Drug Toxicities

Question 1

• overdose: higher than 4 gm in 24 hr
• early: anorexia, nausea, vomiting
• 24-48 hours: elevated PT, increased transaminases
• 48 hrs - 7 days: elevated ICP, hepatic encephalopathy, coma, multi organ failure
• hepatic necrosis

Answer 1

acetaminophen toxicity

Question 2

antidote for acetaminophen?

Answer 2

NAC within 8-12 hours

Question 3

• tinnituds
• early respiratory alkalosis
• metabolic acid later due to accumulation , uncoupling of ox phosphorylation, depletion of bicarb
• hyperpyrexia
• coma, convulsions, resp failure

Answer 3

salicylates

Question 4

• blood sample (>3.5 moderate or severe)
• correct hyperthermia
• mechanical ventilation
• fluids, glucose, electrolytes
• sodium bicarb to alkalinize urine
• osmotic diuretics

Answer 4

salicylate poisoning

Question 5

• CNS stimulation, muscle rigidity or hyperactivity
• seizures
• vtach or vfib
• HTN
• circulatory failure
• coma, death

Answer 5

cocaine, amphetamines, phencyclidine (Sympathomimetics)

Question 6

give:
- control convulsions with diazepam
- succinylcholine
- beta blockers contraindicated

Answer 6

sympathomimetics

Question 7

• unconscious, pin point pupils, shallow respirations
• cyanosis, hypotension, GI spasms
• twitching muscles
• death from resp depression

Answer 7

opioids

Question 8

• naloxone, give repeated doses b/c short DOA

- maintain body warmth

Answer 8

opioids

Question 9

• drowsy, tremors, disorientation, hallucinations, tachycardia, coma
• control convulsions with diazepam

Answer 9

antihistamine overdose

Question 10

• anticholinergic effects
• arrhythmias, hypotension
• seizures (treat w/ diazepam and pancuronium)
• give sodium bicarb to maintain pH and reverse cardiac membrane depressant effects

Answer 10

Tricyclics

Question 11

• hypotension, bradycardia, cardiogenic shock
• convulsions, coma
• bronchospasm with asthma
• hypoglycemia, hyperkalemia

Answer 11

beta blockers

Question 12

• treat with glucagon
• wide conduction defects may respond to sodium bicarb
• torsades resulting from sotalol treated w/ isoproterenol, magnesium, overdrive pacing

Answer 12

beta blockers

Question 13

• altered mental status, fever, agitation, myoclonuds

- hyperreflexia, ataxia, diaphoresis, shivering, diarrhea

Answer 13

serotonin syndrome

Question 14

• tx: cyproheptadine, propanolol

- dantrolene

Answer 14

serotonin syndrome treatment

Question 15

• major visual impairment
• slurring of speech
• BAC 150-300 mg%

Answer 15

moderate ethanol poisoning

Question 16

-approaching stupod
-severe hypoglycemia
-convulsions
-fatal
BAC 300-500 mg %

Answer 16

severe ethanol poisoning

Question 17

• support vitals
• avoid depressants
• hemodialysis

Answer 17

acute ethanol poisoning treatment

Question 18

• treat seizures with IV diazepam
• prevent withdrawal with chlorodiazepoxide
• addiction and family counseling

Answer 18

chronic poisoning

Question 19

given to discourage alcohol use, inhibits acetaldehyde dehydrogenase

Answer 19

disulfiram

Question 20

oral opioid antagonist, promise in treating alcohol addiction

Answer 20

naltrexone

Question 21

analog of homotaurine and GABA, maintenance of abstinence from alcohol

Answer 21

acamprosate

Question 22

• rapidly metabolizes to formalldehyde
• blindness, CNS toxicity, metabolic acidosis
• treat with IV ethanol, competes for alcohol dehydrogenase
• fomepizole (synthetic alcohol dehydrogenase inhibitor)
• treat acidosis with sodium bicarb

Answer 22

methanol poisoning

Question 23

• kidney damage due to calcium oxalate crystals

- treat: IV ethanol, fomepizole

Answer 23

ethylene glycol and diethylene glycol poisoning