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Renal Exam III > Emergency Toxicology > Flashcards

Emergency Toxicology Flashcards

1
Q

what is propranolol

A

beta blocker that blocks binding of epinephrine and NE

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2
Q

what is propranolol use for

A

angina, myocardial infraction, and hypertension problems (cardiovascular)

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3
Q

beta 3 receptors are found where

A

fat cells

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4
Q

beta 2 receptors are found where

A

heart lungs, GI, liver, uterus, vascular smooth muscle, muscle, and skeletal muscle

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5
Q

beta 1 receptors are found where

A

heart and kidney

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6
Q

third generation beta blockers also

A

possess vasodilator actions through blockade of vascular alpha adrenoceptors

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7
Q

what are the serious side effects of opioid overdose

A

respiratory arrest
coma
death
unconsciousness

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8
Q

what are some signs that lead to opioid overdose?

A 
cool to touch
unresponsive to pain
hunger diminished
scars of veins
pupils pinpointed
low blood pressure
diminished urine
breathing is SLOW
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9
Q

actions of opioids mu receptor

A 
Miosis
Dependency
Constipation
Analgesics
Respiratory depression
Euphoria
Sedation
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10
Q

what is the most frequent cause of patients presenting to emergency department with altered mental status

A

alcohol

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11
Q

causes of a large anion gap

A

M Methanol
U Uremia
D DKA, Alcohol Ketosis, Starvation Ketosis
Ketoacidosis, Acetoacetic acid, Beta Hydroxybutyric Acid
P Phenformin, Metformin
I Isoniazid, Iron, Inborn errors of metabolism
L Lactic acidosis(CN, CO, H2S) metformin
E Ethylene Glycol
S Salicylates

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12
Q

methanol is also know as

A

wood alcohol

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13
Q

how is methanol produced

A

distillation of hard wood

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14
Q

top three sources of methanol ?

A

gas line antifreeze
carburator fluid
windshield washing solution

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15
Q

what does dietary metanol arise from

A

fruits and vegetables as free alcohol, methyl esters of fatty acids, or methoxy groups on polysaccharides such as pectin

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16
Q

_____has the ability to be converted to methanol

A

aspartime (nutrasweet)

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17
Q

methanol tasts

A

bitter sweet

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18
Q

distribution of methanol

A

whole body

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19
Q

what is the major metabolite of methanol

A

formate

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20
Q

what is responsible for the toxicity of methanol

A

formate

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21
Q

ingestion of 4ml of methanol causes

A

blindness

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22
Q

ingestion of 15 ml of methanol causes

A

death

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23
Q

how is methanol absorbed

A

all routes (skin, inhalation, and ingestion)

24
Q

main route of metabolis of methanol is what

A

oxidation via alcohol dehydrogenase

25
Q

how much slower is the metabolism of methanol

A

5 times slower

26
Q

about how much of methanol dose is metabolised to formic and formaldelhdye

A

40%

27
Q

what is the rate limiting step of methanol metabolism

A

folic acid

28
Q

what are the symptoms of acute toxicity of methanol

A 
diminished sensation of light
reduced central vision
photophoia
blurred vision
retinal edema
hyperemia of optic discs`
29
Q

what are the symptoms of acut toxicity in the CNS

A 
cephalgia
dizziness
seizure
sutpor
coma
30
Q

methanol poisoning survivors of severe poisoning may have damage to the ______leading to ____________

A

putamen

extrapyramidal movement disorder

31
Q

what are the GI symptoms for acute toxicity of methanol

A

nausea
vomiting
severe abdominal pain

32
Q

what GI enzyme is elevated in methanol poisoning

A

amylase

33
Q

in general peek levels greater than _____-are considered toxic in methanol poisoning

A

50mg/dl

34
Q

what is the treatment of methanol poisoning

A 
bicarbonate therapy 
folic acid
dialysis
ethylalchol therapy
fompeizole
35
Q

where is ethylene glycol found

A 
Detergents
Paints
Lacquers
Drugs
Dyes
Hydraulic brake fluid
Polishes
Cosmetics
Glycerine substitute in enemas
Preservative in juices
Early medicinals
BREAK FLUID
COOLANT
WINDSHIELF DEICER, RADIATOR ANTIFREEZE
36
Q

how does ethylene glycol taste

A

sweet taste

37
Q

what is often used as a substitute for alcohol

A

ethylene glycol

38
Q

toxicity of ethylene glycol is limited to

A

ingestion (lethal dose is 100ml but expections are known

39
Q

what is the metabolism of ethylene glycol

A

metabolized in liver by alcohol dehydrogenase yielding a variety of acids *glycoaldehyde glycolic acid, glyyozyic acid, oxali acid and formic acid

40
Q

what may contribute to the organ damage seen in ethylene glycl ingestion

A

oxalic acid–precipitates in the kidney, myocardium, brain, and pancreas

41
Q

how do you treat ethylene glycol poisoning

A

same as methanol ingestion

42
Q

what are the three stages of ethylene glycol poisoning

A 
CNS stage (30 minutes to 12 hours)
Cardiopulmonary stage (stage 2)--12-24 hours
stage 3 (renal stage) 36-48 hours
43
Q

a _______occurs early in ethylene glycol poisoning

A

osmolar gap (may not be present late in the course

44
Q

what will serum calcium be in ethylene glycol poisoning

A

LOW

45
Q

the rise in the anion gab corresponds to the amount of glycolic acid where as the ______may not reflect this

A

osmolar gap

46
Q

what is woods lamp evalulation useful for?

A

A wood’s lamp examination of the urine or the emesis may show fluorescence from the fluorescein coloring added to most ethylene glycol antifreeze.

47
Q

cardiac glycoside

A

positive inotropic action that causes increased force of contraction on a diseased heart (slows the SA node impulse) and Negative chronotropic action. Slows the conduction velocity reflected by slowing the heart rate due to increased vagal tone, prolonged refraction periods of the AV node and bundle of HIS

48
Q

what percentage of digotoxin is excreted unchanged by the kidneys

A

85%

49
Q

what are the GI symptoms assoc with digitoxin

A

anorexia, nausea and vomitting

50
Q

CNS effects of digitoxin

A

Cephalgis, fatique, malaise, drowsiness, generalized muscle weakness, irritability, vertigo, dizziness, syncope, apathy, lethargy, opisthotonus, and seizures.

51
Q

what are the psychiatric symptoms

A

amnesia, aphasia, confusion, disorientation, delirium, hallucinations, impaired memory

52
Q

type of vision most affected by digitoxin

A

color vision

53
Q

cardiac affect of digitoxin

A

cardiac dysrhythmia

54
Q

what are some factors that can lead to increased likelihood of dig toxicity

A 
age of the patient
degree of heart disease
electrolyte disturbance (hyperkalmeia, hypomagnesemia, and hypercalcemia)
hypoxia, hepatic disease
renal disease
antibiotic therapy
55
Q

which antibiotic cause increased likelhood of digotoxin toxicity

A

erythromycin and tetracycle

56
Q

common accidental ingestion in children

A

salicylate

Renal Exam III (1 decks)

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