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2021 Pre-registration > Chapter 16: Emergency treatment of poisoning > Flashcards

Chapter 16: Emergency treatment of poisoning Flashcards

1
Q

What resources are available for you to use to determine degree of risk and management?

A

TOXBASE / UK national poisons information service

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2
Q

What drusg can cause delayed-action toxicity?

A

Aspirin
Paracetamol
Iron
TCA

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3
Q

Action to take if someone has an obstructed airway?

A

Unable to breath so lift chin or jaw thrust

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4
Q

Most common effect of CNS depressants in overdose?

A

Hypotension especially systolic <70: risk of permanent neuronal damage and renal tube necrosis (Death of cells)

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5
Q

How to increase BP if hypotensive?

A

Raise foot of bed or NACL infusion

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6
Q

What drugs can cause severe hypertension?

A

Sympathomimetics: amfetamines/phencyclide and cocaine

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7
Q

Cardiac defects and arrhythmias can occur with:

A

TCA, antipsychotics and antihistamines

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8
Q

What drug overdose can cause hypothermias?

A

barbituates

phenothiazines

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9
Q

What drug class can cause hyperthermia (particularly in children)?

A

CNS stimulants - remove clothing and use a fan

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10
Q

When do seizures need treatment and with what?

A

> 5mins (status epilepticus - medical emergency)
prolonged and frequent

give buccal midazolam or rectal diazepam or iv lorazepam

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11
Q

Poisons toxic in small amounts such as antidepressants can be reversed with:

A

activated charcoal, sooner you give it the more effective it is. Can be effective 1hr after ingestion too

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12
Q

What drugs can activated charcoal be used for?

A

Carbamazepine
Phenobarbitol
Quinine
Theophylline

If vomit - give anti emetic

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13
Q

Symptoms of acute alcohol intoxification?

A

ataxia
dysarthria
nystagmus
drowsy

progress to: coma, hypotension, acidosis

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14
Q

Symptoms of aspirin poisoning?

A 
hyperventilation
tinnitus
deaf
vasodilation
sweating
rarely coma

give activated charcoal within 1 hr of ingesting >125mg/kg aspirin

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15
Q

Signs of opioid poisoning?

A

Coma
Respiratory depression
pinpoint pupils

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16
Q

antidote for opioid toxicity?

A

naloxone

if buprenorphine tox: naloxone only partially reverses

methadone = Long MOA so continuous monitoring is required

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17
Q

How many days after paracetamol overdose can there be severe liver damage?

A

3-4 days: hepatic failure, encephalopathy, coma, death

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18
Q

When working out the ingested dose of paracetamol in obese patients, what weight should you use?

A

110kg rather than actual body weight

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19
Q

Antidote for paracetamol overdose?

A

Acetylcysteine - best within 8hours of ingestion

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20
Q

Signs and symptoms of antidepressant poisoning?

A 
Dry mouth
Coma
Hypertension
Hypothermia
Convulsions - give iv lorazepam or iv diazepam
Respiratory failure 
arrhythmias
Cardiac conduction defects 
Dilated pupils
Urinary retention
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21
Q

Antidote for antidepressant poisoning?

A

Activated charcoal: if given within an hour, there is reduced absorption of the drug

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22
Q

SSRI poisoning symptoms?

A 
Nausea
Vomiting
Agitation 
Tremor
Nystagmus
Drowsy
Tachycardia
Convulsions
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23
Q

Signs and symptoms of serotonin syndrome?

A

hyperthermia, rhabdomyolysis, renal failure, coagulopathies

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24
Q

Signs and symptoms of antimalarial poisoning?

