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