Chapter 31 - Medical Toxicology Flashcards
If a patient presents to an emergency room with elevated transaminases and an uncertain time of overdose acetominophen ingestion, the appropriate next step would be…
A. Repeat transaminase in 8 hrs
B. Begin N-acetylcysteine
C. Place patient on transplant list
D. Obtain liver biopsy
B. Begin N-acetylcysteine
Which of the following is true regarding acetaminophen overdose during pregnancy?
A. There is no fetal risk because acetaminophen does not cross the placenta
B. The risk to the fetus from N-actulcysteine is higher than that from acetaminophen
C. The risk for fetal liver damage is highest during the first trimester
D. The fetal liver will have decreased CYP450-mediated metabolism of acetaminophen compared to an adult
D. The fetal liver will have decreased CYP450-mediated metabolism of acetaminophen compared to an adult
All of the following are true regarding acetaminophen toxicity in alcoholics except…
A. The treatment nomogram is modified for alcoholics
B. The presence of alcohol in the body may be protective
C. Chronic alcoholics have induction of CYP2E1
D. Alcoholics have decreased glutathione stores because of malnutrition
A. The treatment nomogram is modified for alcoholics
All of the following statements are true regarding acetaminophen overdose except…
A. Renal toxicity can occur
B. Minor prolongations of the prothrombin time can occur in the absence of hepatotoxicity
C. The mortality is less than 0.5%
D. Use of 4 g acetaminophen per day over 4 weeks is associated with a high risk of hepatotoxicity
D. Use of 4 g acetaminophen per day over 4 weeks is associated with a high risk of hepatotoxicity
All of the following are indications for hemodialysis in salicylate overdose except…
A. Acute lung injury
B. Hearing loss
C. Renal failure
D. Hepatic injury with coagulopathy
B. Hearing loss
In salicylate toxicity, alkalinization of the serum with intravenous sodium bicarbonate produces all of the following effects except…
A. Correction of metabolic acidosis
B. Removal of salicytate from the CNS
C. Enhanced urinary excretion of salicytate
D. Displacement of salicylate from alpha-1-acid glycoprotein
D. Displacement of salicylate from alpha-1-acid glycoprotein
The settings on a ventilator in a salicylite-poisoned patient must be constantly adjusted to maintain preventilator levels of…
A. Hypocarbia
B. Oxygen partial pressure
C. Tidal volume
D. Alveolar oxygen
A. Hypocarbia
The mechanism for increased cardiovascular risk in users of selective cyclooxygenase 2 inhibitors may involve…
A. Increased activity of vitamin K-dependent clotting
B. Decreased fibrinolysis
C. Inhibition of endothelial-derived PGI2
D. Inhibition of PGE2
C. Inhibition of endothelial-derived PGI2
The antiplatelet effects of COX-1 inhibitors are due to effects on…
A. TXA2
B. PGF
C. PGD
D. Leukotrienes
A. TXA2
The treatment of intentional nonasprin NSAID overdose usually includes all of the following except…
A. Serum acetaminophen concentration
B. Activated charcoal
C. Protein pump inhibitors
D. Hemodialysis
D. Hemodialysis
The most logical treatment to prevent iron absorption in significant overdose situations is…
A. Whole bowel irrigation
B. Induced emesis
C. Activated charcoal
D. Magnesium hydroxide
A. Whole bowel irrigation
A rare form of injury from iron overdose that can occur 2 to 8 weeks after ingestion is…
A. Peripheral neuropathy
B. Gastric outlet obstruction
C. Pancreatitis
D. Bronchiolitis obliterans
B. Gastric outlet obstruction
The target organ for deferoxamine toxicity is the…
A. Liver
B. Lung
C. Kidney
D. Peripheral nervous system
B. Lung
During the 6 hr period following a significant iron overdose, which of the following almost always occurs?
