MISC Flashcards
1
Q
What type of drug is imipramine?
A
TCA
2
Q
What type of drug is desipramine?
A
TCA
3
Q
Toxicity: anticholinergic effects, arrhythmia, hypotension, coma, seizures
A
TCAs
4
Q
Toxicity: GI and CNS effects followed by severe cardiotoxicity (hypotension, vasodilation, QRS prolongation, hypokalemia)
A
(hydroxy)chloroquine
5
Q
Trade name for diphenoxylate atropine?
A
Lomotil (antidiarrheal)
6
Q
Toxicity: anticholinergic effects with delayed opioid effects
A
diphenoxylate atropine (Lomotil)
7
Q
Toxicity: warmth, oral and epigastric burning, vomiting, abrupt seizures
A
camphor (vaporub)
8
Q
Imidazoline is found in which common medications?
A
Visine and Afrin
9
Q
Toxicity: potent central alpha agonism with CNS depression and inhibition of sympathetic output (hypotension, bradycardia, miosis)
A
Imidazoline (Visine, Afrin)
10
Q
What kind of medication is chlorpromazine?
A
antipsychotic
11
Q
Toxicity: anticholinergic symptoms, extrapyramidal syndromes (ataxia, rigidity, dystonia), CNS depression, seizures, arrhythmia
A
chlorpromazine (antipsychotic)
12
Q
Oil of wintergreen has what toxic ingredient?
A
salicylate
13
Q
Toxicity: hyperpnea, vomiting, tinnitus, fever, seizure
A
methyl salicylate
14
Q
Toxicity: GI effects, seizures, arrhythmias, hypokalemia, hyperglycemia, acidosis
A
theophylline
15
Q
Toxicity with ingestion of ammonium fluoride (wheel cleaners/rust cleaner) depends on what?
A
concentration of fluoride (binds Ca++/Mg++)
16
Q
Acetonitrile is found in what?
A
artificial nail remover
17
Q
Toxicity: metabolism leads to cyanide production causing histiotoxic hypoxia/lactic acidosis
A
acetonitrile
18
Q
What 5 major drug classes can present with hypotension and bradycardia?
A
central alpha2 agonist (clonidine), B blocker, CCB, cardiac glycosides (digoxin), acetlycholinesterase inhibitor (organophosphates)
19
Q
Ingestion of oleander is similar to what toxicity?
A
digoxin
20
Q
Ingestion of foxglove is similar to what toxicity?
A
digoxin
21
Q
Ingestion of lily of the valley is similar to what toxicity?
A
digoxin
22
Q
What kind of medication is diltiazem?
A
CCB
23
Q
What kind of medication is verapamil?
A
CCB
24
Q
What kind of medication is amlodipine?
A
CCB
25
What kind of medication is isradipine?
CCB
26
What kind of medication is nifedipine?
CCB
27
What kind of medication is carvedilol?
B blocker
28
What kind of medication is guanfacine?
central alpha2 agonist (clonidine-like)
29
What kind of medication is tetrahydrozoline?
central alpha2 agonist (clonidine-like)
30
What kind of medication is oxymetazoline?
central alpha2 agonist (clonidine-like)
31
What kind of medication is neostigmine?
acetylcholinesterase inhibitor (organophosphate-like)
32
What kind of medication is sarin?
acetylcholinesterase inhibitor (organophosphate-like)
33
Miosis: anticholinergic or cholinergic?
cholinergic
34
Mydriasis: anticholinergic or cholinergic?
anticholinergic
35
Hypertension: anticholinergic or cholinergic?
anticholinergic
36
Hypotension: anticholinergic or cholinergic?
cholinergic
37
Organophosphate toxicity: anticholinergic or cholinergic?
cholinergic
38
Bradycardia: anticholinergic or cholinergic?
cholinergic
39
Mushroom toxicity is similar to what?
organophosphates (cholinergic)
40
Jimson weed toxicity is what toxidrome?
anticholinergic
41
Benztropine is used in what disease?
Parkinson's
42
Benztropine toxicity is what toxidrome?
anticholinergic
43
Mescaline toxicity is similar to what?
LSD (hallucinogen)
44
Toxidrome: disorientation, hallucination, anxiety, sweating, seizures
hallucinogen (LSD)
45
Robitussin or Nyquil toxic ingredient?
