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Poison/Toxicology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Tetanus prophylaxis vaccines

A
  • Tdap or Td
  • Give if it ws given >5 yrs ago
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2
Q

4 Don’ts in general bite management

A
  1. Suck the venom out
  2. Apply a tourniquet or pressure bandages
  3. Drain the bite site
  4. Capture the snake & bring it to the ED
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3
Q

Pit Vipers head, fangs

A
  • Triangle shaped, vertically elliptical pupils, heat-sensing pit behind nostrils
  • Front, mobile fangs, small row of teeth, persistent reflexes
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4
Q

PV Venom effects 3

A
  1. Local tissue damage
  2. Coagulopathies
  3. Neurotoxic
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5
Q

PV diagnosis

A
  • Quantify swelling: distance from bite, circumference
  • Lab monitor: CBC, platelets, PT/INR, aPTT, fibrinogen…
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6
Q

PV management

A
  • ABCs
  • Maintain limb at heart level
  • Pain: IV opioids, avoid NSAIDs, icepacks
  • Life-threatening bleeding: blood products + antivenom
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7
Q

PV antivenom indication

A
  1. Progression of local tissue damage
  2. Coagulopathy: PT >15 s, fibrinogen <150, platelets <150K
  3. Systemic signs: HoTN, anaphylaxis, neurotoxicity
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8
Q

PV FabAV (CroFab): allergy, initial dose, maintenance dose

A
  • Latex, papaya, pineapple, papain, bromelain, sheep
  • 4-6 vials
  • 2 vials Q6H x3
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9
Q

PV F(ab’)2 (Anavip): allergy, initial dose, maintenance dose

A
  • Papain, cresol, horses
  • 10 vials
  • 4 vials PRN
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10
Q

PV antivenoms counseling points 4

A
  1. Repeat labs in 3-5 days
  2. Hypersensitivity rxns possible w/ future antivenom
  3. Avoid activities with bleeding risks for 14 days
  4. Monitor serum sickness
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11
Q

Coral snakes body, fangs

A
  • Red on yellow, kill a fellow vs Red on black venom lack
  • Much smaller fangs, hang onto victim and chew
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12
Q

CS clinical manifestations

A
  • Minimal/No local tissue injury
  • Speech: slurred, dysphagia
  • Ocular: diplopia, ptosis (drooping)
  • Neuromuscular: paresthesias/weakness/fasciculations (minor), paralysis (life-threatening)
  • Pulmonary: stridor, resp paralysis
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13
Q

CS management supportive care when?

A

Intubate at earliest signs of bulbar paralysis

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14
Q

CS antivenom Antivenin

A
  • Requires skin testing prior to administration
  • 3-5 vials in 250-500 mL NS
  • Initial rate: 25-50 mL/hr for the first 10 mins
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15
Q

CS Antivenin counseling point

A

Serum sickness

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16
Q

Alkalis: dissociated ___ –> ___ necrosis

A

hydroxide ions (OH) –> liquefactive

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17
Q

Acids: dissociated ___ –> ___ necrosis

A

hydrogen (H) –> coagulative

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18
Q

Household chemicals imaging should be done when?

A

within 12 hrs of ingestion (no later than 24 hrs)

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19
Q

HC management: decontamination for oral & dermal exposure

A
  1. Remove clothing, jewelry, irrigation with water
  2. Blisters should be popped
  3. No role for gastric decontamination
  4. Dilutional therapy avoid unless asymptomatic + w/i first few mins of ingestion
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20
Q

HC management: symptomatic & supportive care

A
  1. Airway inspection, intubation
  2. Airway inflammation: dexamethasone
  3. HoTN: IV fluid repletion
  4. Surgical intervention as necessary
  5. No role for empiric antibiotics
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21
Q

HC ocular exposures tx

A
  1. Remove contact lenses, false eye lashes etc
  2. Immediate + copious irrigation: hold eyes open for at least 15 mins, use room temp (tepid) water or 0.9% NaCl
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22
Q

HC ocular exposures when to refer

A

Strong or concentrated caustic/pain, swelling, lacrimation or photophobia despite irrigation

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23
Q

Hydrofluoric acid: cause of toxicity, binds to ___, result in ___

A
  • Liberation of F- ions, not H+
  • Extra/Intracellular Mg, Ca
  • Hypomagnesemia, hypocalcemia –> ventricular arrhythmia
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24
Q

Hydrofluoric acid toxicity local tissue injury, absorption, systemic effects

A
  • Minimal visible damage
  • Deep penetration
  • Life threatening cardiac effects: hypocalcemia, hypomagnesemia, hyperkalemia
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25
Q

Hydrofluoric acid toxicity management

A
  1. Decontamination: water, saline
  2. Airway management: avoid succinylcholine due to hyperkalemia
  3. Pain control: topical calcium gluconate gels, avoid sedating analgesics, nebulized calcium for pulmonary exposures
  4. Electrolyte repletion calcium + Mg
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26
Q

Hypochlorite examples & management

A
  1. Household bleach: dilute with water
  2. Industrial strength cleaners/swimming pool disinfectants: symptomatic, supportive care
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27
Q

Hypochlorite combination: chlorine vs chloramine

A
  1. Chlorine (hypochlorite + acid) dissolution –> hypochloric acid + hypochlorous acid
  2. Chloramine (hypochlorite + ammonia) dissolution –> hypochlorous acid + ammonia + oxygen radicals
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28
Q

Single-use detergent sacs toxicity clinical manifesfations

A
  • GI, pulmonary, ocular, metabolic
  • CNS seizures
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29
Q

Single-use detergent sacs toxicity diagnosis

A
  • Changes in mental status or resp difficulty, persistent ocular symptoms
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30
Q

Single-use detergent sacs toxicity management

A
  • Decontamination w water
  • Resp difficulty w/ hypoxemia: oxygen, bronchodilators, intubate if necessary
  • Prolonged V/D: IV fluid
  • Seizures: BZD
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31
Q

Hydrogen peroxide mechanism of toxicity

A
  1. Local tissue injury: [low] = irritant, [high] = corrosive
  2. Gas formation: H2O2 interacts w/ tissue catalase –> O2, H2O liberation
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32
Q

H2O2 clinical manifestations [High]

A

Gas embolization
- Gastric/Intestinal perforation
- Rapid deterioration in mental status, HoTN, cardiac ischemia, coma, intestinal gangrene

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33
Q

H2O2 toxicity management [Low]

A

Dilute w water, remove contaminated clothing + jewelry

34
Q

H2O2 toxicity management [High]

A
  • Decontamination: oral - no role for gastric, ocular - copious irrigation w/ tepid water
  • Monitor airway & intubate prn
  • Trendelenburg position if evidence of gas in the heart
  • Gastric suctioning if abdominal distention
  • Life threatening gas emboli: hyperbaric O2
35
Q

Ethanol mechanism of toxicity

A
  • Oxidation of ethanol –> acetyl-CoA + change in redox potential –> hypoglycemia
36
Q

Ethanol toxicity diagnosis

A
  • Changes in mental status, serum ethanol, complete metabolic panel, head CT
37
Q

Artificial nail removal contains ___ which endogenously converted to ___

A

Acetonitrile -> cyanide

38
Q

Toothpaste toxicity: ingredient of concern ___, give ___

A

Fluoride –> milk

39
Q

Magnet toxicity: refer to healthcare facility when

A

2 magenets or 1 magnet + metallic object

40
Q

Solvent-based paints abuse potential: methods of administration

A
  • Sniffing
  • Huffing: pour substance onto fabric and place over mouth/nose
  • Bagging
41
Q

