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CCFP > Antidotes/toxidromes > Flashcards

Antidotes/toxidromes Flashcards

1
Q

TCA

A

Sodium bicarbonate

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2
Q

Digoxin

A

Mg sulfate

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3
Q

Isoniazid

A

Pyridoxine

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4
Q

Anticholinergic

A

Physostigmine

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5
Q

SMELTV

A

hemodialysis

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6
Q

Tylenol

A

rumack matthew normogram (>4h ingestion start)

N acetylcysteine

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7
Q

Salicylate

A

Alkalinization with IV sodium bicarbonate to urine pH>7.5 q1h repeat

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8
Q

Toxic alcohols

A

Fomepazole or ethanol
Bicarbonate

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9
Q

Beta blocker

A

Atropine 1mg IV max 3 dose
Glucagon
Calcium chloride through CVC
Vasopressor
Insulin and glucose
Lipid emulsion

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10
Q

Opioid

A

Narcan titrate to RR>12

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11
Q

CCB

A

Calcium

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12
Q

Digoxin toxicity

A

Arrhythmias, bradycardia
GI symptoms

Treat with active charcoal if <2h and protected airway
Digibind (antibody) for arrhythmia
Atropine 0.5mg IV for bradycardia

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13
Q

Cocaine intoxication

A

Tachycardia and ischemic changes

ABC/vitals
Avoid succs for airway (use rocuronium)
Manage hyper/hypothermia
Diazepam 5mg IV q3-5min for agitation
Phenyamine 1-5mg IV for HTN (avoid BB)
Bicarb for QRS widening

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14
Q

Neuroleptic malignant syndrome

A

Rigidity, altered mental status, fever, autonomic disfunction

Can use dantrolene or benzodiazepine

Treat hypothermia, follow serum CK

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15
Q

Activated charcoal

A

Useful in the first one to two hours after ingestion

Most effective gastric decontamination

1-2g/kg q2-6h

Contraindicated and caustic acids and alkalis, alcohol, lithium, heavy metal, high risk aspiration

Useful in phenobarbital, phenytoin, carbamazepine, salicylate

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16
Q

Whole bowel irrigation

A

Use for toxic foreign bodies, such as drug packets, sustained release drugs, or toxic material, not bound by active charcoal

Contraindicated in mechanical obstructions, ileus, perforation

17
Q

Gastric lavage

A

Useful within one hour with active charcoal afterwards

Useful for large ingestions, substances, not found by active charcoal, aspiration risk

Contraindicated in corrosive, hydrocarbons, none intubated patients with decreased GCS

18
Q

Anticholinergic induced agitation

A

Physostigmine

19
Q

Excitation syndrome causes

A

Anticholinergic
Sympathomimetic
Hallucinogenic
Drug withdrawal

Treats with benzodiazepine, supportive care

20
Q

Clinical depressive syndrome causes

A

Ethanol
Sedatives or hypnotics
Opioids
Cholinergics (parasympathomimetics)
Toxic alcohol

21
Q

Acetaminophen toxicity

A

Toxic above 150mg/kg (7.5-10g in adults)

0.5-24h NV or asymptomatic
24-72h RUQ and hepatic injury

Initial and four hour Tylenol level and evaluate on rumack Matthew normogram

ALT and INR levels

Treat with active charcoal or N acetylcysteine, either based on normogram or if unknown time of ingestion or abnormal AST/ALT

22
Q

Salicylate toxicity

A

Fatal above 10g in adults, 3 g in children

Tinnitus, tachypnea, nausea, vomiting, vertigo

Respiratory alkalosis initially, then metabolic acidosis

Serum levels >40mg/dl (2.9mmol/l) possible toxicity

Measure q28d until below this level and asymptomatic and normal RR

Avoid intubation due to risk of neural toxicity and acid pH from apnoea

Multi dose active charcoal

Serum and urine alkalization with IV sodium bicarb (3amps in 1L D5W at maintenance x2) target urine pH >7.5

Monitor for hypokalaemia and sugar

Early nephrology consult for possible dialysis

23
Q

Methanol and ethylene glycol toxicity

A

Profound metabolic acidosis and osmolar gap

Status, epilepticus, shock, ischemic bowel

Vision, blurry, scotoma, blindness is seen in methanol

Flank pain and haematuria are seen in ethylene glycol

Blood, electrolytes for anion gap, serum ethanol, calcium for ethylene glycol associated hypoglycaemia

Urinanalysis for oxalate crystals

Treat with fomepazole (alcohol dehydrogenase inhibitor) or ethanol, NAHCO3, HD

24
Q

Benzodiazepine poisoning

A

Rule out coingestants

Urine BZD metabolites

Intubation

Avoid GI decontamination due to aspiration risk, unless airway protected and coingestant treatable by charcoal

Consider avoiding flumazenil due to seizure risk

25
Q

Beta blocker ingest

A

Airway
NS IV bolus with atropine 1mg x3
Glucagon 5mg IV bolus
Calcium chloride
Vasopressor
High dose insulin and glucose
Lipid emulsion IV

26
Q

Opioid ingestion

A

Look for respiratory depression, and small pupils

Naloxone titrate RR>12
Start 0.04mgIV qmin or 2mg qmin if CR arrest

If no effect in 5-10mg consider other diagnoses

Manage overshoot withdrawal symptoms expectantly (not with opioids)

27
Q

Magnesium sulfate toxicity

A

Calcium gluconate IV as treatment

Look for LOC, high RR, high urine output, loss of reflex

28
Q

Drugs with AC properties

A

TCA
Muscle relaxant
Mood stabilizer
Antihistamine
Antipsychotic
Antiparkinsonians
Antiepileptics

29
Q

Syndromes associate with antipsychotic use

A

NMS
anticholinergic toxidrome
EPS
Metabolic syndrome
Prolactinemia

CCFP (25 decks)

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