Dextromethorphan
46
Levorphanol is a synthetic analog of what?
codeine
47
Dextromethorphan is the D-isomer of what?
levorphanol (codein analog)
48
Dextromethorphan (Robitussin) effect is a combination of what two medications?
codeine and ketamine
49
Toxidrome: delusions, paranoia, anxiety, sweating, piloerection, seizures, hyperreflexic
Sympathomimetics (cocaine, amphetamine)
50
Toxidrome: tinnitus, confusion, agitation, flushing, seizures
salicylates
51
Seratonin agonists: mydriasis or miosis?
mydriasis
52
Normal anion gap?
10
53
Normal osmolar gap?
10
54
Anion gap =
AG = (Na + K) - (Cl - HCO3)
55
Osmolarity (calculated) =
OG = 2xNa + Glucose/18 + BUN/2.8 + (ethanol/4.6)
56
Which is the only alcohol to create an osmolar gap but not an anion gap?
isopropyl
57
Presence of calcium oxalate crystals in urine is indicative of what ingestion?
ethylene glycol
58
Flumazenil administration can precipitate seizures in which toxic ingestion?
TCAs (or chronic benzodiazepine use)
59
Activated charcoal can be used if the ingestion was in what time frame?
less than 1 hour ago
60
Alkalizing urine promotes excretion of which drugs (general)?
weakly acidic drugs
61
How do you alkalinize the urine?
Add bicarbonate (75 mEq/L) to IVF
62
When alkalinizing urine, target urine pH of what?
>7.5
63
Which common drug toxicities benefit from urine alkalinization?
salicylate, methotrexate, phenobarbital
64
Overdose of which protein-bound medication may still benefit from hemodialysis?
valproic acid (binding sites saturated)
65
Intralipid therapy was first introduced as a treatment for which toxicity?
local anesthetic (bupivacaine)
66
Which CCB toxicity is amenable to intralipid therapy?
verapamil
67
Which drug class toxicities are amenable to intralipid therapy?
beta-blockers, TCAs, antidysrhythmics
68
Acetaminophen antidote?
NAC (N-Acyetylcysteine)
69
Anticholinergic antidote?
Physostigmine
70
When giving physostigmine, also give what?
atropine (to prevent bradycardia)
71
Beta-blocker and CCB antidote?
Glucagon
72
Benzodiazpine antidote?
Flumazenil
73
Digoxin antidote?
Digoxin-specific antibody fragments (Fab)
74
NAC mechanism?
promotes glutathione repletion and limits production of NAPQI (tylenol toxin)
75
Physostigmine mechanism?
Acetylcholinesterase inhibitor (increases ACh)
76
Side effect of digoxin-specific antibody antidote?
severe hypokalemia
77
Ethylene glycol or methanol antidote?
Ethanol or Fomepizole
78
Which vitamins can be given in ethylene glycol ingestion in addition to antidotes?
pyridoxine (B6) and thiamine (B1)
79
Organophosphate antidote?
atropine or Pralidoxime
80
Pralidoxime mechanism?
competes with organophosphates and reactivates acetylcholinesterase
81
Sulfonylurea antidote?
Octreotide
82
Toxic metabolite in acetaminophen ingestion?
NAPQI
83
NAPQI is hepatotoxic if not conjugated to what?
glutathione
84
Most common cause of mortality in tylenol ingestion?
cerebral edema from hepatic encephalopathy
85
NAC is ideally administered within what time frame of tylenol ingestion?
within 8 hours
86
NAC most common side effect?
anaphylaxis
87
"150" rule for tylenol ingestion?
toxic dose is 150 mg/kg, give NAC if levels >150, initial loading dose of NAC is 150 mg/kg
88
Pepto-Bismol toxicity is due to what ingredient?
salicylate
89
What is the general mechanism of salicylate toxicity?
uncouple oxidation phosphorylation
90
Hyperpnea in salicylate toxicity is initially due to what?
direct stimulation of medullary respiratory center
91
TCA causes prolongation of EKG intervals due to impact on which phase of cardiac cycle?
slowing of sodium flux (prolonged phase 0 depolarization)
92
TCA toxicity: hypertension or hypotension?
hypotension (vasodilation)
93
TCA effect on NE and serotonin?
inhibition of reuptake (initial hyperadrenergic state then catecholamine depletion)
94
R wave in aVR >3 mm indicative of what toxicity?
TCA
95
TCA toxicity: what medication is important to start?
sodium bicarbonate (alkalinization and sodium loading)
96
Citalopram is what type of medication?
SSRI
97
Which SSRI has the greatest potential for cardiotoxicity?
citalopram
98
Toxicity: clonus, diaphoresis, muscular rigidity, hyperthermia
serotonin syndrome
99
Cyproheptadine can be useful in what toxicity?
serotonin syndrome (antiserotonergic)
100
Chlorpormazine can be useful in what toxicity?
serotonin syndrome (antiserotonergic)
101
Serotonin syndrome vs NMS: onset slow or fast?
sertonin syndrome fast (<24h), NMS slow (days to weeks)
102
Serotonin syndrome vs NMS: which has dilated pupils?
serotonin syndrome
103
Serotonin syndrome vs NMS: which has bradyreflexia?
NMS
104
Ingestion of angel's trumpet leads to what type of toxicity?
anticholinergic
105
Cyclobenzaprine is what type of medication?
muscle relaxant (Flexeril)
106
Carisoprodol is what type of medication?
muscle relaxant (Soma)
107
Muscle relaxant toxicities are similar to which class?
TCAs
108
Acetylecholinesterase enzyme is found where in the body?
Plasma, RBCs, NMJ
109
Carbamate vs organophosphate: which binds reversibly to AChE?
carbamate binds reversibly, organophosphates eventually "age" into a permanent bond
110
Atropine reverses the effects of cholinergics at which receptors?
muscarinic (only)
111
Nicotinic cholinergic receptors are found where in the body?
NMJ
112
If a small child ingests ethanol, be sure to check which lab?
glucose (hypoglycemia common)
113
Isopropyl alcohol is metabolized by alcohol dehydrogenase to what?
acetone
114
Windshield washing fluid has what toxic ingredient?
methanol
115
Antifreeze has what toxic ingredient?
ethylene glycol
116
Ethylene glycol is metabolized by alcohol dehydrogenase to what?
oxalic acid (calcium oxalate crystals)
117
Methanol is metabolized by alcohol dehydrogenase to what?
formic acid
118
Formic acid (methanol) is a potent toxin to which organ?
eyes
119
What supplement may be of benefit in methanol poisoning?
folate
120
Patients with beta-blocker toxicity present with what lab abnormality?
hypoglycemia
121
Consider giving which two medications in beta-blocker overdose?
glucagon and insulin
122
Which antidote can be tried in clonidine toxicity?
naloxone
123
Digoxin mechanism of action?
Inhibition of Na-K ATPase
124
Digoxin overdose effect on Na and K?
K stays out (hyperkalemia), Na stays in (hyponatremia)
125
Avoid doing what to your patient with digoxin toxicity?
vagal stimulation
126
Which electrolyte abnormalities can potentiate digoxin toxicity?
hypokalemia, hypomagnesemia, hypercalcemia
127
What medication is contraindicated in sympathomimetic toxicity?
beta-blockers (leads to unopposed alpha stimulation, worsened hypertension)
128
Which drug is known as the "date rape drug"?
GHB
129
GHB mechanism of action?
GABA agonist
130
Pseudohyperchloremia may be seen in which toxicity?
Dextromethorphan (hydrobromide salt/bromide read as chloride ion)
131
Acid or base: tissue necrosis?
acid
132
Acid or base: liquefaction necrosis?
base
133
Acid or base: coagulating proteins?
acid
134
Acid or base: dissolves proteins?
base
135
Which is worse: low viscosity or high viscosity hydrocarbon?
low viscosity (spread rapidly)
136
Which is worse: low volatility or high volatility hydrocarbon?
high volatility (quickly enter circulation/brain)
137
Which medication should be avoided in hydrocarbon toxicity?
beta-agonists (epinephrine) due to high chance of arrhythmia
138
What toxicities can shift oxygen-hemoglobin curve to the left?
carbon monoxide (CO) and methemoglobinemia
139
CO binds more tightly to: fetal or adult hemoglobin?
fetal
140
Which common medicine can cause cyanide toxicity?
sodium nitroprusside
141
The addition of what to sodium nitroprusside can prevent cyanide toxicity?
thiosulfate
142
Cyanide mechanism of toxicity?
