ICU Tox

Question 1

CYPS inducer

Answer 1

Rifampicin, Carbamazepine, Phenytoin

Question 2

CYP substrates

Answer 2

Warfarin, CINs, Amiodarone, Statin, Diltizaem, TKIs, Rivaroxabam, Apixaban

Question 3

CYP inhibitors

Answer 3

Macrolides
Azoles
Verapamil
Grapejuice
Protease inhibitors

Question 4

P-gp Substrates

Answer 4

Diltiazem
Digoxin
Cyclosporin
Dabigatran

Question 5

P-gp Inhibitors

Answer 5

Macrolide
Azoles
Amiodarone
Verapamil

Question 6

P-gp inducers

Answer 6

Rifampicin
Dex
St Johns warts

Question 7

Warfarin

decreased levels

Answer 7

St Johns Warts, Carbamazapine, Rifampicin, Phenytoin, ETOH

Question 8

Warfarin

increased levels

Answer 8

Metro, Erythromycin, Azole antifungals, NSAIds

Question 9

Serotonin syndrome

Answer 9

occurs within hours
tremor, hyperreflexia, clonus, tachycardia etc

drugs - SSRI, TCA, Tramadol, MAOi etc

Question 10

Cholinergic toxicity
drugs
sx

Answer 10

WET
stigmines
DUMBBELS - diarrhoea, urinartion, mitosis, bronchorrea, bradycardia, emesis, lacrimation, salivation

Question 11

Anticholinergic toxicity
drugs
sx

Answer 11

DRY
antidepressants, antihistamines, antiparkinson drugs, antipsychotics, antispasmodics, and mydriatics.

Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone

Question 12

NMS antidote

Answer 12

Bromcriptine

Question 13

Alpha 1

neurotransmitter
function

Answer 13

Increase peripheral resistance –> increased preload

*block = postural hypotension

uses Norepinephrine and some Adrenaline

Question 14

Alpha 2

neurotransmitter
function

Answer 14

Inhibits NE and Ace release

Epinephrine

Question 15

Beta 1

neurotransmitter
function

Answer 15

Increases inotropy/chonotrophy
increases AV conduction

Epinephrine and Adrenaline - similar

Dobutamine, isoprenaline- agonist (B1 >B2)

Question 16

Beta 2

neurotransmitter
function

Answer 16

Vasodilation, reduced peripheral resistance, bronchodilaton

Epinephrine

Question 17

Antidote

Digoxin

Answer 17

Feb antibodies

Question 18

Antidote - Cyanide

Answer 18

Dicobalt edetate

Question 19

Antidote - CO

Answer 19

O2

Question 20

Antidote Organophosphate

Answer 20

Atropine

Question 21

Antidote Benzo

Answer 21

Naloxone

Question 22

Antidote Iron

Answer 22

Desferriozamine

Question 23

NIV - physiological benefits

Answer 23

Alveolar ventilation - reverses acidosis and hypercapnoea
Alveolar recruitment
Reduction in WOB
Reduction in left ventricular after load –> improved LV function

Question 24

NIV indications

Answer 24

Hypercapnoea

• exac COPD
• post extubation acute Resp failure
• OSA/OHS
• CF –> bridge to transplant
• Acute asthma

Hypoxia

• APO –>alveolar recruitment, decreased after load, decreased WOB
• post op resp failure

Question 25

Predictors of successful use of NIV

Answer 25

Younger age
Unimpaired GCS
Mod hypercapnia (not severe)
Rapid improvement

Question 26

OOH Cardiac Arrest - unfavourable prognosis

Answer 26

Myoclonic status epilepticus - Best marker of poor outcome at 24 hours

Duration of CRP
Duration of anoxia
Pupillary light reaction (absent Day 3)
Brainstem reflexes (absent Day 3)
Response to pain (absent Day 3)
BGL on admission (high)

Question 27

Amityptilline antidote

Answer 27

Commonly have cardiac conduction abnormalities

Give Sodium bicarb for ORS .100msec or ventricular arrhythmia

Question 28

Hyperventilation in ICP

Answer 28

Reduces ICP by reduction in cerebral blood flow