Hematemesis
Bloody diarrhea
Iron Poisoning Rx (2)
IV Deferoxamine
PO Deferasirox
Acute Mercury Poisoning Symptoms of Vapor (1) and Salt Ingestion (1)
Vapor - pneumonitis
Salt ingestion - bleeding renal failure
Chronic Mercury Poisoning (3)
Auditory and Visual Loss
Ataxia
Paresthesia
Mercury Poisoning Rx (3)
Succimer PO
Dimercaprol (IM)
Unithiol
Copper Poisoning Disease and Rx
Wilson’s Disease
Rx: Penicillamine and Treintene
Substance Abuse: Opiates (Morphine, Heroin, Methadone) - Overdose (3)
Pinpoint pupils
Respiratory depression
Coma
Substance Abuse: Opiates (Morphine, Heroin, Methadone) Rx (1)
Naloxone
Substance Abuse: Opiates (Morphine, Heroin, Methadone) Withdrawal Symptoms (1)
Flu-like symptoms
Substance Abuse: Opiates (Morphine, Heroin, Methadone) Withdrawal Rx (2)
Cloniidine
Methadone
Substance Abuse: Amphetamine and Cocaine - Dopamine Receptors are located in
Nucleus accumbens
Substance Abuse: Amphetamine and Cocaine - Overdose Symptoms (3)
Euphoria
Hypervigilance
Paranoia
Substance Abuse: Amphetamine and Cocaine - Rx (2)
Haloperidol
Lorazepam
Substance Abuse: Amphetamine and Cocaine - Withdrawal Symptoms (3)
Dysphoric mood
Unpleasant dreams
Cocaine (crash)
Substance Abuse: Amphetamine and Cocaine - Withdrawal Rx (2)
Bromocriptine
Amantadine
Substance Abuse - Cocaine is a powerful inhibitor of?
Dopamine transporters (Causes dopamine to accumualte)
Substance Abuse: Cocaine produces what and reduces what?
Produces euphoria
Reduces fatigue
Substance Abuse: Barbs and Benzos Overdose (5)
Impaired judgment
Slurred speech
Uncoordination
Unsteady gait
Coma
Substance Abuse: Barbs and Benzos Overdose Rx
Flumazenil for Benzo
Substance Abuse: Barbs and Benzos Withdrawal (2)
Benzo - anxiety and rebound insomnia
Barb - life threatening seizures
Substance Abuse: Barbs and Benzos Overdose Rx
Sodium bicarbonate
Substance Abuse: Hallucinogens (LSD) Affect what receptors?
Serotonin receptors
Substance Abuse: Hallucinogens (LSD) Overdose Symptoms (4)
Idea of reference
Depersonalization
Illusions
Flashbacks
Substance Abuse: Hallucinogens (LSD) Rx (2)
Haloperidol
Diazepam
Substance Abuse: Hallucinogens (LSD) Withdrawal
None
Malignant Hyperthermia from what drugs (2)
Succinylchoine and volatile anesthetics
Malignant Hyperthermia Sxs (3) and Onset
Hyperthermia, hypertension, muscle rigidity
Onset within minutes
Malignant Hyperthermia Rx
Dantrolene
Serotonin Syndrome from what drugs? (6)
SSRI, MAOI, Linezolid
Sumatriptan, St.John wort, Ginseng, LSD
Serotonin Syndrome Sxs (5) and Onset
Hyperthermia, hypertension, tremors, clonus, mydriasis, coma
Onset: Within hours
Serotonin Syndrome: Rx
Benzos
Neuroleptic Malignant Syndrome from what drugs? (1)
D2-blocking antipsychotics
Neuroleptic Malignant Syndrome Sxs (3) and Onset
Hyperthermia, parkinsonism, hypertension
Onset and 1-3 days
Neuroleptic Malignant Syndrome Rx (3)
Diphenydramine
Botulenum
Dantrolene
PCP MOA
Binds to glutamate receptors –> prolonged depolarization
PCP Overdose Sx (3)
Vertical nystagmus
Impulsiveness
Violent behaviora
PCP Rx (3)
Dark room
Talk down
Haloperidol
PCP Withdrawal
None
Cannabis MOA
Inhibits Gaba
Cannabis Overdose Sxs (3)
Slowed time
Impaired judgment
Amotivational syndrome
Cannabis Rx (2)
Abstinence
Support
Cannabis Withdrawal
None
Nicotine MOA
Activates dopamine receptors
Nicotine Overdose Sx (3)
Headache
Increased depression
Impotency
Nicotine Overdose Rx (4)
Nicotine patch
Fluoxetine
Wellbutrin
Varenicline
Nicotine Withdrawal (5)
Irritability
Increased appetite
Anxiety
Depressed mood
Decreased heart rate
Nicotine Withdrawal Rx (2)
Education
Wellbutrin
Caffeine MOA
Antagonist of adenosine receptors
Caffeine Overdose Sxs (3)
Restlessness
Agitation
Insomnia
Caffeine Withdrawal Sxs (3)
Headache
Drowsiness
Nausea
Caffeine Rx (2)
Analgesics
Lower caffeine intake
Inhalants Types (2) and MOA (1)
Glue and paint thinner
MOA: GABA receptors
Inhalants overdose Sxs (3)
Uncoordination
Lethargy
Unsteady gait
Inhalants Rx (2)
Education
Counselling
Inhalants withdrawal (1)
None
Ethylene Glycol (antifreeze) and Methanol: Rx
Fomepizole (alcohol DH inhibitory)
Cyanide Poisoning Does What? (2)
Inactivating cytochrome oxidase
Interferes ETC
Cyanide Poisoning Antidoes (3)
Hydroxocobalamin
Sodium thiosulfate and amyl nitrate