A. Bradycardia
B. Respiratory depression
C. Vomiting
D. Asymptomatic period
C. Vomiting
All of the following may be indicated in the treatment of vitamin A toxicity except…
A. Dexamethasone
B. Intravenous Ca
C. Loop diuretics
D. Activated charcoal
B. Intravenous Ca
All of the following may be indicated in the treatment of Vitamin D overdose except…
A. Bisphosphonates
B. Corticosteroids
C. Calcitonin
D. Thiazide diuretics
D. Thiazide diuretics
Neuropathy is most likely associated with an overdose of…
A. Vitamin E
B. Vitamin C
C. Pyridoxine
D. Niacin
C. Pyridoxine
A coagulopathy is least likely to develop following toxic doses of…
A. Vitamin A
B. Vitamin E
C. Pyridoxine
D. Niacin
C. Pyridoxine
Which of the following best describes the association between vitamin C and risk of oxalate neprolithiasis?
A. It is a significant clinical concern in all patients
B. It is a significant clinical concern in children and not adults
C. It is a significant clinical concern in adults and not children
D. It is not a significant clinical concern
D. It is not a significant clinical concern
Which of the following drug classes in an overdose situation is least likely to cause hypoglycemia?
A. First-generation sulfonylureas
B. Meglitinides
C. Alpha-glucosidase inhibitors
D. Second-generation sulfonureas
C. Alpha-glucosidase inhibitors
Hypoglycemia in the presence of high-insulin plasma levels, high C-peptide plasma levels and absent insulin-binding antibodies is most likely the result of overdose of…
A. Exogenous insulin
B. Sulfonylureas
C. Corticosteroids
D. All of the above
B. Sulfonylureas
Glucagon is the drug of choice for overdose from…
A. Sulfonylureas
B. metformin
C. Alpha-glucosidase inhibitors
D. None of the above
D. None of the above
Overdose of aminoglycosides may produce…
A. Aseptic meningitis
B. acute lung injury
C. Hepatotoxicity
D. Neuromuscular blockade
D. Neuromuscular blockade
An unusual adverse effect of fluoroquinolone therapy is…
A. Sleep paralysis
B. nonproductive cough
C. Alopecia
D. Tendon rupture
D. Tendon rupture
Lactic acidosis is a serious adverse effect associated with overdose of…
A. Nucleosideanalog reverse transcription inhibitors
B. penicillin
C. Vancomycin
D. Aminoglycosides
A. Nucleosideanalog reverse transcription inhibitors
The Jarich-Herxheimer reaction occurs after administration of…
A. Amphotericin B
B. Erythromycin
C. Ciprofloxacin
D. Procaine penicillin G
D. Procaine penicillin G
Which of the following statements is true regarding acute ingestions of long-acting anticoagulant rodenticides?
A. The risk of coagulation abnormalities is the same in both intentional and small nonintentional overdoses
B. Coagulation problems can persist for weeks in intentional overdose
C. The 4 hr post-ingestion INR is more clinically relevant than the 48 hr measure
D. All children should be hospitalized for 12 hrs after a single unintentional dose
B. Coagulation problems can persist for weeks in intentional overdose
The ideal immediate antidote for life-threatening bleeding in a hemodynamically stable patient with warfarin overdose is…
A. Intravenous vitamin K
B. Whole blood transfusion
C. Prothrombin complex concentrate infusion
D. Fresh frozen plasma infusion
C. Prothrombin complex concentrate infusion
Theoretically, the duration of coagulopathy in long-acting anticoagulant overdose will be shortened by the administration of…
A. Phenobarbital
B. Cimetidine
C. Omeprazole
D. Quinine
A. Phenobarbital
In patients with gastrointestinal hemorrhage secondary to warfarin-like anticoagulants, the ideal route for vitamin K administration is…
A. Sublingual
B. Intramuscular
C. Subcutaneous
D. Intravenous
C. Subcutaneous
All of the following have a place in the treatment of acute thryoid hormone overdose except…
A. High-dose asprin
B. acetominophen
C. Activated charcoal
D. Beta-adrenergic blockers
A. High-dose asprin
In patients with asthma, an alternative drug for use in thyroid hormone overdose is…
A. Nifidipine
B. nicardipine
C. diliazen
D. Nimodipine
C. diliazen
A drug that can sedate a patient with thyroid hormone overdose and also theoretically provide enhanced thyroid elimination is…
A. Midazolam
B. Phenobarbital
C. Propofol
D. Mannitol
B. Phenobarbital
Which of the following is considered primary therapy for thyroid hormone overdose?
