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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
Q

Phenothiazine overdose can cause:

A

dystonic reactions (movement disorders)

26
Q

Dystonic reactions can be treated with:

A

procyclidine or diazepam

27
Q

Second gen antipsychotics (e.g. olanzapine, clozapine) can cause the following symptoms in overdose:

A 
Drowsy
Convulsions
EPS
Abnormal ECG
Hypotension
28
Q

Treat antipsychotic (2nd gen) overdose with:

A

activated charcoal

29
Q

Signs and symptoms of benzodiazepine overdose?

A 
Drowsy
ataxia - lack of co-ordination 
coma
resp depression
nystagmus 
dysarthria - speech disorder
30
Q

Antidote for benzodiazepine overdose?

A

Flumazenil

31
Q

Effects of beta-blocker overdose?

A

cardiac: bradycardia, hypotension, syncope, conduction abnormalities, heart failure

CNS: confusion, convulsions, hallucination, resp depression, bronchospasm

32
Q

Which beta blocker is most associated with causing coma and convulsions?

A

Propranolol

33
Q

Signs and symptoms of CCB poisoning?

A 
n/v
dizzy
agitation
confusion
coma
34
Q

Symptoms of verapamil and diltiazem (rate limiting CCBS) in overdose?

A

hypotension

arrhythmias

35
Q

Symptoms of dihydropyridines (amlodipine etc) in overdose?

A

Severe hypotension

36
Q

Treatmetns for CCB overdose?

A 
Activated charcoal within 1hr
or
severe: calcium gluconate, calcium chloride
or
symptomatic bradycardia: atropine 
or severe: insulin and glucose infusion
37
Q

Signs and symptoms of iron overdose?

A 
N/V
Diarrhoea
haematemesis
rectal bleeding
abd. pain
38
Q

Antidote for iron overdose?

A

Desferrioxamine

39
Q

Symptoms of lithium intoxication?

A 
Apathy
restlessness
Vomiting 
Diarrhoea
Tremor
Muscle twitching
Weakness
40
Q

Signs of severe lithium toxicity (>2mmol/l)?

A 
Coma
Convulsions
electrolyte imbalance 
renal failure
dehydration
41
Q

Range of lithium levels:

A

0.4-1mmol/L

42
Q

How to treat lithium toxicity?

A

Ensure adequate hydration by increasing fluids and urine output without diuretics
(generally a supportive measure)

43
Q

Signs and symptoms of cocaine poisoning?

A

CNS stimulant: agitation, dilated pupils, tachycardia, hypertension, hallucination, hyperthermia, cardiac effects - MI/pain/arrhythmias

44
Q

How to treat cocaine poisoning?

A

Supportive measures: cool down temperature and agitation

45
Q

signs and symptoms of MDMA (Ecstasy) poisoning?

A 
coma
convulsions
hyperthermia
renal failure
hepatitis
hypotension
intracerebral haemmorhage
hyponatraemia
46
Q

What else would you be concerned about with MDMA use?

A

water intoxication

47
Q

Theophylline poisoning symptoms?

A 
Severe vomiting 
agitation
restless
dilated pupils
sinus tachycardia
hyperglycaemia
Serious:
haematemesis
convulsions
ventricular arrhythmias
SEVERE HYPOKALAEMIA (range: 3.5-5.3)
48
Q

Treatment for theophylline poisoning?

A

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
Q

What happens in cyanide poisoning?

A

noxious poison that prevents the RBC from using oxygen so cells die

50
Q

Antidote for cyanide poisoning?

A

Dicobalt edetate - toxic associated with anaphylaxis and potentially fatal

51
Q

Digoxin antidotes?

A

1) Hold digoxin doses

2) digibind

52
Q

Heparin toxicity antidote?

A

Protamine

53
Q

Opioid toxicity antidote?

A

Naloxone

54
Q

Rivaroxaban/apixaban antidote?

A

Adexenate alfa

55
Q

Dabigratran antidote?

A

Idaricizumab

56
Q

Benzodiazepine antidote?

A

Flumazenil

57
Q

methotrexate antidote?

A

Folinic acid

58
Q

Antidote of ethylene glycol and and methanol poisoning?

A

Fomepizole

59
Q

carbon monoxide antidote?

A

oxygen

60
Q

Cerebral oedema treatment?

A

Mannitol

61
Q

If you are suspecting some poison toxicity, who could you contact?

A

National poisons information service

62
Q

Digoxin toxicity antidote?

A

Digoxin specific antibody (Rarely used)

2021 Pre-registration (15 decks)

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