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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
Management of Cocaine Overdose | Headache (HA)
CT scan (could be due to bleeding)
26
Management of Cocaine Overdose | Seizures
Phenytoin/diazepam/CT Scan
27
Management of Cocaine Overdose | MI
Nitrates, Calcium Channel blockers, avoid Beta-blockers
28
Management of Cocaine Overdose | Rhabdomyalysis
Alkalinization of urine (bicarbonate)
29
Management of Cocaine Overdose | CVA
Supportive
30
Carbon Monoxide Poisoning Treatment
Supplemental 100% oxygen
31
Carbon Monoxide Poisoning Treatment
Supplemental 100% oxygen
32
Two types cathartics
Saline (Mg) and saccharides (sorbitol)
33
[True/False] Cathartics can enhance drug removal which decreases morbidity/mortality.
False. | Cathartics have never been shown to decrease morbidity/mortality.
34
Cathartics contraindications.
Ingestion of corrosives.
35
What is the best known drug removed by dialysis?
Ethanol
36
Naloxone
Opioid overdose
37
[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.
False Do not induce emesis in someone with a TCA overdose Only do lavage if less than 1 hour post ingestion
38
TCA Overdose QRS interval meaning: 0.10-0.15 0.16 Below 0.10
Correlates with increased risk of seizures Correlates with increased risk for both seizures and arrhythmia Dose not rule out the possibility of toxicity
39
Dimercaprol (BAL)
Heavy Metal overdose
40
N-acetylcysteine
Tylenol overdose
41
Classical triad of opioid intoxication
Miosis (pupil constriction) Respiratory Depression Depressed level of consciousness
42
Methylene blue
Nitrate overdose
43
Pralidoxime (2-PAM)
Organophosphate overdoses
44
CaNa2EDTA
Heavy Metal overdose
45
Sodium Thiosulfate
Cyanide overdose
46
Ethanol
Antifree (its metabolite) and methanol overdose
47
Pyridoxine (Vitamin B6)
INH overdose
48
Phentolamine (alpha-1 antagonist)
Any alpha-1 agonist overdose | Pseudophedrine
49
Syrup of Ipecac Contraindications
Less than 6 months Seizing or comatose patients Corrosive substances
50
Gastric Lavage Contraindication
Unprotected airway Hydrocarbons Corrosives
51
Cocaine Toxidromes
``` Sympathomimetic Euphoria CVAs are common Rhabdomyalysis (muscle break down) Hyperthermia Possible seizures ```
52
Management of Cocaine Overdose | Anxiety/psychosis
Diazepam/haloperidol
53
Management of Cocaine Overdose | Sinus tachycardia
Observation/diazepam
54
Management of Cocaine Overdose | Hypertension
Labetalol
55
Management of Cocaine Overdose | Headache (HA)
CT scan (could be due to bleeding)
56
Management of Cocaine Overdose | Seizures
Phenytoin/diazepam/CT Scan
57
Management of Cocaine Overdose | MI
Nitrates, Calcium Channel blockers, avoid Beta-blockers
58
Management of Cocaine Overdose | Rhabdomyalysis
Alkalinization of urine (bicarbonate)
59
Treatment of Organophosphate Poisoning
Flushing of body Atropine for CNS and nicotininc effects 2-PAM for CNS effects
60
When there is inadequate tissue oxygenation is metabolic alkalosis or acidosis present?
Metabolic acidosis
61
Carbon Monoxide Poisoning Treatment
Supplemental 100% oxygen
62
What two medications are chemically and structurally similar to TCAs?
Carbamazepine | Cyclobenzaprine
63
TCA Cardiac Toxicity Signs
Tachycardia and HTN Vasodilation Myocardial depression and cardiac conduction from inhibition of fast Na+ channels
64
TCA CNS Toxicity
Sedation/coma from anticholinergic effects | Seizures from NE and Serotonin reuptake inhibition
65
Clinical Presentation of TCA toxicity
TCA Tonic-clonic seizures Cardiac Anticholinergic
66
TCA Bicarbonate Mechanisms
Increases plasma protein binding | Stabilization of fast Na+ channels
67
What is your optimum pH of the blood when treating TCA overdose?
7.45-7.55
68
[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.
False Do not induce emesis in someone with a TCA overdose Only do lavage if
69
TCA Overdose QRS interval meaning: 0. 10-0.15 0. 16
Correlates with increased risk of seizures Correlates with increased risk for both seizures and arrhythmia Dose not rule out the possibility of toxicity
70
TCA Contraindications
Physostigmine | Flumazenil
71
What vasopressors can be used in a TCA overdose if needed?
NE and phenylephrine | Dopamine should be avoided secondary to depletion of amines.
