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MLSCI 466 > Clinical toxicology > Flashcards

Clinical toxicology Flashcards

1
Q

what is the fundamental approach to poison exposed patient

A

A- airway
B- breathing
C- circulation
D- decontamination
E- Elimination
F- find an antidote

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2
Q

why can the airway be endangered (3)

A

-sedation causes small airway
- vomit blockage
- increased secretion (mucus)

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3
Q

why is circulation assessed

A

signs of poor perfusion
establish vascular access early in poisoned patient

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4
Q

how to do CPR

A

compression
airway - tilt head
breathing

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5
Q

treatment for poor perfusion/ circulation

A

IV/ medications to increase BP

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6
Q

what is the goal of decontamination

A

prevent or minimize absorption

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7
Q

what is the best option for decontamination

A

activated charcoal given within first hour

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8
Q

T/F EMESIS should NOT be given to patients who are vomiting

A

T

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9
Q

which substances does activated charcoal NOT work in

A

Pesticides
hydrocarbon
acids and alkali
iron
lithium
solvents

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10
Q

when is whole bowel irrigation (using PEG) done

A

ingestion of iron, lead, lithium

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11
Q

what are the methods used for elimination

A
  1. urine alkalization
  2. hemodialysis
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12
Q

what substance is urine alkalization most effective

A

salicylates

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13
Q

when is hemodialysis performed

A

ingestion of; STUMBLE
Salicylates
Theophyline
Uremia
Methanol
Barbituates
Lithium
Ethlylene Glycol

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14
Q

what methods are used for decontamination

A
  1. vomitting - DONT USE EMESIS
  2. gastric lavage
  3. activated charcoal
    4.whole bowel irrigation
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15
Q

what are the 5 common toxidromes

A
  1. sedative/hypnotic
  2. opioid
  3. cholinergic
  4. anticholinergic
  5. sympathomimetic
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16
Q

what is the diagnosis for opioids

A

naloxone (narcan)

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17
Q

where are cholinergic toxidromes found

A

organic phosphorous compounds = pesticides

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18
Q

what are common cholinergic toxidrome symptoms

A

SLUDGE and KILLER B’s

Salivation
Lacrimation
Urination
Diarrhea
GI distress
Emesis

Bronchorrhea, Bronchospasms, Bradycardia

19
Q

common drugs of sympathomimetic

A

cocaine
meth

20
Q

purpose of blood gas tes

A

calculate the anion and osmolar gap

21
Q

anion gap formula

A

sodium- (bicarb + chloride)

22
Q

what does anion gap >12 mean

A

toxic substances presence leading to metabolic acidosis

23
Q

what causes high anion gap metabolic acidosis?

A

MUDPILES

methanol
uremia
diabetic keoacidosis
paraldehyde
iron
lactic acidosis
ethylene glycol
salicylates

24
Q

osmolar gap formula

A

measures - calculated osmols

25
Q

calculated osmole formula

A

2(na)+glucose+urea

26
Q

what does >10 osmolar gap lead to

A

toxic alcohol ingestion

27
Q

what are limitations of the tox screen (4)

A

-does not screen all substances
-takes days to get results
-expensive
- high false pos and neg

28
Q

what does PADIS stand for

A

poison and drug information service

29
Q

ASA toxic and severely toxic reference range

A

150-200 = toxic

300-500 = severe

30
Q

symptoms seen with ASA overdoes

A

respiratory alkalosis initially into metabolic acidosis

31
Q

decontamination and (2) elimination methods for ASA overdoes

A

D: activated charcoal

E: urinary alkalinization and hemodialysis

32
Q

Tylenol toxic reference range

A

> 150 mg/kg

33
Q

How does acetaminophen toxic metabolism work

A

non toxic (suilfation and glucuronidation) are saturated so the P450 pathway starts making NAPQI

NAPQI depletes glutathione = cell dysfunction

34
Q

what are the 4 phases of acetaminophen poisoning

A

P1 (<24hr) - vomit

P2 (24-72hr) - upper abdominal pain and increased AST/ALT/bili/INR

P3 (72-96hr) - hepatic necrosis, renal failure, heart damage

P4 (4d-2wk) - liver transplant or death

35
Q

what is used to screen acetaminophen level for possible poisoning

36
Q

purpose of N-acetylcysteine (NAC)

A

glutathione substitute used within 8 hours to limit acetaminophen

37
Q

decontamination and antidote of acetaminophen

A

D; activated charcoal

F; NAC

38
Q

T/F carbon monoxide poisoning can be resolved using IV fluids

39
Q

what is the antitote for carbon monoxide poisoning

A

100% supplemental oxygen (hyperbaric chamber)

40
Q

what are the 3 stages of ethylene glycol poisoning

A

1- acute neurologic
2- cardiopulmonary
3- renal

41
Q

how to we prevent alcohol metabolism

A

block alcohol dehydrogenase (ADH) using ethanol or fomepizole

42
Q

T/F methanol has toxic metabolites while ethanol does NOT

43
Q

What is a clinical finding found in methanol poisoning but not ethanol

A

visual changes (impacts the eyes)

44
Q

what are the elimination and antitote for toxic alcohols

A

E; hemodialyiss
F; ethanol or fomepizole

MLSCI 466 (8 decks)

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