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CH 27 Toxicology > Lecture > Flashcards

Lecture Flashcards

1
Q

Anticholinergic drug examples

A

atropine, antihistamines, antipsychotics

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2
Q

Anticholinergic mnemonic

A 
Blind as a bat
Red as a beet
Hot as a hare
Dry as a bone
Mad as a hatter
Blotted as a toad
The heart runs alone (tachycardia)
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3
Q

Anticholinergic signs and symptoms

A

Increase; HR, Temp, Pulip

Decrease; Bowel, Diaphoresis

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4
Q

What is a poison?

A

Toxic by nature, no matter the dose or route of entry

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5
Q

What is a drug?

A

Substance with a therapeutic effect when given at an appropriate dose and circumstance
Dose-dependent and route dependent

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6
Q

Bioavailability

A

The extent to which a drug is present in sufficient amounts to produce the desired result

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7
Q

Half life

A

The point when bio availability of a drug has decreased to 50%

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8
Q

Peak time concentration

A

How long it takes a drug to exert its maximum clinical effects

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9
Q

Excretion

A

How a drug is removed from the body

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10
Q

Potentiation

A

Enhancement of the effect of one class of drug by taking it with another drug of a different class

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11
Q

Synergism

A

Action of two drugs in the same class in which the effects are greater then the independent effects

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12
Q

Antagonist

A

Drug with affinity for cell receptor, binds but does not activate it. Preventing the normal cell from activating it. Blocks the receptor

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13
Q

Agonist

A

Binds to a receptor and activates it

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14
Q

How do toxicokinetics differ from pharmacokinetics

A

When a drug is taken in overdose, normal pharmacokinetics don’t apply due to saturated metabolic pathways and a change in the desired effect, half-life and excretion time

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15
Q

Six common routes of absorption

A 
Ingestion
Inhalation
Injection
Absorption
Ocular
Rectal
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16
Q

What does ABCD referred to in the approach to a poisoned patient

A

Airway
Breathing
Circulation
Decontamination - protect yourself and decontaminate the patient as needed

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17
Q

Common OPQRTS and SAMPLE questions to include

A

What was taken, when, route, how much, why, acute or chronic reaction, other exposures, vomiting nausea aspiration, suicidal

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18
Q

What are significant findings for the following body systems in the poisoned patient?
Eyes, Mucous membranes, Bowel sounds, Skin, Neuro

A 
Eyes - pupils and nystagmus
Mucous- hydration
Bowel - hypo/hyperactive
Skin- Rash, dry, diaphoretic
Neuro - reflexes
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19
Q

AEIOUTIPS for a neuro exam

A 
Alcohol
Endocrine/ Epilepsy
Intoxication
Oxygen
Uremia
Trauma/Tumor
Infection
Psychological
Shock/Stroke
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20
Q

OTIS CAMPBELL for seizure/neuro exam

A 
Organophosphates
Tricyclics
Insulin
Sympathomimetics
Cocaine
Amphetamines
PCP
Benz withdrawal
Ethanol
Lead/Lithium
Lidocaine
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21
Q

Anticholinergic toxidrome

A 
\+HR
=RR
\+Temp
pupil dilation
-bowel sounds
-diaphoresis
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22
Q

Cholinergic toxidrome

A 
=HR
=RR
=Temp
pupil constriction
\+bowel sounds
\+diaphoresis
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23
Q

Sympathomimetic toxidrome

A 
\+HR
\+RR
\+Temppupil dilation
\+bowel sounds
\+diaphoresis
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24
Q

Sedative Hypnotic toxidrome

A

-HR
-RR
-Temp
=pupils
-bowel sounds
-diaphoresis

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25
Q

Opioid toxidrome

A

-HR
-RR
-Temp
pupil constriction
-bowel sounds
-diaphoresis

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26
Q

6 examples of anticholinergic agents

A 
Atropine
Antihistamines
Antipsychotics
Scopolamine
TCA's
Jimson Weed
27
Q

Treatment for anticholinergic toxicity

A

Supportive care

28
Q

Typical S&Sy of anticholinergic OD (mneumonic)

A 
Hot as a hare
Blind as a bat
Dry as a bone
Red as a beat
Mad as a hatter
29
Q

Causes of cholinergic toxicity

A

Organophosphates
Carbonates
Nerve Agents

30
Q

Treatment for cholinergic toxicity

A 
Atropine
Pralidoxime (2PAM)
31
Q

S&Sy of cholinergic toxicity

A

Muscarinic Sy - SLUDGE
Nicotinic Sy - MTWTF
(Muscle Cramps, Tachycardia, Weakness, Twitching, Fasciculations)

32
Q

Muscular effects of cholinergic toxicity

A

weakness, fasciculation, paralysis, similar to Succs, don’t use Succs to intubate

