Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCOL Cumulative Final > Final Exam Toxicology > Flashcards

Final Exam Toxicology Flashcards

1
Q

Cholinergic Toxidrome

A

SLUDGE

Salivation

Lacrimation

Urination

Defecation

Gastrointestinal Symptoms

Emesis

Triple B’s/Killer B’s

Bronchorrhea

Bradycardia

Bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anticholinergic Toxidrome

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sympathetic Toxidrome

A

Agitation

Anxiety

Bronchodilation

HTN

Mydriasis

Tachycardia

Urinary Retention

Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Toxidrome Comparison

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment Strategies

A

Prevent absorption

Enhance elimination

Block effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

GI Decontamination: Activated Charcoal

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other Methods of GI Decon

A

Emesis

Not recommended

Gastric Lavage

Scare evidence

Use within 30-60 minutes of ingestion

Cathartics

No indication for routine use

Whole Bowel Irrigation

Large amount of osmotically balanced polyethylene glycol electrolyte lavage solution

Ingestion of toxic amount of drug that is not adsorbed to activated charcoal, ER preparations, or Body packers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is Activated Charcoal NOT Useful

A

Caustic/corrosive solution

Heavy metals (iron/lead/mercury)

Alcohols

Rapidly absorbed substances

Cyanide

Organophosphates

Aliphatic hydrocarbons

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hemodialysis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Urinary Alkalization

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Opioids

A

Causative agents: Buprenorphine, Codeine, Fentanyl, Heroin, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Oxymorphone, Tapentadol, Tramadol

Mechanism of toxicity: Increased stimulation of opioid receptors

Receptor and Clinical effects

u – Analgesia, sedation, euphoria, respiratory, depression, GI dysmotility, bradycardia, pruritis, physical dependence

k – Analgesia, miosis

g – Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Opioid Overdose: Clin Presentation

A

Sedation

Respiratory distress

Bradycardia

Hypotension

Miosis

Emesis

Constipation

Seizures (meperidine, tramadol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Overdose Treatment: Naloxone (Narcan)

A

MOA: Competitively inhibits binding of opioids to opioid receptors

Goals of therapy: Reinstitution of spontaneous ventilation

Use lower practical dose; escalate rapidly as clinically indicated

IV: 0.4-2 mg as initial dose

Repeat dose at 2-3 minute intervals

Consider other causes of toxicity if no response after 10mg of naloxone

Adverse Reaction: Withdrawal

Pharmacokinetics: T1/2 = 30-90 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Benzodiazepines and Barbiturates

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Benzodiazepines and Barbiturates: Clin Presentation

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Benzodiazepines and Barbiturates: Management and Monitoring

A

Supportive Care

Maintain airway

Hemodynamic support

Minimum 24h monitoring period for overdoses on long-acting hypnotics or drugs with significant enterohepatic recirculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Benzodiazapine Antidote: Flumazenil

A

MOA: Competitive benzodiazepine antagonist

Rapidly reverses sedative effect of benzodiazepines and Zolpidem

Dose:

0.2mg over 30 seconds

Repeat doses: 0.2 mg over 30 seconds repeated at 1-min intervals

Maximum Cumulative Dose: 3mg (usual total dose 1-3 mg)

Caution: May precipitate benzo withdrawal

Boxed Warning: Seizures

Caution in multi-substance overdoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Beta Blocker & Calcium Channel Blocker Toxicity

A

Beta Blockers

B1 selective: Acebutolol, Atenolol, Betaxolol, Bisoprolol, Esmolol, Metoprolol, Nebivolol

Mixed: Carvedilol, Labetalol, Propranolol

Calcium Channel Blockers

Dihydropyridine: Amlodipine, Nicardipine, Nifedipine, Nimodipine

Non-dihydropyridine: Verapamil, Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Beta Blocker & Calcium Channel Blocker Toxicity Clinical Presentation

A

Bradycardia

Hypotension

CCB-Specific

Vasodilatory shock

Hyperglycemia

Dihydropyridines: Reflex tachycardia in mild – moderate overdose

BB-Specific

Propranolol: Hypoglycemia, seizures, coma, and dysrhythmias

Prolonged QRS and QT intervals

Rare: Prolonged PR interval or high-grade AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Beta Blocker & Calcium Channel Blocker Mechanism of Toxicity

