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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
how much slower is the metabolism of methanol
5 times slower
26
about how much of methanol dose is metabolised to formic and formaldelhdye
40%
27
what is the rate limiting step of methanol metabolism
folic acid
28
what are the symptoms of acute toxicity of methanol
``` diminished sensation of light reduced central vision photophoia blurred vision retinal edema hyperemia of optic discs` ```
29
what are the symptoms of acut toxicity in the CNS
``` cephalgia dizziness seizure sutpor coma ```
30
methanol poisoning survivors of severe poisoning may have damage to the ______leading to ____________
putamen | extrapyramidal movement disorder
31
what are the GI symptoms for acute toxicity of methanol
nausea vomiting severe abdominal pain
32
what GI enzyme is elevated in methanol poisoning
amylase
33
in general peek levels greater than _____-are considered toxic in methanol poisoning
50mg/dl
34
what is the treatment of methanol poisoning
``` bicarbonate therapy folic acid dialysis ethylalchol therapy fompeizole ```
35
where is ethylene glycol found
``` 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
how does ethylene glycol taste
sweet taste
37
what is often used as a substitute for alcohol
ethylene glycol
38
toxicity of ethylene glycol is limited to
ingestion (lethal dose is 100ml but expections are known
39
what is the metabolism of ethylene glycol
metabolized in liver by alcohol dehydrogenase yielding a variety of acids *glycoaldehyde glycolic acid, glyyozyic acid, oxali acid and formic acid
40
what may contribute to the organ damage seen in ethylene glycl ingestion
oxalic acid--precipitates in the kidney, myocardium, brain, and pancreas
41
how do you treat ethylene glycol poisoning
same as methanol ingestion
42
what are the three stages of ethylene glycol poisoning
``` CNS stage (30 minutes to 12 hours) Cardiopulmonary stage (stage 2)--12-24 hours stage 3 (renal stage) 36-48 hours ```
43
a _______occurs early in ethylene glycol poisoning
osmolar gap (may not be present late in the course
44
what will serum calcium be in ethylene glycol poisoning
LOW
45
the rise in the anion gab corresponds to the amount of glycolic acid where as the ______may not reflect this
osmolar gap
46
what is woods lamp evalulation useful for?
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
cardiac glycoside
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
what percentage of digotoxin is excreted unchanged by the kidneys
85%
49
what are the GI symptoms assoc with digitoxin
anorexia, nausea and vomitting
50
CNS effects of digitoxin
Cephalgis, fatique, malaise, drowsiness, generalized muscle weakness, irritability, vertigo, dizziness, syncope, apathy, lethargy, opisthotonus, and seizures.
51
what are the psychiatric symptoms
amnesia, aphasia, confusion, disorientation, delirium, hallucinations, impaired memory
52
type of vision most affected by digitoxin
color vision
53
cardiac affect of digitoxin
cardiac dysrhythmia
54
what are some factors that can lead to increased likelihood of dig toxicity
``` age of the patient degree of heart disease electrolyte disturbance (hyperkalmeia, hypomagnesemia, and hypercalcemia) hypoxia, hepatic disease renal disease antibiotic therapy ```
55
which antibiotic cause increased likelhood of digotoxin toxicity
erythromycin and tetracycle
56
common accidental ingestion in children
salicylate

Renal Exam III (1 decks)

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