Clinical Toxicology

Question 1

Metabolism of Acetaminophen (APAP)

Answer 1

Sulfation
Glucuronidation
Oxidation CYP450 2E1

Question 2

Toxic Metabolite of Paracetamol

Answer 2

N-Acetyl-p-benzoquinone imine (NAPQI)

Question 3

Stages of Paracetamol Toxicity

Answer 3

I - N/V, anorexia, diaphoresis
II - Asymptomatic, Clinical Improvement
III - Abdominal pain, hepatic failure, coma, death
IV - Recovery

Question 4

Antidote for Paracetamol Toxicity

Answer 4

N-Acetylcysteine (NAC)

Question 5

Salicylates Toxicity

Answer 5

Salicylism

Question 6

Salicylates Poisoning S/S

Answer 6

Mild: Tinnitus
Severe: Lethargy, Convulsions, coma, Metabolic Acidosis

Question 7

Treatment of Salicylates Poisoning

Answer 7

Urine Alkalinization with NaHCO3
Vitamin K1/ fresh frozen plasma (for bleeding)
Hemodialysis or Hemoperfusion (100mg/dL)

Question 8

Digoxin toxicity treatment

Answer 8

Lidocaine or Phenytoin
Digoxin-specific Fab antibodies (Digibind)
Potassium Chloride
Cholestyramine

Question 9

Treatment for Organophosphates Poisoning

Answer 9

Atropine
Pralidoxime

Question 10

Treatment for Strychnine poisoning

Answer 10

Diazepam
Phenobarbital
Neuromuscular blockers
Skeletal muscle relaxant

Question 11

S/S of Strychnine Toxicity

Answer 11

Rigor Mortis
Spinal Convulsion
Sardonic smile
Resp. Arresrt

Question 12

Skeletal Muscle relaxants

Answer 12

Succinylcholine - Malignant Hyperthermia (DOC: Dantrolene)
Tubocurarine - Release Histamine (DOC: Epi)

Question 13

Methylxanthine

Answer 13

Theophylline (1,3-dimethylxanthine)

Question 14

Signs and symptoms of Theophylline poisoning

Answer 14

Seizures, Cardiac Dysrhythmias

Question 15

S/S of Tricyclic Anti-Depressant Toxicity

Answer 15

Convulsions, Cardiotoxicity, Coma
Anticholinergic Effects
Pulmonary depression

Question 15

Management of Methylxanthine Toxicity

Answer 15

Ipecac Syrup
Activated Charcoal
Whole Bowel Irrigation
Hemoperfusion & Hemodialysis
B-blockers - Arrhythmia
Diazepam - Seizure

Question 16

TCA Poisoning Management

Answer 16

Physostigmine: DOC for Anticholinergic signs & symptoms NaHCO3: DOC for Cardiopulmonary toxicity
Phenytoin &/or Benzodiazepine: DOC for CNS manifestations

Question 17

Beta-blockers poisoning S/S

Answer 17

Bradycardia
Hypotension
Bronchospasm

Question 18

Treatment of B-blocker Poisoning

Answer 18

Glucagon
Atropine
Epi

Question 19

CCBs Poisoning Management

Answer 19

Calcium Chloride IVP
Glucagon

Question 20

Warfarin Toxicity

Answer 20

Bleeding

Question 21

Treatment for Warfarin Toxicity

Answer 21

Vit. K (Phylloquinone)

Question 22

Heparin Toxicity

Answer 22

Bleeding

Question 23

Treatment foHeparin Toxicity

Answer 23

Protamine Sulfate (acts as the base to neutralize heparin activity)

1mg Protamine = 100IU Heparin

Question 24

Chloramphenicol Toxicity

Answer 24

Gray Baby Syndrome
Aplastic Anemia
Bone Marrow Depression

Question 25

Treatment for Chloramphenicol Toxicity

Answer 25

Charcoal Hemoperfusion

Question 26

Vancomycin Toxicity

Answer 26

Red Man/Red Neck - Inc. Histamine

Question 26

Treatment for Vancomycin Toxicity

Answer 26

Antihistamine Slow Infusion

Question 27

Isoniazid (INH) Toxicity S/S

Answer 27

Peripheral Neuropathy
Hepatitis

Question 28

Isoniazid Toxicity Management

Answer 28

Pyridoxine (Vit. B6)
Activated Charcoal can limit further absorption of the drug form in the GIT
Benzodiazepine

Question 29

Lithium Toxicity

Answer 29

Mild: polyuria, blurred vision, weakness, slurred speech, Ataxia, tremor & myoclonic jerks

Severe: delirium, coma, seizures & hyperthermia

Question 30

Treatment for Lithium Toxicity

Answer 30

Ipecac Syrup, NA polysterene sulfonate, WBI (SR products), hemodialysis (rebound effects)

Question 31

S/S of K Toxicity

Answer 31

Cardiac Irritability
Dysrhythmia
Peripheral Weakness