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

BB/CCB Supportive care

A

Early airway and respiratory support

Early GI decon

Activated charcoal (single dose) for all IR ingestions if within 4 hours

Whole Bowel irrigation (polyethylene glycol electrolyte mixture) for SR preparations if early and Asymptomatic

Manage Shock

Isotonic IV fluids: Limit 1-2 L to avoid fluid overload and pulmonary edema

Symptomatic bradycardia

Cutaneous and transvenous pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

BB/CCB Pharmacotherapy PT 1 (Atropine/Calcium)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

BB/CCB Pharmacotherapy PT 2 (Glucagon)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

BB/CCB Pharmacotherapy PT 3 (Catecholamines)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

BB/CCB Pharmacotherapy PT 4 (High-dose insulin euglycemia therapy (HIET))

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Specific Pharmacotherapy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Monitoring

A

Observe in the ICU until bradycardia, hypotension, EKG abnormalities, and/or CNS Toxicity resolve

Beta Blockers

Toxicity from regular release beta blockers poisoning typically occurs within the first 6 hours

Sotalol: Delayed ventricular dsyrhythmias up to 9 hours post-ingestion

Observe PTs who ingest ER preparations for at least 24 Hours

Calcium Channel Blockers

If IR preparation ingestion, ensure that serial EKGs over 6-8 Hours have remained unchanged

Observe PTs who ingest ER products for at least 24 Hours, even if asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Digoxin

A

Cardioactive steroid used for management of supraventricular arrhythmias and heart failure

MOA:

Inhibition of the Na/K/ATPase pump in myocardial cells

Increased intracellular Ca via Na/Ca exchange pump

Increased myocardial contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Digoxin Toxicity Diagnosis

A

Therapeutic range 0.4-2 ng/mL

Suggestion to lower upper limit 1ng/mL

Clinical presentation

Symptoms

Electrolyte abnormalities

EKG findings

Timing of Symptom onset

Acute vs chronic toxicity

30
Q

Digoxin Toxicity: Clin Presentation

31
Q

The Digitalis Effect

32
Q

Digoxin Antidote: DigiFab

A

Digifab: Digoxin-specofoc antibody fragments

Binds with digoxin to decrease serum digoxin concentration (SDC)

Increased Renal clearance of Bound Digoxin

Dosing

Emperic dosing

  • Acute: 10-20 vials
  • Chonic: 3-6 Vials

Known Amount

-Calculate Total Body Load:

–Capsules: amount (mg) digoxin capsules ingested

–Tablets 0.8 x amount (mg) digoxin tablets ingested

-Calculate number of vials needed

–Total body load (mg)/0.5

33
Q

DigiFab indications

34
Q

Acetaminophen Overdose: Clinical Presentation

35
Q

APAP Toxic Doses

A

Acute Toxicity

Single Ingestion of 150 mg/kg

Chronic Toxicity

Less well defined

Evaluate in PTs taking more than 200 mg/kg/d (or 10 g/d) in 24H

Evaluate in PTs taking more than 150 mg/kg/d (or 6 g/d) in 48H

36
Q

Factors Affecting APAP Toxicity

A

APAP dose

Pattern of use

Acute vs Chronic alcohol ingestion

Concomitant Medication ingestion

Age

Nutritional status

Presence of Chronic liver disease

37
Q

APAP Toxicity Supportive Care

A

GI Decon with Activated Charcoal

If within 4 hours of acute APAP ingestion

May be given after 4 hours if extended-release APAP ingestion of drugs that delay gastric emptying time

Liver Transplant

Lifesaving procedure when APAP ingestion has progressed to irreversible liver failure

Qualifying factors: Poor projected outcome and high risk of mortality based on MELD, Kings Criteria, and Apache II scores

38
Q

Pharmacotherapy: N-Acetylcysteine (NAC)

A

Cysteine prodrug and hepatic GCH precursor

Replenishes and maintains hepatic GCH stores by providing Cysteine, which detoxifies reactive metabolites of APAP

May reduce NAPQI back to APAP by enhancing Sulfonation pathway

May reduce mortality from 5% to 0.7%

39
Q

Utility of Rumack-Matthew Nomogram

40
Q

Unknown Time of Ingestion: To Treat or not to Treat

A

If Normal APAP and Normal AST/ALT do not treat, otherwise TREAT

41
Q

Treatment Duration

A

Decision to discontinue NAC after extending treatment beyond standard protocol length is PT specific and should be continued if:

