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Poison/Toxicology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

If they breathe very rapidly, toxidrome?

A

stimulant - cocaine

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2
Q

If shallow, slow breathing, toxidrome?

A

Antidepressant - opioids, fentanyl, tranquilizers, high dose of anti-anxiety

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3
Q

If rapid HR, high BP, toxidrome?

A

Cocaine, crystal meth

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4
Q

If low HR, BP, toxidrome?

A

alcohol, antidepressant, opioid

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5
Q

Pinpoint pupils, toxidrome?

A

opioids = heroine, methadone, fentanyl

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6
Q

Dilated and reactive pupils, toxidrome?

A

stimulants

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7
Q

Dilated and unreactive pupils, toxidrome?

A

Anticholinergics - atropine, scopolamine

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8
Q

If frothy sputum from lungs, toxidrome?

A

Opioids

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9
Q

Flumazenil is used in what kind of overdose?

A

BZD

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10
Q

AT MUDPIES pneumonic

A
  • Alcohol
  • Toluene
  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Paraldehyde
  • Iron, Isoniazid
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates, strychnine
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11
Q

Avoid activated charcoal in what kind of OD?

A

Alcohols, cyanide, lithium

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12
Q

Multiple-dose AC useful in ___ (4)

A

Theophyline, phenobarbital, phenytoin, salicylate

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13
Q

Ion trapping: acidification vs alkalinization which one is clinically useful?

A

Alkalinization

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14
Q

Acidifying agent

A

Ammonium chloride, ascorbic acid

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15
Q

Alkalinizing agent

A

Sodium bicarbonate

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16
Q

Alkalinization useful in ___ (3)

A

Phenobarbital, salicylates, isoniazid

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17
Q

Drugs frequently dialyzed include ___ (6)

A

The SMELL
1. Salicylates
2. Methanol
3. Ethylene glycol
4. Long acting barbiturates
5. Lithium
6. Theophylline

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18
Q

APAP OD Stage II AST/ALT level

A

> 1,000 IU/L

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19
Q

APAP Stage III AST/ALT level

A

> 10,000 IU

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20
Q

APAP toxic levels in adults vs children

A
  • 7.5 g in adults
  • 150 mg/kg in children
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21
Q

Normal serum APAP concentration

A

10-30 mcg/mL

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22
Q

Normal ALT level

A

4-36

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23
Q

Normal AST level

A

8-33

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24
Q

Normal bilirubin level

A

0.1-1.2

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25
Q

Normal Creatinine level

A

0.7-1.3

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26
Q

Normal glucose level

A

70-100 mg/dL

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27
Q

Normal INR

A

0.8-1.1

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28
Q

Normal lactate

A

0.5-2.2

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29
Q

Normal phosphate

A

2.8-4.5

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30
Q

Normal Prothrombin time (PT)

A

11-13.5 sec

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31
Q

Activated charcoal dose and time given

A
  • 1 g/kg
  • Within 1-2 hrs of ingestion
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32
Q

APAP OD antidote name and time given

A
  • N-acetylcysteine (NAC)
  • Within 8 hrs of ingestion
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33
Q

When do we treat APAP OD with antidote?

A

Treat if 150 mcg/mL or above at 4 hrs of ingestion

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34
Q

NAC oral dose: loading, maintenance & regimen duration

A
  • Loading: 140 mg/kg
  • Maintenance: 70 mg/kg Q4H x17 doses
  • Duration: 72 hrs
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35
Q

NAC IV dosing for 3-bag regimen: first, second, last

A
  1. 150 mg/kg over 1 hr
  2. 50 mg/kg over 4 hrs
  3. 100 mg/kg over 16 hrs
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36
Q

NAC high dose regimen

A
  • 150 mg/kg over 1 hr
  • 250 mg/kg over 20 hrs
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37
Q

D/c NAC if:

A
  1. Serum APAP undetectable
  2. AST downward trend: 2 consecutive decreasing AST values, AST <1,000 IU, AST/ALT ratio of 0.4
  3. INR <2
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38
Q

Normal pH level

A

7.35 - 7.45

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39
Q

Normal PaCO2

A

35-45

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40
Q

Normal HCO3

A

22-26

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41
Q

Metabolic acidosis lab

A
  1. pH <7.35
  2. HCO3 <22
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42
Q

Metabolic alkalosis lab

A
  1. pH >7.45
  2. HCO3 >26
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43
Q

Respiratory acidosis lab

A
  1. pH <7.35
  2. PaCO2 >45
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44
Q

Respiratory alkalosis lab

A
  1. pH >7.45
  2. PaCO2 <35
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45
Q

Causes of metabolic acidosis

A

MUDPILES
Methanol, Uremia, DKA, Paraldehyde, Isoniazid/Iron/Ibuprofen, lactic acidosis, Ethylene glycol, Salicylate

46
Q

Anion Gap calculation

A

AG = Na - Cl - HCO3

47
Q

Causes of non-anion gap metabolic acidosis

A

HARDUP
Hyperchloremia/alimentation, Acetazolamide, Renal tubular acidosis, Diarrhea, Ureterosigmoid fistula, Pancreatic fistula

48
Q

When is NaHCO3 given in metabolic acidosis?

A

pH <7.15, toxin excretion, life-threatening hyperK+

49
Q

Metabolic alkalosis treatment

A
  1. Treat underlying disorder
  2. IV saline, K+ supplementation
  3. Acetazolamide
50
Q

Respiratory acidosis treatment

A
  1. Underlying disorder
  2. Improve airway function with bronchodilators, mechanical ventilation
51
Q

Respiratory alkalosis treatment

A
  1. Underlying disorder
  2. Correct breathing with mechanical ventilation
52
Q

Adrenergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity

A
  1. up
  2. up
  3. up
  4. up
  5. mydriasis
  6. agitated
  7. yes
  8. 0
53
Q

Anticholinergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity

A
  1. up
  2. up
  3. 0
  4. up
  5. mydriasis
  6. delirious
  7. no
  8. down
54
Q

Cholinergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity

A
  1. down
  2. down
  3. 0
  4. 0
  5. miosis
  6. altered
  7. yes
  8. up
55
Q

Opioid BP, HR, RR, T, pupils, mental status, sweat, bowel activity

A
  1. down
  2. down
  3. down
  4. down
  5. miosis
  6. depressed
  7. no
  8. down
56
Q

Salicylates in alkalotic system

A

Ionized -> not permeable to cell membranes -> trapped outside the cell/ inside the plasma = :)

57
Q

Salicylate respiratory effects

A

Respiratory alkalosis
- High pH -> salicylate ionized -> trapped in plasma
- Eventually can’t breathe as fast/deep -> low pH -> unionized -> move into the cell

58
Q

What happens to salicylates inside the cell?

A

Uncoupling mitochondrial oxidative phosphorylation -> increase CO2 production -> increase pyruvic and lactic acid production

59
Q

Why is hypoK not good in salicylate OD?

A

HypoK prevents alkalinization of urine

60
Q

When do you perform hemodialysis for salicylate OD?

A
  • Levels >80-100 mg/dL, OR
  • > 60 mg/dL with renal failure, altered mental status, CHF, poor response
61
Q

Which IV BZD contain propylene glycol as a solvent?

A

Lorazepam and Diazepam

62
Q

Beer’s criteria drugs

A

Zolpidem, zaleplon, eszopiclone, diphenhydramine, doxylamine, hydroxyzine, lithium, clonazepam

63
Q

Non BZD IV sedatives given bolus IV push

A

Etomidate, ketamine, propofol

64
Q

Non BZD IV sedatives given continuous IV

A

Propofol, dexmedetomidine

65
Q

Which Non BZD IV sedative is HoTN neutral or up?

66
Q

What is a major SE for propofol?

A

HoTN, PRIS

67
Q

Lithium toxicity risk factors

A
  • Older age: decreased GFR
  • Low output HF
  • DDI
  • Decreased sodium intake
68
Q

Qualitative toxicology test is best for

69
Q

Quantitative toxicology test is best for

70
Q

Activated charcoal is NOT for:

A

Lithium, alcohol, cyanide, hydrocarbons

71
Q

C/I for using flumazenil as antidote for BZD OD

A
  1. Seizure
  2. Coingestion that provokes seizures, arrhythmias
  3. Long-term BZD
  4. TCA use on EKG
  5. Hypoxia
  6. Hypoventilatioin
  7. HoTN
  8. Head trauma
72
Q

Warfarin antidotes

A
  1. AC
  2. Vitamin K
  3. Fresh Frozen Plasma (FFP)
  4. Prothrombin Complex Concentrate (PCC)
73
Q

4-Factor PCC must be administered with __?

74
Q

Management of INR 4.5-10.0

A
  • Hold warfarin
  • Resume when INR therapeutic
75
Q

Management of INR 10.0+

A
  • Hold warfarin
  • Administer 2.5 mg Vit K PO
76
Q

Management of INR with any major bleeding

A
  • Hold warfarin
  • Administer 5-10 mg Vit K as a slow IV infusion
77
Q

Dabigatran antidotes

A
  1. AC
  2. FFP
  3. Idarucizumab (Praxbind)
    Hemodialysis
78
Q

Rivaroxaban, Apixaban antidotes

A
  1. AC
  2. 4F-PCC
  3. Andexanet alfa (recombinant FXa)
79
Q

Enoxaparin antidote

A

Protamine sulfate

80
Q

Phenobarbital clinical manifestations

A

Coma, HoTN, bradycardia…

81
Q

Phenobarbital treatment

A
  1. ABCs
  2. AC
  3. Enhance elimination: urinary alkalinization, hemodialysis, MDAC
82
Q

Phenobarbital MDAC dosing

A
  • 25-50g Q2-6H
  • Never exceed 24 hrs
83
Q

Phenobarbital MDAC monitoring

A
  • Prior to every dose
    1. Normal bowel sounds
    2. Aspiration risk
84
Q

Phenobarbital when to d/c MDAC

A

Reversal of life-threatening CNS, respiratory and/or CV symptoms

85
Q

Phenobarbital hemodialysis indicated for…

A

Severe toxicity
- Renal or hepatic failure
- Pulmonary edema
- Coma
- Serum phenobarbital >100 mcg/mL

86
Q

Phenytoin acute toxicity >20

87
Q

Phenytoin acute toxicity >30

A

Ataxia, poor coordination, tremor

88
Q

Phenytoin acute toxicity >50

A

Lethargy, confusion, slurred speech, stupor

89
Q

Phenytoin IV only s/s

A

Cardiotoxicity (HoTN), dermal toxicity (Purple glove syndrome)

90
Q

Phenytoin chronic toxicity

A

Frontal bossing, gingival hyperplasia, cerebellar effects, hepatotoxicity, agranulocytosis

91
Q

Phenytoin treatment

A
  1. ABC
  2. AC
  3. MDAC
  4. Cardiac - IV fluid bolus
92
Q

Valproic acid toxicity results in…

A

Hyperammonemia –> encephalopathy

93
Q

Phenobarbital vs Valproic acid: target channel

A

Chloride vs Sodium

94
Q

Valproic acid clinical manifestations

A

Seizures, hypernatremia, hepatotoxicity

95
Q

Valproic acid treatment

A
  1. ABCs
  2. AC
  3. Antidote = levocarnitine
  4. MDAC, hemodialysis
96
Q

Valproic acid antidote levocarnitine PO or IV dose?

A
  • PO: asymptomatic, 330 mg 3 times daily, max 3g/day
  • IV: symptomatic: loading dose 100 mg/kg, maintenance dose 15 mg/kg (max 6 g/day)
97
Q

Carbamazepine toxicity clinical manifestation

A

Seizures, tachycardia, HoTN, QT prolongation, respiratory depression, hyponatremia

98
Q

Carbamazepine treatment

A
  1. ABCs
  2. AC
  3. MDAC, hemodialysis (seizures, coma)
  4. QRS: sodium bicarbonate
  5. Hyponatremia: hypertonic saline
99
Q

What antiepileptics cause hyponatremia?

A

Lamotrigine, Oxcarbazepine

100
Q

What antiepileptics cause seizures?

A

Lamotrigine, Oxcarbazepine, Rufinamide, Tiagabine, Topiramate, Vigabatrin, Zonisamide

101
Q

Antiepileptics treatment

A
  1. ABCs
  2. AC
  3. QRS: sodium bicarb
  4. HoTN: IV fluids, vasopressors prn
  5. Seizures: BZD > propofol > barbiturates
102
Q

Selective BB

A

Acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol

103
Q

Nonselective BB

A

카라 핀 풀어써, 팀?
- Carvedilol, labetalol, pindolol, propranolol, sotalol, timolol

104
Q

Intrinsic sympathomimetic activity (ISA) of BB

A

Partial agonists –> both beta agonist & antagonist

105
Q

Membrane stabilizing activity of BB

A

Block sodium channels similar to class I antiarrhythmics

106
Q

Vasodilatory agents of BB

A

Alpha1 antagonism, beta2 agonism, NO mediated, CCB

107
Q

CCB vs BB: hyper vs hypoglycemia

A
  • CCB = hyperglycemia
  • BB = hypoglycemia in children
108
Q

CCB/BB HDIET is reserved for…

A

Significant poisoning, myocardial dysfunction

109
Q

Digoxin toxicity s/s

A
  • Tachy- & Bradyarrhythmia
  • GI, color vision aberrations, yellow halos around lights, hyper-/hypoK
110
Q

Digoxin treatment - DSFab MoA and indication

A
  • Create [ ] gradient which causes digoxin to diffuse out of cells which can then be bound and excreted
  • Life-threatening dysrhythmias

Poison/Toxicology (3 decks)

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