Chapter 19: Toxicology

Question 1

Discuss

Types of toxins

Answer 1

Opioids, sympathomimetics, sedative-hypnotics, anticholinergics, cholinergics

Question 2

Discuss

S/S Opioids

Answer 2

Hypoventilation/arrest, pinpoint pupils, sedation/coma, hypotension

Question 3

Discuss

S/S Sympathomimetics

Answer 3

Hypertension, tachycardia, dilated pupils, agitation/seizures, hyperthermia

Question 4

Discuss

S/S Sedative-hypnotics

Answer 4

Slurred speech, sedation/coma, hypoventilation, hypotension

Question 5

Discuss

S/S Cholinergics

Answer 5

Stimulate the parasympathetic nerve. DUMBBELSS: Defecation, urination, miosis (constricted pupils), bronchorrhea (excess sputum production), bradycardia, emesis, lacrimation, salivation, sweating

Question 6

Discuss

Treatment for absorbed and surface contact poisons

Answer 6

If in eyes, rinse with water from medial to lateral for at least 15 min. Only time not to irrigate with water is when chemical reacts with water.

Question 7

Discuss

Activated charcoal

Answer 7

Suspended in sorbitol (laxative). Contraindicated with ingested acid, alkali or petroleum product since vomiting will agitate damage already done to esophagus by these chemicals. More contraindications: decreased LOC and can’t protect airway; inability to swollow. DOSE: 1 g/kg body weight. Deliver through straw because it’s disgusting.

Question 8

Discuss

Delirium tremens

Answer 8

Withdrawal from alcohol. Agitation, fever, sweating, tremors, all the way to seizures.

Question 9

Discuss

Opiate abuse

Answer 9

Pinpoint pupils most diagnostic sign. Countered by Narcan (naloxene).

Question 10

Discuss

Examples of sedative hypnotics. Antidotes?

Answer 10

Barbituates, benzodiazepines, etc. Antidote exists for benzodiazepine, reversing respiratory depression and sedation.

Question 11

Discuss

Inhalants

Answer 11

Same effects as sedative hypnotics. Effective and lethal dose are close. Keep pt from exerting himself, since pt’s become hypersensitive to adrenaline and can easily develop V fib.

Question 12

Discuss

Most common sympathomimetic?

Answer 12

Cocaine. Lasts < 1 hr.

Question 13

Discuss

Plants

Answer 13

Dieffenbachia: dumbcane. Can cause respiratory distress from swelling.

Question 14

Discuss

Common opioids

Answer 14

Butorphanol, codeine, fentanyl derivatives, heroin, hydrocodone (Vicodin), hydromorphone (Dilaudid), Meperidine (Demerol), Methadone (Dolophine), morphine, oxycodone (Percocet), oxycodone hydrochloride (OxyContin), pentazocine (Taiwin), propoxyphene (Darvon)

Question 15

Discuss

Barbiturates

Answer 15

Amobarbital (Amytal), butabarbital (butisol), pentobarbital (Nembutal), Phenobarbital (Luminal), Secobarbital (Seconal)

Question 16

Discuss

Benzodiazepines

Answer 16

Alprazolam (Xanax), Chlordiazepoxide (Librium), Diazepam (Valium), Flunitrazepam (Rohypnol), Lorazepam (Ativan), Oxazepam (Serax), Temazepam (Restoril)

Question 17

Discuss

Classic description of pt on anticholinergics

Answer 17

Blind as a bat, mad as a hatter, red as a beet, hot as hell, dry as a bone, bowel and bladders lose their tone, heart runs alone