A. Corticosteroids
B. Propylthiouricil
C. Iodine contrast media
D. None of the above
D. None of the above
All of the following may be indicated in the management of overdose with a histamine 1 receptor antagonist except…
A. Lorazepam
B. Physostigmine
C. Warming blankets
D. Sodium bicarbonate
C. Warming blankets
Which of the following is least important in the management of an intentional histamine 1 receptor antagonist overdose?
A. Serum gamma glutamyl transpeptidase
B. ECG
C. Creatine phosphokinase
D. Serum acetaminophen levels
A. Serum gamma glutamyl transpeptidase
Oral overdose of histamine 2 receptor antagonists…
A. Are treated identically as histamine receptor 1 receptor antagonist overdoses
B. Require gastric lavage
C. Require seizure prophylaxis with phenytoin
D. Generally have a good outcome
D. Generally have a good outcome
Which of the following should be avoided in the treatment of decongestant overdose?
A. Activated charcoal
B. Benzodiazipines
C. Phentolamine
D. Propranolol
D. Propranolol
First-line drugs for the treatment of ventricular dyshythmias from decongestant overdose include…
A. Verapamil and diltiazem
B. Aminodarone and lidocane
C. Quinidine and procainamide
D. Atropine and magnesium sulfate
B. Aminodarone and lidocane
Vasoconstriction from excessive doses of triptan antimigraine therapy can be treated with all of the following except…
A. Metoprolol
B. Phentolamine
C. Nitroglycerine
D. Sodium nitroprusside
A. Metoprolol
Triptan overdose differs from ergot overdose in that…
A. Calcium channel blockers are contraindicated
B. Vomiting is less
C. Coronary ischemia does not occur
D. Diuretics are indicated in the management of hypertension
B. Vomiting is less
Weight loss drugs, methylsergide, and ergotamine have all been associated with…
A. Amyotropic lateral sclerosis
B. Parkinson’s disease
C. Myocardial valvular abnormalities
D. Hepatic angiosarcoma
C. Myocardial valvular abnormalities
Nonanion gap metabolic acidosis is seen following overdose of…
A. Phenytoin
B. Gabapentim
C. Topiramate
D. Levetiracetam
C. Topiramate
Which of the following is least likely to cause the drug rash with eosinophilia and systemic symptoms (DRESS) syndrome?
A. Valproic acid
B. Phenytoin
C. Carbamazepine
D. Primidone
A. Valproic acid
In calcium channel blocker overdose, what serum laboratory parameter may correlate with the severity of poisoning?
A. Elevation of potassium
B. Decrease in bicarbonate
C. Elevation in ionized Ca
D. Elevation in glucose
D. Elevation in glucose
The calcium channel blocker with the most negative ionotropic effect on the heart in overdose is…
A. Nicardipine
B. Nifedipine
C. Diltiazen
D. Verapamil
D. Verapamil
All of the following are true regarding calcium channel blocker overdose except…
A. Nausea and vomiting are common early manifestations
B. Hypotension is common
C. CNS depression is uncommon without severe hypotension
D. All types can produce severe bradycardia in significant overdoses
A. Nausea and vomiting are common early manifestations
All of the following are useful in the treatment of calcium channel blocker overdose except…
A. Glucagon
B. Euglycemia insulin therapy
C. Physostigmine
D. Calcium
C. Physostigmine
Patients with a history of sustained release calcium channel blocker ingestion should undergo all of the following except…
A. Hospital admission for at least 24 hrs
B. Whole bowel irrigation
C. Continuous ECG monitoring
D. Digoxin therapy
D. Digoxin therapy
In patients overdosing on beta-blockers alone and not taking any concomitant medication, what property of beta-blockers would render them most toxic?
A. Water solubility
B. Membrane-stabilizing activity
C. Vasodilatory activity
D. Cardiac selectivity
B. Membrane-stabilizing activity