Evidence of hepatic injury

  • AST significantly above normal
  • PT/INR> twice normal
  • Encephalopathy

APAP metabolism is incomplete (APAP detectable)

Continue treatment with NAC until evidence of hepatic injury resolves and APAP is undetectable

42
Q

Organophosphates

A

Agents: Malathion, Parathion, methyl parathion, diazinon

MOA/Mechanism of Toxicity: Increased concentration of acetylcholine (ACh) at muscarinic and nicotinic cholinergic synapses-> cholinergic excess

43
Q

Organophosphate Clin Presentation

44
Q

Management of Organophosphate Tox

A

Atropine MOA: Competitive antagonist of AcH at muscarinic receptors; reverses excessive secretions, miosis, bronchospasm, vomiting, diarrhea, diaphoresis, and urinary incontinence

Pralidoxime (2-PAM) MOA: Enhances regen of AChE to lower ACh concentrations and improve muscarinic and nicotinic effects

45
Q

Serotonin Overview

A

Serotonin (5-HT): Monoamine neurotransmitter synthesized from tryptophan

5-HT1A and 5-HT2A most commonly implicated in serotonin syndrome

Found in the CNS, platelets, and GI tract

CNS: regulates appetite, memory, mood, and sexual activity

Peripherally: Assists in regulating clotting, peristalsis, and vascular tone

L-Tryptophan -> 5 Hydroxytryptamine (Serotonin)

46
Q

Causative Agents

A

Increased Serotonin Production – L-Tryprophan

Inhibition of serotonin reuptake – Chlorpheniramine, cyclobenzaprine, dextromethorphan, meperidine, methadone, pentazocine, SSRIs, St. John’s wort, Tramadol, trazodone, TCAs

Inhibition of serotonin metabolism by MAO – Linezolid, methylene blue, phenelzine, selegiline

Increased serotonin release – Dextromethorphan, meperidine, methadone, MDMA, mirtazapine, Fentanyl, cocaine, amphetamines

Stimulation of Serotonin receptors – Buspirone, lithium, LSD, Meperidine, metoclopramide, triptans

47
Q

Diagnosis

A

Diagnosis of exclusion – no confirmatory test

Assess exposure to serotonergic drugs in the last 5 weeks

Monitor signs/Symptoms of serotonin syndrome

Obtain Labs tox screen

48
Q

SS Clin Presentation

49
Q

Differential Diagnosis: SS vs Neuroleptic Malignant Syndrome (NMS)

50
Q

Supportive Care of SS

A

Discontinue offending agent

Administer IV fluids

Control hemodynamic instability

Benzo for agitation

Implement standard cooling measures for hyperthermia

Severe toxicity may warrant sedation, paralysis &/or intubation

51
Q

Pharmacotherapy for SS

52
Q

Monitoring

A

Typically resolves within 24H of cessation of serotonergic drug

Admit and monitor 12-24 Hrs

Concern for delayed cardiotoxicity

53
Q

TCA

A

Mechanism of Toxicity

Inhibition of Serotonin and norepinephrine reuptake at nerve terminals

Direct a adrenergic block

Membrane stabilizing effect

Anticholinergic action

54
Q

TCA Clin Presentation

55
Q

TCA Management

56
Q

TCA Monitor

57
Q

Stimulant Toxicity

A

Causative Agents

Amphetamines/Dextroamphetamines/Methamphetamines

Methylenedioxymethamphetamine (MDMA/Ecstasy)

Synthetic Cathinones (bath salts)

Methylphenidate

Cocaine

58
Q

Stimulant OD Management/Supportive care

59
Q

Toxic Alcohols

60
Q

Clin Presentation of Methanol

61
Q

Clin Presentation of Ethylene Glycol

62
Q

Clin Presentation of Isopropanol

63
Q

Mechanism of Alcohol Toxicity

64
Q

Supportive care for Alcoholic Toxicity

65
Q

The Role of Vitamins in Alcohol Toxicity

66
Q

Treatment indications of Alcohol Toxicity

67
Q

Alcohol Antidotes: Ethanol and Fomepizole

A

Not as helpful with isopropanol

68
Q

Pharmacotherapy: Fomepizole

69
Q

Pharmacotherapy: Ethanol

70
Q

Co-Ingestion of Ethanol

PCOL Cumulative Final (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions