Block 3 materials (poisoning)

Question 1

Severe GI distress leading to necrotizing gastroenteritis with hematemesis and bloody diarrhea, dyspnea, shock and coma –– typically seen in children who have ingested iron tablets

Answer 1

Iron Poisoning

Treatment
deferoxamine, deferasirox, deferiprone (iron chelators)

gastric aspiration
carbonate lavage

Question 2

Acetaminophen poisoning

Answer 2

N-acetylcysteine (replenish glutathione)

Question 3

Organophosphates or AChE inhibitor poisoning

Answer 3

Atropine & Pralidoxime

Question 4

Antimuscarinic/anticholinergic agent poisoning

Answer 4

Physostigmine

Question 5

Benzodiazepine poisoning

Answer 5

Flumazenil

Question 6

Arsenic poisoning

Answer 6

Dimercaprol (British anti-Lewisite(BAL) & Succimer

Question 7

B-blocker poisoning

Answer 7

Atropine
Glucagon
Saline

Question 8

Carbon monoxide poisoning

Answer 8

100%O2 & or hyperbaric O2

Question 9

Copper poisoning

Answer 9

copper chelators: penicillamine, trientine

Question 10

Cyanide poisoning

Answer 10

Hydroxocobalamin
Nitrites & sodium thiosulfate

Question 11

Dabigatran poisoning

Answer 11

Idarucizumab

Question 12

Digoxin poisoning

Answer 12

Digoxin Fabs

Question 13

Direct factor XA inhibitors (i.e apixaban) poisoning

Answer 13

Andexanet alfa

Question 14

Heparin poisoning

Answer 14

Protamine sulfate

Question 15

Mercury poisoning

Answer 15

Dimercaprol & Succimer

Question 16

Lead poisoning

Answer 16

Penicillamine
Calcium disodium EDTA
Dimercaprol (British anti-Lewisite(BAL))
Succimer
(PEDS)

Question 17

Methanol & Ethylene glycol poisoning

Answer 17

Fomepizole > ethanol, dialysis

Question 18

Methemoglobin poisoning

Answer 18

Methylene blue
Vitamin C

Question 19

Methotrexate poisoning

Answer 19

Leucovorin

Question 20

Opioid poisoning

Answer 20

Naloxone

Question 21

Salicylate & TCA poisoning

Answer 21

Sodium bicarbonate (NaHCO3

Question 22

Warfarin poisoning

Answer 22

Vitamin K & Fresh frozen plasma

Question 23

Lethargy, bradycardia, hypotension, cool skin, flaccid muscles, decreased gag reflex, miosis, respiratory and CNS depression, seizures

Answer 23

Morphine poisoning

Rx: Naloxone

Question 24

impaired judgment, mydriasis, tactile hallucinations (bugs crawling), paranoia, angina, coronary vasospasm, sudden cardiac death

Answer 24

Cocaine poisoning

Rx: Benzodiazepines, mixed a/B blockers (HTN/Tachycardia)

Question 25

: restlessness, irritability, anxiety

Answer 25

Nicotine intoxication

Rx: NRT, bupropion, varenicline, clonidine

Question 26

Respiratory failure, severe anion gap metabolic acidosis, & ocular damage

Answer 26

Methanol poisoning

Rx: Fomepizole (long acting alcohol dehydrogenase inhibitor)

Question 27

: acute: gastroenteritis, hypotension, metabolic acidosis, garlic breath, rice water stools, torsade’s, seizures; chronic: pallor, skin pigmentation, alopecia, stocking glove neuropathy, myelosuppression

Answer 27

Arsenic poisoning

Rx:
Dimercaprol (British anti-Lewisite(BAL)), Succimer, Penicillamine, or activated charcoal

Question 28

: mild anorexia, N/V, delayed jaundice, hepatic and renal failure

Answer 28

Acetaminophen poisoning

Rx: N-acetylcysteine (replenish glutathione)

Question 29

tachycardia, hypertension, hyperthermia (hot, dry skin), delirium, hallucinations, mydriasis

Answer 29

Atropine poisoning

Rx: Physostigmine & control cardio/hyperthermia

Question 30

major psychosis, serotonin syndrome, hyperpyrexia, acute renal and hepatic failure, cardiac arrhythmia, coronary vasospasm, seizures, cardiac arrest, death

Answer 30

Amphetamine poisoning

Rx: Benzodiazepine

Question 31

pink/cherry red skin, bitter almond breath, cardiovascular collapse, seizures, coma

Answer 31

Cyanide poisoning

Rx:
Activated charcoal
Hydroxocobalamin
Nitrites and Sodium thiosulfate

Question 32

renal failure, urine crystals, increases anion and osmolar gap, CNS excitation

Answer 32

Ethylene glycol poisoning

Rx:
alkalinization via fomepizole (ADH inhibitor) > ethanol, hemodialysis

Question 33

respiratory depression, hyperpyrexia, prolonged QT (Na+ channel inhibition), convulsions, coma