Paint mechanism of toxicity on cardiac

A

Increased sensitivity or myocardium to epinephrine

42
Q

Paint toxicity clinical manifestation stage 3

A

Seizures, coma, death

43
Q

Paint toxicity management

A
  1. GI decontamination no role
  2. Airway management
  3. Arrhythmias: avoid exogenous catecholamines
  4. Electrolyte replacement
  5. BZD for seizures/agitation
44
Q

Mothballs contain 1 of 3 main ingredients:

A
  1. Paradichlorobenzene
  2. Naphthalene
  3. Camphor
45
Q

Paradichlorobenzene management

A

Dilute with water (not milk), antiemetics prn

46
Q

Naphthalene: when to refer, mechanism of toxicity, tx

A
  • Ingestion of >1 mothball
  • Oxidant stress –> hemolysis + methemoglobinemia –> anemia
  • Transfusion (packed RBCs), methylene blue
47
Q

Camphor: when to refer, management

A
  • Ingestions >30 mg/kg
  • Symptomatic & supportive, BZD –> propofol, barbiturates
48
Q

Alcohol addiction

A

1. Psychological dependence
2. Physical dependence
3. Tolerance

49
Q

Alcohol ADEs - chronic users

A
  1. Alcoholic liver disease
  2. Alcohol and heart- cardiomyopathy
  3. Alcohol and hematopoietic- malabsorption
  4. Fetal alcohol syndrome
50
Q

Alcohol withdrawal syndrome symptoms

A
  1. Abstinence syndrome
  2. Hallucinosis - visual and auditory, ‘pink elephants’
  3. Seizures
  4. Delirium tremens - autonomic hyperactivity
  5. Wernicke-Korsakoff syndrome
51
Q

Alcohol withdrawal syndrome treatment

A

Naltrexone, acamprosate, CDPX, oxazepam, haloperidol

52
Q

Osmolality is affected by __, __, ___, ___, and ___

A

Ethyl ether, isopropanol, methanol, ethylene glycol, acetone

53
Q

Isopropyl alcohol metabolism

A

Acetone (ketonemia)- kidney (ketonuria), lungs (acetone breath)

54
Q

Isopropyl alcohol treatment

A
  1. ABC
  2. Decontamination - AC x
  3. Elimination enhancement - dialysis
  4. Lab: high osmolal gap, high serum ketones, hypoglycemia
55
Q

Methanol toxicity clinical presentation

A

Blindness, “snowfield” vision

56
Q

Methanol treatment

A
  1. ABC
  2. Decontamination- AC x
  3. Elimination enhancement: hemodialysis
  4. Ethanol therapy- block formation of toxic metabolites
  5. Folic acid therapy
  6. Fomepizole- slow down metabolism
57
Q

Ethylene glycol metabolism cofactors for nontoxic**

A

Thiamine, pyridoxine

58
Q

Ethylene glycol clinical presentation

A
  1. CNS depression
  2. Cardiopulmonary: tachy
  3. Renal
  4. Lab: large anion gap acidosis, osmolal gap, urine oxalate crystals, hypocalcemia
59
Q

Ethylene glycol treatment

A
  1. Decontamination: AC x
  2. Elimination enhancement: hemodialysis
  3. Ethanol therapy
  4. Metabolic acidosis: sodium bicarbonate
  5. Pyridoxine, thiamine, Mg
  6. Antizole (Fomepizole)
60
Q

Opiate overdose symptoms & treatment

A

1. Pinpoint pupils: none
2. coma: naloxone
3. resp depression: naloxone, ventilation
4. bradycardia: naloxone
5. HoTN: fluids, naloxone
6. hypothermia: rewarm
7. pulmonary edema: (+) end expiratory pressure, naloxone

61
Q

Heroin methods of administration

A
  1. IV, PO, SQ, smoke, snort
  2. Chasing the dragon
  3. Speedball
  4. Moon-rock, speedball rock
  5. Body packing
62
Q

