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PPS 946 > Clinical Toxicology > Flashcards

Clinical Toxicology Flashcards

1
Q

Things activated charcoal are not effective for:

A 
(Micoal)
Minerals
Iron
Cyanide
Organic Solvents
Alcohol
Lithium
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2
Q

Two types cathartics

A

Saline (Mg) and saccharides (sorbitol)

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3
Q

[True/False] Cathartics can enhance drug removal which decreases morbidity/mortality.

A

False.

Cathartics have never been shown to decrease morbidity/mortality.

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4
Q

Cathartics contraindications.

A

Ingestion of corrosives.

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5
Q

What is the best known drug removed by dialysis?

A

Ethanol

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6
Q

Naloxone

A

Opioid overdose

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7
Q

Diphenhydramine

A

Antipsychotics-acute dystonic reactions

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8
Q

Desferroxamine

A

Iron overdose

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9
Q

Dimercaprol (BAL)

A

Heavy Metal overdose

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10
Q

N-acetylcysteine

A

Tylenol overdose

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11
Q

Glucagon

A

For insulin and beta blocker overdose

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12
Q

Methylene blue

A

Nitrate overdose

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13
Q

Pralidoxime (2-PAM)

A

Organophosphate overdoses

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14
Q

CaNa2EDTA

A

Heavy Metal overdose

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15
Q

Sodium Thiosulfate

A

Cyanide overdose

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16
Q

Ethanol

A

Antifree (its metabolite-ethylene glycol) and methanol overdose

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17
Q

Pyridoxine (Vitamin B6)

A

INH overdose

Can be used in Ethylene Glycol Overdose

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18
Q

Phentolamine (alpha-1 antagonist)

A

Any alpha-1 agonist overdose

Pseudophedrine

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19
Q

Syrup of Ipecac Contraindications

A
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20
Q

Gastric Lavage Contraindication

A

Unprotected airway
Hydrocarbons
Corrosives

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21
Q

Cocaine Toxidromes

A 
Sympathomimetic
Euphoria
CVAs are common
Rhabdomyalysis (muscle break down)
Hyperthermia
Possible seizures
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22
Q

Management of Cocaine Overdose

Anxiety/psychosis

A

Diazepam/haloperidol

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23
Q

Management of Cocaine Overdose

Sinus tachycardia

A

Observation/diazepam

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24
Q

Management of Cocaine Overdose

Hypertension

A

Labetalol

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25
Q

Management of Cocaine Overdose

Headache (HA)

A

CT scan (could be due to bleeding)

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26
Q

Management of Cocaine Overdose

Seizures

A

Phenytoin/diazepam/CT Scan

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27
Q

Management of Cocaine Overdose

MI

A

Nitrates, Calcium Channel blockers, avoid Beta-blockers

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28
Q

Management of Cocaine Overdose

Rhabdomyalysis

A

Alkalinization of urine (bicarbonate)

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29
Q

Management of Cocaine Overdose

CVA

A

Supportive

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30
Q

Carbon Monoxide Poisoning Treatment

A

Supplemental 100% oxygen

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31
Q

Carbon Monoxide Poisoning Treatment

A

Supplemental 100% oxygen

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32
Q

Two types cathartics

A

Saline (Mg) and saccharides (sorbitol)

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33
Q

[True/False] Cathartics can enhance drug removal which decreases morbidity/mortality.

A

False.

Cathartics have never been shown to decrease morbidity/mortality.

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34
Q

Cathartics contraindications.

A

Ingestion of corrosives.

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35
Q

What is the best known drug removed by dialysis?

A

Ethanol

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36
Q

Naloxone

A

Opioid overdose

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37
Q

[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.

A

False
Do not induce emesis in someone with a TCA overdose
Only do lavage if less than 1 hour post ingestion

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38
Q

TCA Overdose QRS interval meaning:
0.10-0.15
0.16
Below 0.10

A

Correlates with increased risk of seizures
Correlates with increased risk for both seizures and arrhythmia
Dose not rule out the possibility of toxicity

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39
Q

Dimercaprol (BAL)

A

Heavy Metal overdose

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40
Q

N-acetylcysteine

A

Tylenol overdose

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41
Q

Classical triad of opioid intoxication

A

Miosis (pupil constriction)
Respiratory Depression
Depressed level of consciousness

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42
Q

Methylene blue

A

Nitrate overdose

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43
Q

Pralidoxime (2-PAM)

A

Organophosphate overdoses

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44
Q

CaNa2EDTA

A

Heavy Metal overdose

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45
Q

Sodium Thiosulfate

A

Cyanide overdose

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46
Q

Ethanol

A

Antifree (its metabolite) and methanol overdose

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47
Q

Pyridoxine (Vitamin B6)

A

INH overdose

48
Q

Phentolamine (alpha-1 antagonist)