Answer 33

TCA poisoning

Rx: NaHCO3 (stabilizes cardiac cell membrane), activated charcoal

Question 34

Chronic: pallor, skin pigmentation (rain drop pattern), alopecia, Stocking glove neuropathy, & myelosuppression

Answer 34

Arsenic poisoning

Rx:
Penicillamine
Activated charcoal
Dimercaprol (British anti-Lewisite(BAL))

Succimer

Question 35

Drugs contraindicated in hemodialysis

Answer 35

A : Amphetamines
V : Verapamil
O : OP Poisoning , Opioids
I : Imipramine
D : Digitalis
Dialysis : Diazepam

Question 36

Carbamazepine
Ethylene glycol
Lithium
Methanol
Metformin
Phenobarbital
Salicylate
Theophylline
Valproic acid

Poisoning requires which type of treatment?

Answer 36

Hemodialysis

Question 37

Amphetamine poisoning

Answer 37

Rx:
1) Benzodiazepines: sedation and control ofseizures
2) Ammonium chloride

Question 38

Cheese Reaction: TCA & MAO Inhibitors

Answer 38

Tyramine (cheese, wine, smoked meats) –– is metabolized by MAOA in the intestines and is not absorbed

Phentolamine is the drug of choice for ‘cheese reaction’

Question 39

Lubiprostone
Classification: Cl- channel activator
Mechanism of Action: activates the type 2 Cl- channels in the small intestine –– increasing Cl- rich fluid content into the intestine stimulating intestinal motility and shortens intestinal transit time
Clinical Indications: women with IBS (predominantly constipation)
Adverse Effects: category C (pregnancy)

Question 40

Any drug that increases 5-HT

1) Activity (neuromuscular;clonus
hyperreflexia, hypertonia, tremor, seizure)

2) autonomic instability (eg,
hyperthermia, diaphoresis,
diarrhea)

3) altered mental status

Answer 40

Serotonin syndrome

Rx:
Cyproheptadine (5-HT2
receptor antagonist)

Question 41

Hypertensive crisis:

Eating tyramine-rich foods (eg,
aged cheeses, cured meats,
wine, chocolate) while taking
MAOIs

Answer 41

Rx: Phentolamine

Question 42

Neuroleptic malignant
syndrome:

Malignant FEVER:
Myoglobinuria, Fever,
Encephalopathy, Vitals
unstable,  Enzymes (eg,
CK), muscle Rigidity (“lead
pipe”)

Answer 42

Rx:
Dantrolene, dopaminergics (eg,
bromocriptine, amantadine),
benzodiazepines; discontinue
causative agent

Question 43

Tricyclic antidepressant toxicity:

Respiratory depression,
hyperpyrexia, prolonged QT
Tricyclic’s: convulsions, coma,
cardiotoxicity (arrhythmia due
to Na+ channel inhibition

Answer 43

Supportive treatment, monitor
ECG, NaHCO3
(prevents arrhythmia), activated
charcoal

Question 44

Disulfiram Reaction (Enzyme: Aldehyde Dehydrogenase):

Answer 44

MOA:
Disulfiram inhibits aldehyde dehydrogenase, leading to the accumulation of acetaldehyde when ethanol is consumed.

Adverse effects:
1) Flushing
2) headache/nausea
3) palpitations,

deterring alcohol consumption.

Question 45

Smoking Cessation Medication

Target: Nicotinic acetylcholine receptors

● Moa:
Acts as a (alpha 4 beta 2) partial agonist at these receptors, reducing craving and
withdrawal symptoms.

● Clinical uses: Smoking cessation

Adverse effects:
1) mood changes
2) vivid dreams.

Answer 45

Varenicline:

Question 46

Bupropion

MOA:

Clinical uses:

Adverse effects:

Toxicity

Answer 46

atypical antidepressant (NE-DA reuptake inhibitor)

MOA:
inhibits NE and DA reuptake

Clinical Indications:
1) depression
2) smoking cessation

Adverse Effects:
1) seizures
2) HTN

Toxicity:
1) stimulant effects (tachycardia, insomnia), 2) headache/seizures in patients with eating disorders

Question 47

atypical antidepressant (NE-DA reuptake inhibitor)

MOA:
inhibits NE and DA reuptake

Clinical Indications:
1) depression
2) smoking cessation

Adverse Effects:
1) seizures
2) HTN

Toxicity:
1) stimulant effects (tachycardia, insomnia), 2) headache/seizures in patients with eating disorders

Answer 47

Bupropion