Heroin clinical presentation

A
  1. Coma/lethargy
  2. Pinpoint pupils - except demerol
  3. Constipation
  4. Desire for sweets
  5. Resp depression
  6. HoTN
  7. Hypothermia
  8. Infectious: endocarditis, AIDS, hepatitis, tetanus, meningitis
  9. Crush injuries: rhabdomyolysis, can fall, immobility
  10. “necklace”
  11. Milk/ Ice
63
Q

Heroin treatment

A
  1. ABC
  2. Lab: heroin x useful, chemistry
  3. No physostigmine
  4. Designer drug problems: fentanyl, alpha-methyl-fentanyl, fluorofentanyl, sufentanyl
  5. Naloxone IV: monitor pupils, respirations
  6. Nalmefene
64
Q

Heroin withdrawal early s/s

A

Craving for drugs and anxiety

65
Q

Heroin withdrawal intermediate s/s

A

Yawning, perspiration, runny nose, lacrimation

66
Q

Heroin withdrawal late s/s

A

Rise in BP & RR, pulse rate, fever, resetlessness, N

67
Q

Heroin withdrawal tx

A
  1. Other opioids questionable: morphine, propoxyphene w codeine
  2. Opioid antagonist Naloxone: risky
  3. Methadone
  4. Naltrexone
  5. Buprenorphine (Subutex)
  6. Sympatholytics: clonidine, propanolol
68
Q

Cocaine HCl methods of administration

A

No smoking (degrades), snorted, IV, applied to mucous membranes

69
Q

Crack?

A
  • Almost pure cocaine
  • Crack sound/rock appearance
  • Higher % abusers bc it’s so addicting: rapid peak, euphoria followed by dysphoria
  • Smoking same feeling as IV
  • Intense psychological effect due to rapidly increased Cp
70
Q

Cocaine effects

A
  • MI +/- CAD
  • CP with ST elevation
  • Paranoid psychosis
  • Pupils dilated
71
Q

Cocaine tx

A
  • Mild: supportive
  • Anxiety, agitation, seizures: BZD
  • Paranoia: haloperidol
  • Beware of speedball (cocaine & heroin)
  • Hyperthermia: use cooling, caution w/ thioridazine
  • Tachy: BB but may aggravate coronary & systemic artery vasoconstriction
  • Avoid lidocane bc risk of seizures
72
Q

Phencyclidine (PCP) other names

A

Angel dust, peace pill, hog, sherman, rocket fuel

73
Q

PCP effects

A
  • Anesthesia/Analgesia: dissociative anesthetic
  • Sensory isolation
  • Altered perceptions
74
Q

PCP abuse

A
  • Good titration, easy synthesis
  • Active PO, pulmonary, IV
  • Analogues: ketamine (Special K)
  • Adulterant in other marginal products
75
Q

PCP clinical presentation

A

Blank stare, nystagmus, psychotomimetic effects, strength (no pain), auditory hallucinations, gruesome injuries, PCP psychosis

76
Q

PCP tx

A
  • Enhanced elimination (?)
  • Decrease sensory environment: quiet! don’t try to talk down
  • Rhabdomyolysis
77
Q

LSD

A
  • Inadvertent ingestion
  • Window panes
  • Death rare
78
Q

LSD effects

A
  • Psychotropic: cats afraid of mice, unpleasant rxn (bad trip), aggression
  • Recreational: synesthesias = hear color, touch music
  • Flashback
79
Q

LSD tx

A
  • Panic: talk down, reassure, avoid restraints
  • Gut decontamination C/I bc can precipitate psychotic rxns
80
Q

Date rape drugs effects

A

Sedation, amnesia, respiratory problems

81
Q

Ecstasy, MDMA, MDA effects

A

Hyperthermia, rhabdomyolysis, hyponatremia, cerebral infarct

82
Q

Methamphetamine effects (long term)

A
  1. Addiction
  2. Violent behavior/out of control rages
  3. Anxiety
  4. Delusions
  5. Repetitive motor activity

Poison/Toxicology (3 decks)

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