A

Any alpha-1 agonist overdose

Pseudophedrine

49
Q

Syrup of Ipecac Contraindications

A

Less than 6 months
Seizing or comatose patients
Corrosive substances

50
Q

Gastric Lavage Contraindication

A

Unprotected airway
Hydrocarbons
Corrosives

51
Q

Cocaine Toxidromes

A 
Sympathomimetic
Euphoria
CVAs are common
Rhabdomyalysis (muscle break down)
Hyperthermia
Possible seizures
52
Q

Management of Cocaine Overdose

Anxiety/psychosis

A

Diazepam/haloperidol

53
Q

Management of Cocaine Overdose

Sinus tachycardia

A

Observation/diazepam

54
Q

Management of Cocaine Overdose

Hypertension

A

Labetalol

55
Q

Management of Cocaine Overdose

Headache (HA)

A

CT scan (could be due to bleeding)

56
Q

Management of Cocaine Overdose

Seizures

A

Phenytoin/diazepam/CT Scan

57
Q

Management of Cocaine Overdose

MI

A

Nitrates, Calcium Channel blockers, avoid Beta-blockers

58
Q

Management of Cocaine Overdose

Rhabdomyalysis

A

Alkalinization of urine (bicarbonate)

59
Q

Treatment of Organophosphate Poisoning

A

Flushing of body
Atropine for CNS and nicotininc effects
2-PAM for CNS effects

60
Q

When there is inadequate tissue oxygenation is metabolic alkalosis or acidosis present?

A

Metabolic acidosis

61
Q

Carbon Monoxide Poisoning Treatment

A

Supplemental 100% oxygen

62
Q

What two medications are chemically and structurally similar to TCAs?

A

Carbamazepine

Cyclobenzaprine

63
Q

TCA Cardiac Toxicity Signs

A

Tachycardia and HTN
Vasodilation
Myocardial depression and cardiac conduction from inhibition of fast Na+ channels

64
Q

TCA CNS Toxicity

A

Sedation/coma from anticholinergic effects

Seizures from NE and Serotonin reuptake inhibition

65
Q

Clinical Presentation of TCA toxicity

A

TCA
Tonic-clonic seizures
Cardiac
Anticholinergic

66
Q

TCA Bicarbonate Mechanisms

A

Increases plasma protein binding

Stabilization of fast Na+ channels

67
Q

What is your optimum pH of the blood when treating TCA overdose?

A

7.45-7.55

68
Q

[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.

A

False
Do not induce emesis in someone with a TCA overdose
Only do lavage if

69
Q

TCA Overdose QRS interval meaning:

  1. 10-0.15
  2. 16
A

Correlates with increased risk of seizures
Correlates with increased risk for both seizures and arrhythmia
Dose not rule out the possibility of toxicity

70
Q

TCA Contraindications

A

Physostigmine

Flumazenil

71
Q

What vasopressors can be used in a TCA overdose if needed?

A

NE and phenylephrine

Dopamine should be avoided secondary to depletion of amines.

72
Q

Classical triad of opioid intoxication

A

Miosis (pupil constriction)
Respiratory Depression
Depressed level of consciousness

73
Q

Signs of Beta-Blocker Overdose

A

Bradycardia and depression of inotropy (force of contraction)

74
Q

Treatment of Beta-Blocker Overdose

A

Glucagon 3mg IV
Can follow-up with continuous infusion.
Monitor for hyperglycemia

75
Q

Where does hydrocarbon toxicity mainly come from?

A

Aspiration

Pneumonitis

76
Q

Group 1 Hydrocarbons

A

Greases (non-toxic)

77
Q

Group 2 Hydrocarbons

A

Kerosene, gasoline

78
Q

Group 3 Hydrocarbons

A

Ring hydrocarbons-benzene

79
Q

Group 4 Hydrocarbons

A

Chlorinated hydrocarbons: carbon tetrachloride

80
Q

Hallmarks of Phencyclidine (PCP) toxicity

A

Violent or bizarre behavior

81
Q

What is the primary concern of PCP toxicity?

A

Self-induced injury.

82
Q

What can achieve chemical calming in PCP toxicity?

A

Haloperidol or diazepam

83
Q

What are the characteristics of Theophylline toxicity?

A

N/V, agitation

Dysrhythmias and seizures

84
Q

What levels of Theophylline does toxicity begin?

A

20mg/L

85
Q

What are life threatening levels of Theophylline toxicity?

A

50-60mg/L

86
Q

What exacerbates Theophylline toxicity?

A

Hypokalemia

87
Q

What do seizures due to Theophylline toxicity respond to?

A

Phenytoin

Diazepam

88
Q

In severe seizures due to Theophylline toxicity what do you want to consider to treat it?