Binds to cytochrome oxidase resulting in histiotoxic hypoxia
143
CO mechanism of toxicity?
binds to hemoglobin with a higher affinity than oxygen
144
"Cherry red" skin color is common in which toxicity?
cyanide
145
A serum lactate >10 in a victim of a house fire is highly indicative of what toxicity?
cyanide
146
Cyanide antidotes?
nitrites or hydroxocobalamin (B12; first-line)
147
Mechanism of nitrites antidote in cyanide toxicity?
nitrites converts hemoglobin into methemoglobin, which highly binds cyanide
148
Nitrite administration in cyanide toxicity is contraindicated when?
concomitant CO poisoning or G6PD
149
How does sodium thiosulfate prevent cyanide toxicity?
provides sulfur donor for rhodanese, an enzyme that detoxifies cyanide (converts to thiocyanate)
150
Methemoglobin is a form of hemoglobin that is produced when what happens?
the iron (Fe2+; ferrous) is oxidized (Fe3+; ferric)
151
Mechanism of methemoglobin toxicity?
oxidized hemoglobin (Fe3+; ferric state) causes leftward shift in oxygen-hemoglobin dissociation curve
152
A significant difference between the pulse ox and the oxygen sat on a blood gas ("saturation gap") suggests what diagnosis?
methemoglobinemia
153
A patient with a pulse ox consistently around 85% indicates what toxicity?
methemoglobinemia
154
Treatment of methemoglobinemia?
methylene blue or ascorbic acid (vitamin C)
155
Methylene blue is contraindicated for treatment of methemoglobinemia if the patient has what?
G6PD
156
What number of retinal hemorrhages is suggestive of child abuse?
>20 (and in all zones)
157
The ophthalmologic exam should be performed within what time in cases of possible child abuse?
ideally within 24h (no longer than 72h)
158
Which fractures have high specificity for child abuse?
posterior rib, metaphyseal long bone, scapula, sternum
159
A skeletal survey should be obtained in any child of what age who has physical abuse in differential?
any child <24 months
160
The anterior fontanelle remains open until when?
12-24 mo
161
The posterior fontanelle remains open until when?
2-4 mo
162
If you see blood at the meatus in a trauma patient, avoid doing what?
attempting catheter insertion (call Urology first)
163
What is the Parkland formula for fluid resuscitation in burn patients?
24H fluids: 4 mL/kg * TSBA (2nd or 3rd deg; give half during first 8h, half during 16h) + mIVF
164
A burn of what TBSA should receive formal fluid resuscitation? (Parkland)
>20%
165
Closing capacity in an infant: larger or smaller than adult?
larger (larger volume at which small airways collapse)
166
Closing capacity in an infant: larger or smaller than FRC?
larger (CC > FRC, so prone to atelectasis)
167
Infants: have more or less type I muscle fibers than adults?
less (less endurance)
168
The PDA will close in 98% of infants by when?
day 4 of life
169
What is the normal CO (cardiac index) of an infant?
4.0 L/min/m2 (compared to 2.5-3.5 in adult)
170
In what part of the bone does an IO needle go?
metaphysis (between growth plate and shaft, or diaphysis)
171
Umbilical vein remains patent until when?
10-14 days of life
172
Which type of HSV infection causes 90% of neonatal herpes?
HSV-2 (HSV-1 is the cold sore one)
173
What are the 3 common presentations of neonatal CHD?
1-cyanotic (R to L shunt), 2-cardiogenic shock (left-sided obstruction), 3-CHF (L to R shunt)
174
Botulinum neurotoxin acts where in the nerve synapse?
presynaptically (inhibits ACh release)
175
In an infant being treated for botulism, avoid what antibiotic?
aminoglycosides (impede neuromuscular transmission)
176
Patient with methemoglobinemia and G6PD - treatment of choice?
ascorbic acid
177
Normal lactate:pyruvate ratio?
10-20:1 (aerobic glycolysis or muscle catabolism)
178
A high lactate:pyruvate ratio is indicative of what?
anaerobic glycolysis (respiratory chain defects)
179
What defines cardiopulmonary death?
apnea and absent pulse (presence or absence of PEA is not a factor - electric cardiac monitoring is not a factor)