A

Arrhythmias
Convulsions
With: quinine, chloroquine, hydroxychloroquine

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25
Phenothiazine overdose can cause:
dystonic reactions (movement disorders)
26
Dystonic reactions can be treated with:
procyclidine or diazepam
27
Second gen antipsychotics (e.g. olanzapine, clozapine) can cause the following symptoms in overdose:
``` Drowsy Convulsions EPS Abnormal ECG Hypotension ```
28
Treat antipsychotic (2nd gen) overdose with:
activated charcoal
29
Signs and symptoms of benzodiazepine overdose?
``` Drowsy ataxia - lack of co-ordination coma resp depression nystagmus dysarthria - speech disorder ```
30
Antidote for benzodiazepine overdose?
Flumazenil
31
Effects of beta-blocker overdose?
cardiac: bradycardia, hypotension, syncope, conduction abnormalities, heart failure CNS: confusion, convulsions, hallucination, resp depression, bronchospasm
32
Which beta blocker is most associated with causing coma and convulsions?
Propranolol
33
Signs and symptoms of CCB poisoning?
``` n/v dizzy agitation confusion coma ```
34
Symptoms of verapamil and diltiazem (rate limiting CCBS) in overdose?
hypotension | arrhythmias
35
Symptoms of dihydropyridines (amlodipine etc) in overdose?
Severe hypotension
36
Treatmetns for CCB overdose?
``` Activated charcoal within 1hr or severe: calcium gluconate, calcium chloride or symptomatic bradycardia: atropine or severe: insulin and glucose infusion ```
37
Signs and symptoms of iron overdose?
``` N/V Diarrhoea haematemesis rectal bleeding abd. pain ```
38
Antidote for iron overdose?
Desferrioxamine
39
Symptoms of lithium intoxication?
``` Apathy restlessness Vomiting Diarrhoea Tremor Muscle twitching Weakness ```
40
Signs of severe lithium toxicity (>2mmol/l)?
``` Coma Convulsions electrolyte imbalance renal failure dehydration ```
41
Range of lithium levels:
0.4-1mmol/L
42
How to treat lithium toxicity?
Ensure adequate hydration by increasing fluids and urine output without diuretics (generally a supportive measure)
43
Signs and symptoms of cocaine poisoning?
CNS stimulant: agitation, dilated pupils, tachycardia, hypertension, hallucination, hyperthermia, cardiac effects - MI/pain/arrhythmias
44
How to treat cocaine poisoning?
Supportive measures: cool down temperature and agitation
45
signs and symptoms of MDMA (Ecstasy) poisoning?
``` coma convulsions hyperthermia renal failure hepatitis hypotension intracerebral haemmorhage hyponatraemia ```
46
What else would you be concerned about with MDMA use?
water intoxication
47
Theophylline poisoning symptoms?
``` Severe vomiting agitation restless dilated pupils sinus tachycardia hyperglycaemia ``` ``` Serious: haematemesis convulsions ventricular arrhythmias SEVERE HYPOKALAEMIA (range: 3.5-5.3) ```
48
Treatment for theophylline poisoning?
1) repeated doses of activated charcoal 2) supportive measures 3) vomiting: ondansetron 4) hypokalaemia: iv KCL: monitor ecg 5) Convulsions: lorazepam/diazepam 6) Agitation: diazepam 7) if no asthma: give SABA IV e.g. salbutamol for hypokalaemia, tachycardia and hyperglycaemia
49
What happens in cyanide poisoning?
noxious poison that prevents the RBC from using oxygen so cells die
50
Antidote for cyanide poisoning?
Dicobalt edetate - toxic associated with anaphylaxis and potentially fatal
51
Digoxin antidotes?
1) Hold digoxin doses | 2) digibind
52
Heparin toxicity antidote?
Protamine
53
Opioid toxicity antidote?
Naloxone
54
Rivaroxaban/apixaban antidote?
Adexenate alfa
55
Dabigratran antidote?
Idaricizumab
56
Benzodiazepine antidote?
Flumazenil
57
methotrexate antidote?
Folinic acid
58
Antidote of ethylene glycol and and methanol poisoning?
Fomepizole
59
carbon monoxide antidote?
oxygen
60
Cerebral oedema treatment?
Mannitol
61
If you are suspecting some poison toxicity, who could you contact?
National poisons information service
62
Digoxin toxicity antidote?
Digoxin specific antibody (Rarely used)

2021 Pre-registration (15 decks)

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