A

Hemoperfusion

89
Q

What three deleterious effects do organophosphates have on the body systems?

A

Parasympathetic-SLUDGE
Nicotinic-muscle weakness
CNS-confusion, slurred speech, respiratory depression

90
Q

Treatment of Organophosphate Poisoning

A

Flushing of body
Atropine for CNS and nicotininc effects
2-PAM for CNS effects

91
Q

Characteristics of Barbiturate poisoning

A

Respiratory depression
Hypotension
Decreased level of consciousness

92
Q

Clinical Presentation of Barbiturate poisoning

A 
Slurred speech
Lethargy
Ataxia
Hypothermia
Coma
Death
93
Q

Treatment of Barbiturate poisoning

A

Forced diuresis
Alkalinization of the urin
Multiple dose charcoal

94
Q

Normal Plasma Blood levels of Barbiturates

A

15-40mg/L

95
Q

Clinical Presentation of BZDs

A 
Lethargy
Slurred speech
Ataxia
Respiratory Depression
Coma
96
Q

Avoid ____ especially in ultra-short acting BZDs due to rapid progression to coma.

A

Emesis

97
Q

What is indicated for pure benzo overdoses only?

A

Flumazenil

98
Q

What is the dose of flumazenil for benzo overdose?

A

0.2mg IV repeat with 0.5mg every 1 min. until response is achieved or to a max dose of 3mg

99
Q

How does methanol become toxic?

A

It is metabolized and its metabolites are toxic.

formic acid

100
Q

How does methanol toxicity present itself?

A

Osmolar/anion gap.

101
Q

What do you always draw in methanol toxicity?

A

ASA/APAP and ethylene glycol levels

102
Q

Treatment of Methanol Toxicity

A

EtOH therapy: 10% EtOH in D5W over 30-60 minutes then start 1.39ml/kg/h of 10% EtOH solution.
EtOH bind alcohol dehydrogenase, preventing methanol metabolism

Folinic Acid and folic acid-enhances the conversion of formate to CO2 and H2O.

4-methylpyrazole/Fomepizole (4-MP)-blocks alcohol dehydrogenase without causing inebriation.

Hemodialysis-removes methanol and formate from the circulation

103
Q

How is ethylene glycol toxic?

A

Glycolic acid accumulates and causes renal tubular damage. Glycolic acid is metabolized and the metabolites can cause acidosis and some can form oxalate crystals in tissues (within 1-3 hours).

104
Q

Ethylene Glycol Toxicity

Stage 1

A

CNS Stage:
30 minutes to 12 hours
Characterized by intoxication, slurred speech, lethargy, ataxia.
Patients may complain of GI distress

105
Q

Ethylene Glycol Toxicity

Stage 2

A

Cardiac Stage:
Occurs 12-48 hours after ingestion and is characterized by cardiac edema, cardiac dilation, and the development of arrhythmias.
Death is most common during this stage.

106
Q

Ethylene Glycol Toxicity

Stage 3

A

Renal Stage:
Occurs 24-72 hours after ingestion
Characterized by development of acute renal failure, flank pain, and CVA tenderness on physical exam.

107
Q

In Ethylene Glycol overdose what levels must you draw and what must you monitor?

A

Draw ASA/APAP levels

Place patients on an EKG monitor.

108
Q

Treatment of Ethylene Glycol Toxicity

A

Gastric Lavage if less than 4 hours post ingestion
Bicarbonate for metabolic acidosis
Calcium Chloride or Calcium Gluconate for hypocalemia
Ethanol
4-MP
Thiamine, pyridoxin, and folate
Hemodialysis in cases with ARF or high serum EG levels (more than 50mg/L)

109
Q

Childhood ingestions are usually single _____, _____, and _____ recognized.

A

Single chemical agents
Known
Promptly recognized

110
Q

Adult/adolescent ingestions are usually multiple chemical agents, intentional, ____, and with _____ recognition.

A

Unknown

Delayed

111
Q

What is the most common cause of toxic ingestions in the elderly?

A

Chronic overmedication (polypharmacy)

112
Q

What do you want to identify in a patient that you believed has overdosed?

A

Substance
Amount
Route

113
Q

What do you look for upon physical exam?

A 
Vital signs
Coma grade/level of consciousness
Neurologic findings (seizures, nystagmus, miosis (cholinergics), mydriasis (anticholinergics), fixed dilated pupils)
Cardiac-(dysrhythmias)
Odors
114
Q

What are some lab assessments that you can obtain during an overdose?

A 
Electrolytes (anion gap)
Blood gases
Serum osmolality
EKG
Toxic Screen
115
Q

Treatment Principals are?

A 
Provide supportive care
Prevent absorption
Enhance elimination
Interrupt or alter metabolism
Provide specific antibiotics

PPS 946 (22 decks)

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