33
Q

Cardiovascular effects of cholinergic toxicity

A

Sinus tachydysrhythmias, bradycardia, QT prolongation causing Torsades

34
Q

S&Sy of sedative-hypnotic toxicity

A

sleepy, decreased RR

+/- variable BP, HR, Temp

35
Q

Treatment of sedative-hypnotic toxicity

A

Supportive care, monitor RR

36
Q

Causes of sedative-hypnotic toxicity

A

Benzodiazepines, barbiturates, zolpidem

37
Q

S&Sy of opioid toxicity

A

Sleepy, - RR, pinpoint pupils

38
Q

Causes of opioid toxicity

A

heroin, morphine, oxycodone, fentanyl, methadone

39
Q

Treatment for opioid toxicity

A

Narcan, supportive, monitor RR

40
Q

S&Sy of sympathomimetic toxicty

A

Altered, agitated, mydriasis (dilation of the pupil), diaphoretic
elevated HR, RR, BP

41
Q

Causes of sympathomimetic toxicity

A

amphetamines, cocaine, bath salts, huffing

42
Q

Major concerns of Sympathomimetic toxicity

A

Rhabdo, Hyperthermia, Safety

43
Q

Treatments for sympathomimetic toxicity

A

High doses of Benzodiazepines in hopes of decreasing neural output and preserve ATP
Use non-depolarizing paralytics to preserve ATP
Actively cool if hyperthermic (tylenol ineffective)

44
Q

Examples of TCA OD

A

amitriptyline, nortriptyline, amoxapine

45
Q

S&Sy of TCA OD

A

cardiovascular and neurologic toxicity

tachycardia, drowsiness, N/V, monitor for peaked T waves, Widened QRS, Prolonged QT, ALOC, hypotension, seizures

46
Q

Treatment for TCA OD

A 
Widened QRS (50mEq IV Bicarb), QT prolongation Mag 2g if needed,
Maintain BP with Dopamine as needed
47
Q

Causes of SSRI Toxicity

A

SSRI, MAOI, cocaine, dextromethorphan

48
Q

S&SY of SSRI Toxicity

A

AMS, Clonus, Rigidity, Hyperthermia

49
Q

Treatment of SSRI Tocicity

A

Benzodiazepine, Ciproheptadine

50
Q

Causes of Ca++Channel Blocker Toxicity

A

amlodopine, diltiezam, verapamil, felodipine

51
Q

S&SY of Ca++ channel blocker toxicity

A

Hypotension, Brady dysrhythmias, prolonges R-R, Cardiac arrest, seizure, syncope, N/V, ALOC, Hyperglycemia, Hypokalemia

52
Q

Treatment of Ca++ channel Blockers

A

Ca++Cl- 500-1000 SLOW IVP consider 2nd dose with base contact
IV fluids, vasopressor, consider TCP, supportive care

53
Q

Causes of Beta Blocker Toxicity

A

Atenolol, Metoprolol, sotalol, propanolol

54
Q

S&Sy of Beta Blocker toxicity

A

Bradycardias, AV Blocks, prolonged R-R, Torsades, drowsiness, hypotension, CHF type symptoms
-HR, -inotropic, -dromotropic

55
Q

Treatments for Beta Blocker toxicity

A

Glucagon 3-5mg IV over 10 min (will cause vomiting)

Dopamine to maintain BP >100

56
Q

what is the level to consider acetaminophen Toxicity

A

Acute within 8 hr period
Adult: >6g
Children: >200mg/kg

57
Q

Describe the 4 phases of acetaminophen toxicity

A

P1: 0-24hrs N/V
P2: 24-72hrs RUQ Px, Elevated liver enzymes and INR
P3: 72-96hrs hepatic necrosis, renal failure
P4: 4days-weeks
resolution of S&Sy if pts survive this long

58
Q

Salicylate Toxicity S&Sy

A

Tinnitus, GI upset, respiratory stimulant, AMS, acute lung injury, Central hypoglycemia (give D50)

59
Q

CO poisoning S&Sy

A

flu-like, dizzy, bounding pulse, dilated pupils, cyanosis, cherry red skin

60
Q

CO treatment and management

A

high flow O2, reduce anxiety, monitor EKG and LOC

61
Q

Cyanide Poisoning S&SY

A

burning sensation in ENT, cyanosis, shock, seizures

62
Q

Cyanide Poisoning Treatment

A

High flow O2, irrigate eyes and skin

63
Q

Nicotine OD S&SY

A

Tachycardia, N/V and seizures, bradycardia

Parasympathomimetic alkaloid

64
Q

Lethal dose of nicotine

A

30-60mg (.5-1.0mg/kg)
ave e-cigarette contains 9mg, but less than 1 mg is ingested
Have 0-48mg/ml of nicotine solution

CH 27 Toxicology (1 decks)

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