72
Classical triad of opioid intoxication
Miosis (pupil constriction) Respiratory Depression Depressed level of consciousness
73
Signs of Beta-Blocker Overdose
Bradycardia and depression of inotropy (force of contraction)
74
Treatment of Beta-Blocker Overdose
Glucagon 3mg IV Can follow-up with continuous infusion. Monitor for hyperglycemia
75
Where does hydrocarbon toxicity mainly come from?
Aspiration | Pneumonitis
76
Group 1 Hydrocarbons
Greases (non-toxic)
77
Group 2 Hydrocarbons
Kerosene, gasoline
78
Group 3 Hydrocarbons
Ring hydrocarbons-benzene
79
Group 4 Hydrocarbons
Chlorinated hydrocarbons: carbon tetrachloride
80
Hallmarks of Phencyclidine (PCP) toxicity
Violent or bizarre behavior
81
What is the primary concern of PCP toxicity?
Self-induced injury.
82
What can achieve chemical calming in PCP toxicity?
Haloperidol or diazepam
83
What are the characteristics of Theophylline toxicity?
N/V, agitation | Dysrhythmias and seizures
84
What levels of Theophylline does toxicity begin?
20mg/L
85
What are life threatening levels of Theophylline toxicity?
50-60mg/L
86
What exacerbates Theophylline toxicity?
Hypokalemia
87
What do seizures due to Theophylline toxicity respond to?
Phenytoin | Diazepam
88
In severe seizures due to Theophylline toxicity what do you want to consider to treat it?
Hemoperfusion
89
What three deleterious effects do organophosphates have on the body systems?
Parasympathetic-SLUDGE Nicotinic-muscle weakness CNS-confusion, slurred speech, respiratory depression
90
Treatment of Organophosphate Poisoning
Flushing of body Atropine for CNS and nicotininc effects 2-PAM for CNS effects
91
Characteristics of Barbiturate poisoning
Respiratory depression Hypotension Decreased level of consciousness
92
Clinical Presentation of Barbiturate poisoning
``` Slurred speech Lethargy Ataxia Hypothermia Coma Death ```
93
Treatment of Barbiturate poisoning
Forced diuresis Alkalinization of the urin Multiple dose charcoal
94
Normal Plasma Blood levels of Barbiturates
15-40mg/L
95
Clinical Presentation of BZDs
``` Lethargy Slurred speech Ataxia Respiratory Depression Coma ```
96
Avoid ____ especially in ultra-short acting BZDs due to rapid progression to coma.
Emesis
97
What is indicated for pure benzo overdoses only?
Flumazenil
98
What is the dose of flumazenil for benzo overdose?
0.2mg IV repeat with 0.5mg every 1 min. until response is achieved or to a max dose of 3mg
99
How does methanol become toxic?
It is metabolized and its metabolites are toxic. | formic acid
100
How does methanol toxicity present itself?
Osmolar/anion gap.
101
What do you always draw in methanol toxicity?
ASA/APAP and ethylene glycol levels
102
Treatment of Methanol Toxicity
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
How is ethylene glycol toxic?
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
Ethylene Glycol Toxicity | Stage 1
CNS Stage: 30 minutes to 12 hours Characterized by intoxication, slurred speech, lethargy, ataxia. Patients may complain of GI distress
105
Ethylene Glycol Toxicity | Stage 2
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
Ethylene Glycol Toxicity | Stage 3
Renal Stage: Occurs 24-72 hours after ingestion Characterized by development of acute renal failure, flank pain, and CVA tenderness on physical exam.
107
In Ethylene Glycol overdose what levels must you draw and what must you monitor?
Draw ASA/APAP levels | Place patients on an EKG monitor.
108
Treatment of Ethylene Glycol Toxicity
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
Childhood ingestions are usually single _____, _____, and _____ recognized.
Single chemical agents Known Promptly recognized
110
Adult/adolescent ingestions are usually multiple chemical agents, intentional, ____, and with _____ recognition.
Unknown | Delayed
111
What is the most common cause of toxic ingestions in the elderly?
Chronic overmedication (polypharmacy)
112
What do you want to identify in a patient that you believed has overdosed?
Substance Amount Route
113
What do you look for upon physical exam?
``` Vital signs Coma grade/level of consciousness Neurologic findings (seizures, nystagmus, miosis (cholinergics), mydriasis (anticholinergics), fixed dilated pupils) Cardiac-(dysrhythmias) Odors ```
114
What are some lab assessments that you can obtain during an overdose?
``` Electrolytes (anion gap) Blood gases Serum osmolality EKG Toxic Screen ```
115
Treatment Principals are?
``` Provide supportive care Prevent absorption Enhance elimination Interrupt or alter metabolism Provide specific antibiotics ```

PPS 946 (22 decks)

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