General Tox and toxidromes

Question 1

Why is there a delay in ASA absorption?

Answer 1

Bezoar

Question 2

When is dilution indicated for toxics?

Answer 2

for pH changes

Local irritant

Question 3

How can gases cause hypoxia?

Answer 3

Decrease partial pressure of oxygen

Question 4

When is irrigation of the eyes for 2 hours indicated?

Answer 4

If caustic substance contact. Otherwise shorter timeframe is possible

Question 5

How soon does an allergic reaction happen to a bee sting?

Answer 5

within 30 minutes

Question 6

What should be done with venomous bites?

Answer 6

Keep extremity slightly below heart level, and transport. Nothing else.

Question 7

What is the single most frequently involved substance in poisoning fatalities?

Answer 7

Acetaminophen

Question 8

What are the 8 drugs that can kill a 10 kg toddler with one pill?

Answer 8

• Antimalarials
• CCBs /BBs
• Colchicine
• Clonidine
• Methyl Salicylates (oil of wintergreen)
• Opioids
• Sulfonylureas
• TCAs

Question 9

What is the antiarrhythmic of choice for tox overdoses?

Answer 9

Lidocaine

Question 10

What is the vasopressor of choice for tox patients?

Answer 10

Levophed

Question 11

When is gastric lavage indicated for the treatment of overdoses?

Answer 11

If very recent overdose

Question 12

What are the risks of gastric lavage?

Answer 12

Aspiration
GI hemorrhage/perforation
Arrhythmias
Pneumothorax

Question 13

What are the drugs that are NOT absorbed by activated charcoal? (4)

Answer 13

• Alcohols
• Acids/alkalis
• Hydrocarbons
• Fe and other metals

Question 14

What are the four major intoxications that call for dialysis?

Answer 14

Methanol
Ethylene glycol
Salicylates
Li

Question 15

What are the three major indicated for multiple doses of activated charcoal? (3)

Answer 15

ER
Drugs that slow motility
enterohepatic circulation

Question 16

When is whole bowel irrigation indicated?

Answer 16

Drug packets

Fe tablets

Question 17

What EkG effect is common with methadone?

Answer 17

QTc prolongation

Question 18

What must be done after giving a pt naloxone? Why?

Answer 18

Watch them for a few hours, since naloxone has a short half life

Question 19

What motility agent can cause an opiate overdose in kids?

Answer 19

Lomotil

Question 20

What is drug classically causes an opiate-like toxidrome?

Answer 20

Clonidine

Question 21

What is the MOA of clonidine?

Answer 21

Alpha-2 agonist

Question 22

What is the MOA of guanfacine?

Answer 22

Alpha-2 agonist

Question 23

What are the components of the DUMBELS mnemonic for muscarinic intoxication?

Answer 23

Diarrhea
Urination
Miosis
Bradycardia/bronchorrhea
Emesis
Lacrimation
Salivation

Question 24

What are the components of the MTWHFS mnemonic for nicotinic overdose?

Answer 24

Mydriasis
Tachycardia
Weakness
HTN
Fasciculations
Seizures

Question 25

What is the antidote for muscarinic intoxication? Nicotinic?

Answer 25

``` Muscarinic = atropine Nicotinic = 2PAM ```

Question 26

What are the symptoms of anticholinergic poisoning?

Answer 26

No see No spit No pee No shit Hot as a hare...

Question 27

What is the MOA of scopolamine?

Answer 27

Anticholinergic

Question 28

Why is a cholinergic never indicated for the treatment of an anticholinergic poisoning?

Answer 28

Arrhythmias

Question 29

What is the treatment for HTN and tachycardia in a tox pt?

Answer 29

Benzos (not BB since unopposed alpha)

Question 30

What are the two symptoms that differentiate between anticholinergic poisoning and sympathomimetic poisoning?

Answer 30

Decreased BS in anticholinergic | Sweating in sympathomimetic

Question 31

What are the components of the OTIS CAMPBELL mnemonic for drugs that cause toxic seizures?

Answer 31

``` Oragnophosphates TCAs Isoniazid Sympathomimetics camphor, cocaine Amphetamines Methylxanthines PCP Benzo withdrawal EtOH Li Lead ```

Question 32

Coma with stable vital signs is classic for which overdose?

Answer 32

benzos

Question 33

What are the three C's over TCA overdose?

Answer 33

Coma Convulsions Cardiac arrhythmias

Question 34

Why must all APAPs be stat?

Answer 34

Because "normal" levels will be found in overdoses that don't present until later, and may qualify for treatment

Question 35

What are the s/sx of phase 1 of acetaminophen OD, and what is the timeframe?

Answer 35

Nonspecific s/s | 0-24 hours

Question 36

What are the s/sx of phase 2 of acetaminophen OD, and what is the timeframe?

Answer 36

Acute liver injury | 24-72 hours

Question 37

What are the s/sx of phase 3 of acetaminophen OD, and what is the timeframe?

Answer 37

3-4 days death, ARDS maximal liver toxicity

Question 38

What are the s/sx of phase 4 of acetaminophen OD, and what is the timeframe?

Answer 38

Liver regeneration phase, and back to baseline | 5 days after

Question 39

What are the five criteria for d/c a pt with acetaminophen OD?

Answer 39

1. APAP non-detectable 2. NAC has been administered for 24 hours (minimum) 3. Pt is asx 4. No lab evidence of organ damage 5. Not prego

Question 40

How much ASA is in a teaspoon of wintergreen?

Answer 40

7000 mg

Question 41

What causes the fever with ASA intoxication?

Answer 41

Uncoupling of the e- chain

Question 42

What must be added to bicarb in the treatment of ASA overdose?

Answer 42

K+

Question 43

How well do ASA levels correlate with s/sx?

Answer 43

Not well

Question 44

How toxic is a packet of silica gel?

Answer 44

Not very

Question 45

How toxic is a book of matches in a kid?

Answer 45

Not very

Question 46

How toxic is the liquid from a green glow stick?

Answer 46

Not very

Question 47

How toxic if Hg from a thermometer?

Answer 47

Glass is more concerning