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Clin Therapeutics 1 > Exam 2 - Toxicology > Flashcards

Exam 2 - Toxicology Flashcards

1
Q

Most frequent exposures? (Hint: 8)

A

Analgesics, cosmetics, cleaning substances, sedative/hypnotic/antipsychs, foreign body/toys, antidepressants, cardiovascular drugs, topical preparations

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2
Q

Most fatal exposures? (Hint: 9)

A 
Sedative/hypnotic/antipsychotic 
CV drugs
Opioids
Antidepressants
APAP combinations
APAP alone
Stimulants/street drugs
Alcohol
Anticonvulsants
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3
Q

Important questions to ask for exposure history?

A 
What time, what quantity, what strength, if sustained release, and chronic use?
Co-ingestion? 
Intentional vs accidental?
Past medical and psych history?
Any symptoms?
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4
Q

What vital signs to check?

A

HR, RR, BP, temp

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5
Q

What to check in neuro exam?

A 
Mental status
Seizures
Pupils
Muscle tone
Reflexes
Ankle clonus
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6
Q

What two things to look at in HEENT exam?

A

Salivation

Lacrimation

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7
Q

What two things to look at in lung exam?

A

Wheezes

Rales

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8
Q

What to listen for in abdominal sounds?

A

Bowel sounds present or not.

Absent=peripheral anticholinergic

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9
Q

What to check on skin?

A

Flushed vs pale
Sweaty vs dry
Cool vs warm
Track marks

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10
Q

What two things to look at in GU exam?

A

Incontinence

Urinary retention

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11
Q

What are the 7 routine labs to order with toxic exposure?

A
  1. Chemistries
  2. CBC
  3. Serum tox
  4. Urine tox
  5. Salicylates
  6. Acetaminophen
  7. EtOH
    CCSUSAE
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12
Q

What are some other labs to order for toxic exposures?

A 
ABG
Lactate
Serum osmolarity
LFT
Coags
Specific drug concentrations
Co-oximetries
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13
Q

What types of changes on EKGs in toxic exposure?

A 
Arrythmias
Blocks
QRS interval
QTc interval
Terminal R in aVR (tall and wide R, d/t Na+ block)
ST changes
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14
Q

What are the two types of Interval Prolongation? Their causes?

A
  1. Depolarization abnormality QRS prolongation=TCA-like Na+ channel blockade
  2. Repolarization abnormality (prolonged JT interval/QTc)=blockade of inward-rectifying K+ (HERG) current
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15
Q

Drugs that cause Na+ blockade will appear as what on EKG? What type of abnormality?

A

QRS prolongation causing a Terminal R-wave in aVR.
DT: TCA, Type 1A and 1C, Benadryl, Cocaine, etc
Depolarization abnormality.

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16
Q

Drugs that cause blockade of K+ inward rectifying HERG current appear as what on EKG? What type of abnormality?

A

QT prolongation. Prolonged JT interval (QTc).

Repolarization abnormality.

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17
Q

What are the two types of interval prolongations and abnormalities?

A
  1. QRS prolongation causing depolarization abnormality

2. QRc/Prolonged JT prolongation causing depolarization abnormality

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18
Q

TCA, Type 1A and 1C antiarrythmics, Benadryl, and Cocaine can cause what on EKG? How treated?

A

Na+ channel blockade resulting in QRS prolongation due to depolarization abnormality.
Tx=Bicarb

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19
Q

Antipsychotics, Type 1A and III antiarrythmics, Cisapride, Terfanrine, and Methadone can cause what on EKG?

A

K+ (herg) inward current blockade QRc/Prolonged JT prolongation causing depolarization abnormality and Torsades. Tx=Mg2+.

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20
Q

What are the 4 steps in treatment of a poisoned patient?

A
  1. ABCs, including “Tox ACLS”
  2. Antidote
  3. Decontamination/Decrease Absorption
  4. Increase Elimination
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21
Q

What is the mainstay of care for a poisoned patient?

A

Supportive care. Part of ABCs.

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22
Q

ABCs for a poisoned patient include what sorts of things?

A 
Supportive care (mainstay).
Airway and oxygenation. 
BP support/control.
Blood glucose levels
Temperature control
"Tox ACLS"
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23
Q

What is the treatment of Torsades?

A

Mg2+

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24
Q

Tx for Coctaine VT?

A

Lidocaine and bicarb

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25
Q

Tx for wide-complex tach with Term-R in aVR?

A

Bicarb, Lidocaine

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26
Q

Tx for Hydrocarbon VT?

A

Beta-blockers like Esmolol. DO NOT GIVE EPI!

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27
Q

What would NEVER be given with Hydrocarbon VT?

A

Epi

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28
Q

Huffing is inhalation of what?

A

Hydrocarbons

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29
Q

Tx for Propoxyphene VT?

A

Narcan (Naloxone)

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30
Q

Tx for Bupivicaine PEA?

A

Intralipid

31
Q

Antidote for BZD overdose?

A

Flumazanil

32
Q

Antidote for Opioid OD?

A

Narcan

33
Q

Antidote for central anticholinergic OD?

A

Physostigime

34
Q

Antidote for TCA, Saliculates, and Toxin-induced acidosis?

A

Bicarb

35
Q

Antidote for CCD OD?

A

Calcium, Insulin

36
Q

Antidote for BB OD?

A

Calcium, Glucagon

37
Q

Antidote for Digoxin OD?

A

Digibind

38
Q

Antidote for Iron OD?

A

Deferoxamine

39
Q

Antidote for lead OD?

A

EDTA, BAL, Succimer

40
Q

Antidote for Thalium OD?

A

Prussian Blue

41
Q

Antidote for Methanol, Ethylene glycol, wiper fluid, antifreeze?

A

Fomepizole

42
Q

Antidote for Isoniazid OD?

A

VitB6

43
Q

Antidote for Organophosphate OD?

A

2-PAM

44
Q

Antidote for Cyanide OD?

A

Hydroxycobalamin

45
Q

Antidote for Sulfonylureas?

A

Octreotide

46
Q

Antidote for Methemoglobinurea?

A

Methylene Blue

47
Q

Antidote for Hydrofluroic Acid?

A

Calcium

48
Q

Antidote for Valproic Acid?

A

L-Carnitine

49
Q

Antidote for APAP OD?

A

NAC if acute levels at 4h or chronic use has elevated LFT or ACE

50
Q

How to accomplish decontamination/decrease absorption?

A

Remove from exposure to toxin.

Activated charcoal, whole bowel irrigation

51
Q

When to use Activate Charcoal for Decon/Decrease Absorption? When contraindicated?

A

Studies don’t support use.

CI=Airway protection, metal, EtOH, hydrocarbon, caustic

52
Q

When to use Whole Bowel Irrigation for decon/decrease absorption?

A

For massive injection. Body packers, body stuffers, metals.

GyLytely 1-2L/hr

53
Q

Body Packer vs Body Stuffer

A

Packer=smuggling drugs in body in large quantities

Stuffer=smaller quantities

54
Q

When to alkalize urine to increase elimination? What is used? How does it work?

A

ASA overdose. IV Bicarb increases elim 20x. Induced ion trapping in distal tubule.

55
Q

Forced Diusesis w/IV fluids useful for when trying to increase elimination?

A

Drugs excreted unchanged in urine, like Lithium. Rarely used.

56
Q

Hemodialysis useful for when trying to increase elimination?

A 
Good for low molecular weight, uncharged, non-plasma bound, low Vd drugs.
Aspirin
Lithium
Methanol
Ethylene Glycol
Valproic Acid
(Always Like My Excellent Vancomycin)
57
Q

Charcoal Hemoperfusion useful for when trying to increase elimination?

A

Rare. Supplanted by Flux Hemodialysis.

58
Q

Multidose Activated Charcoal useful for when trying to increase elimination?

A

GI Dialysis, drugs that form Bezoars, or enterohepatic circulation
Ex: ASA, theophylline, phenobarb, dapsone, Amantia mushrooms

59
Q

Coma, resp depression, and miosis (tiny pupils) is which toxidrome? Tx?

A

Opioid

Tx=Narcan

60
Q

Agitated, hallucinations, mumbling, directable, picking, and variable wakefulness is which Toxidrome? Tx?

A

Central Anticholinergic

Tx=Physostigmine

61
Q

Tachy, HTN, hyperthermic, mydriasis (large pupils), dry mucous membranes, dry and flushed skin, urinary retention, absent bowel sounds is which Toxidrime? Tx?

A

Peripheral Anticholinergic

Tx=BZDs

62
Q

Tachy, HTN, hyperthermic, mydriasis, agitated delerim, thrashing, diaphoresis; bowel sounds present, normal tone and reflexes. Which Toxidrome and tx?

A

Sympathomimetics (from Amphetamine, cocaine, etc).

TX if VT=Lidocaine, Bicarb. Otherwise probably supportive.

63
Q

Tachy, HTN, hyperthermic, mydriasis, agitated delerium, tremulous, disphoresis, ocular clonus, tremors, hyperreflexia, increased muscle tone, foot beating like crash, increases reflexes/tone. Which Toxidrome and tx?

A

Serotonergic (MAOI, Tramadol, Demerol)

Tx=Supportive?

64
Q

Salivation, lacrimation, urination, diarrhea, GI upset, emesis, brochospasm and brady cardia (SLUDGE) is which toxidrome?

A

Cholinergic

Tx=Supportive?

65
Q

Red flags when treating patient?

A

Acute mental status change, seizure, metabolic acidosis (anion gap), osmolar gap, PT with similar symptoms in close proximity

66
Q

Amphetamine-like drugs ends in what?

A

-“one”

67
Q

Examples of Amphetamine-like drugs?

A

MDMA/Molly, bath salts, khat

68
Q

Which is the only legal synthetic cathinone (amphetamine-like drug)?

A

Bupropion

69
Q

Synthetic cannabinoid symptoms look like what?

A

Looks like sympathomimetic but not

70
Q

Non-cardiogenic pulmonary edema w/frothy sputum from opioid OD treated how?

A

Bipap

71
Q

When does hearing loss return with synthetic opioid OD?

A

24-48h later

72
Q

Synthetic opioid OD might require what to reverse?

A

Very high doses of Narcan

73
Q

Do synthetic hallucinogens cause clonus, tone, and reflex problems?

A

Nope

Clin Therapeutics 1 (12 decks)

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