Clinical Toxicology

Question 1

what is the approach commonly used to treat poisoning

Answer 1

ABCDE

Question 2

what does ABCDE stand for

Answer 2

airways, breathing, circulation, disability, exposure

Question 3

what sort of drugs cause respiratory depression

Answer 3

opiates

Question 4

why is it important to establish vasuclar access and check cardiac rhythm and bp

Answer 4

because many drugs cause cardiac dysrhythmias and shock

Question 5

how do TCAs cause reduced contractility and dysrhythmias and how is it treated

Answer 5

block fast acting sodium channels in the myocardium

treated with sodium bicarbonate

Question 6

what two factors contribute to hypotension in TCA poisoning and how is this treated

Answer 6

reduced contractility and increased vasodilation due to the blocking of alpha-adrenoreceptors
treated with fast acting vasorepressor eg norepinephrine or phenylephrine

Question 7

how is hypertension treated

Answer 7

short acting vasodilator eg nitroprusside

Question 8

what can shock lead to

Answer 8

cardiovasuclar collapse

Question 9

what are the symptms of shock

Answer 9

low bp, tachycardia, cold pale skine, acidosis and lo oxygen tension in arterial blood

Question 10

how is shock managed

Answer 10

increase circulating volume using dextran
increase cardiac output using glucagon, dopamine or dobutamine
correct acidosis with sodium bicarb

Question 11

how do glucagon/dopamin/dobutamine increase cardiac output

Answer 11

activate cardiac D1 or b1 receptors preveting vasodilation

Question 12

what are common disabilities cause by poison

Answer 12

seizures, agitation, delirium, coma

Question 13

what is the general reason for disabilities from poisoning

Answer 13

impaired function of CNS

Question 14

what two disabilities often lead to hypoglycaemia

Answer 14

delirium and coma

Question 15

what is used to treat hypoglycaemia

Answer 15

dextrose

Question 16

how is the impairement of cardiorespiratory function as a result of siezures controlled

Answer 16

benzodiazapines such as diazepam which has anticonvulsant activities

Question 17

how is decreased blood volume in hyperthermia treated

Answer 17

fluid replacement

Question 18

what is the function of dantrolene in the treatment of hyperthermia

Answer 18

prevent excitation contraction

Question 19

how is hypothermia treated

Answer 19

rewarming and basic life support

Question 20

how is exposure reduced after oral ingestion

Answer 20

gastric lavage, emesis, adsorption with activated charcoal, whole bowel irrigation

Question 21

what syrup is used for emesis

Answer 21

ipecacuanha syrup

Question 22

in what circumstances is whole bowel irrigation particularly useful

Answer 22

removing ions and packages of illicit drugs

Question 23

what sort of poisons can be treated with diureses

Answer 23

weak acid/base poisoning

Question 24

what is weak acid treated with

Answer 24

NaHCO3

Question 25

what are weak bases treated with

Answer 25

NH4CL-

Question 26

give an example of a poison which is a weak bases

Answer 26

amphetamines

Question 27

give an example of a 2 posons whicch are weak acids

Answer 27

barbiturate or salicylic acid

Question 28

ODing with what requires treatment with short acting vasorepressors such as nitropruside due to hypotension

Answer 28

monoamine oxidase

Question 29

what is calcium used for in the treatment of hyperthermia

Answer 29

to prevent excitation contractions

Question 30

What is the cholinergic toxidrome

Answer 30

``` Diarrhoea Urination Miosis Bronchorrhoea (pulmonary oedema) Bronchospasm Emesis Lacrimation Salivation ```

Question 31

what is the anti-cholinergic toxidrome

Answer 31

``` Dry mucous membranes Dilated pupils Blurred near vision Warm flushed skin urinary retention tachycardia altered mental state ```

Question 32

what is the method to remember the anticholinergic toxidrom

Answer 32

``` blind as a bat mad as a hatter hot as hades red as beet dry as a bone ```

Question 33

what is the sympathomimetic toxidrome

Answer 33

``` hyperpyrexia dilated pupils excessive sweating mental and physical agitation tachycardia hypertension ```

Question 34

what isthe opiate toxidrome

Answer 34

``` CNS effects: CNS depression respiratory depression pinpoint pupils coma ``` PNS effects: bradycardia hypotension decreased gastrointestinal motility

Question 35

what are the effects of OD with benzodiazapine

Answer 35

vital signs not effected ataxia (clumsiness) drowsiness coma

Question 36

what is dimercatrol and DMSA used to treat

Answer 36

heavy metal poisoning

Question 37

what is calcium EDTA and DMSA used to treat

Answer 37

lead poisoning

Question 38

what is the treatment for iron poisoning

Answer 38

deferoxamine

Question 39

what is penecilllamine used in the treatment of

Answer 39

copper poisoning

Question 40

how is cyanide poisoning treated

Answer 40

thiosulphate therapy

Question 41

how is digoxin poisoning treated

Answer 41

digoxin specific antibodies

Question 42

how are snake bite treated

Answer 42

antivenoms

Question 43

how does pharmicalogical reversal treat poisoning

Answer 43

effects of the poison are blocked or reversed by administration of antagonists which compete for binding of the target

Question 44

how is CO poisoning treated

Answer 44

hyperbaric oxygen

Question 45

what is atropine used to treat

Answer 45

acetylcholinesterase poisoning

Question 46

what is used to treat opiate od

Answer 46

naloxone

Question 47

how is diazepam od treated

Answer 47

flumazenil

Question 48

what s warfarin used to treat

Answer 48

Vitamin K od

Question 49

what is folate and leucovorin used to treat

Answer 49

methotrexate-induced toxicity

Question 50

what is ethanol used to treat

Answer 50

methanol and ethylene glycol posioning