Clinical Toxicology I

Question 1

Toxidrome # 1: A 24 year old male is found down. His VS are BP 110/70 mm Hg, HR 65/minute, T 36 C, RR 5/minute. He is unresponsive to painful stimuli with pinpoint pupils, and decreased bowel sounds

Answer 1

pinpoint pupils means MIOSIS which means OPIODS 
depressed breathing (RR 5/min)
hypomotile bowel sounds 
bradycardia
hypotension

Question 2

What are examples of Opioids?

Answer 2

Meperidine
Methadone
Heroin**
Codeine 
Fentanyl
Oxycodone 
Buprinorphene
Dexmethorphan

Question 3

To treat Opioid overdose - what are you most concerned about?

Answer 3

HYPOGLYCEMIA - or just give glucose because ASA will change your reading when you are still

• remove obstructive process
• assess and protect if necessary
• intravenous fluids in sick patients
• oxygen 100%
• dextrose/Thiamine

Question 4

What is the antidote to Opioid overdose?

Answer 4

Nalaxone
(Nalmefene, Naltrexone)

• -depressed resp rate will tell you the effect
• -can precipitate withdrawal (need to be taken for ten days and Naloxone only lats for 45 mins so give infusion

Question 5

What was Case 1 taking?

Answer 5

Methadone

Question 6

Toxidrome 2: A 34 year old female ingests 50 of her diazepam 10 mg tablets in a suicide attempt. She is found responsive only to painful stimuli, vital signs:
BP 120/80 mm Hg
heart rate 80 beats per minute
T 37 C
respiratory rate 18 breaths per minute.

Answer 6

Diazepam - benzos normally cause respiratory depression and normal vital signs
**Pay attention

Question 7

What are some examples of Benzodiazepines - Case 2?

Answer 7

Valium/diazepam
Ativan/lorazepam
Midalzolam
Zanax/ Alprazolam

Question 8

What are some examples of Barbituates?

Answer 8

Pheonbarbitol

Question 9

What is the antidote to Benzodiazepines?

Answer 9

Flumazenil

Question 10

What are the toxicities of Flumezanil?

Answer 10

• can precipitate withdrawal

- seizures

Question 11

You must do an Acetominophen level on people who take Valium. Why?

Answer 11

you do it routinely

they may be lying or not want to tell you

Question 12

What is the treatment for Acetominophen Overdose?

Answer 12

NAC given within 8 hours of overdose - N-Acetylcysteine - precursor of Gluthathione
—-you have to wait for four hours the Nomogram, given if signs of hepatotoxicity

Question 13

Case 3: A 36 year old female states that she ingested all of her antidepressants. When you arrive, the patient is awake, but 5 minutes later is obtunded, VS: P 140/min, BP 120/80 mm Hg, T 38 C, RR 13/min. PE: pupils 6 mm, dry mucous membranes, dry flushed skin, no bowel sounds. A dysrhythmia is noted

Answer 13

Toxidrome: Tachycardic, hot–> ANTIMUSCARINIC, Anticholinergic

TCAs Overdose - antidepressant that causes heart problems (Widened QRS complex) along w. antimuscarinic

Question 14

In an patient who has overdosed on their antidepressants and is now at risk for dysrytmias, how do you cure it? What is the antidote?

Answer 14

Sodium Bicarbonate - reverses Na blockade and competitive inhibitor and it is good to alkalinize the blood