MRCP Toxicology Flashcards
Management of CO poisoning
Immediate: Tight fitting non-rebreather, 15L More definitive (but takes longer to arrange): hyperbaric oxygen
Drugs at risk of causing SNHL
IV gentamicin
IV vancomycin
IV erythromycin
IV furosemide (NOT oral)
What type of receptor does amlodipine block
L-type calcium channels
hypotensive and tachycardic in overdose
Mechanism behind steroids causing raised blood glucose/diabetes
Increased gluconeogenesis
Pharmacological treatment of neuroleptic malignant syndrome
SC bromocriptine
Drugs that can precipitate psoriasis
Lithium
Beta blockers
NSAIDs
Anti-malarials
Therapy for RA in pregnancy
Sulfasalazine
azathioprine second line
Antipsychotic responsible for agranulocytosis
Clozapine
Safest anti-epileptic in pregnancy
Lamotrigine
Early test to confirm testosterone abuse
Urinary testosterone/epitestosterone ratio
Antidote to beta blocker overdose
Glucagon (treats hypotension and hypoglycaemia)
Renal abnormality seen in solvent abuse (glue/aerosol sniffing)
Distal renal tubular acidosis
Young boy (?bodybuilder ?gay) comatose, spontaneously wakes up and removes own ETT 3h later
GHB overdose
- abused for weight loss & body building
- tastes like seaweed
- rapid reversal of coma
- charcoal within 1h. otherwise supportive measures
Hyponatraemia secondary to ecstasy intoxication (normal neurology & GCS)
Fluid restriction (hypertonic saline considered if reduced GCS and seizures)
Management of calcium channel overdose
Give calcium!
Allopurinol + Azathioprine =
Myelosuppression
Xanthine oxidase inhibition (allopurinol) and azathioprine cause formation of mercaptopurine metabolites due to elevated 6-mercaptopurine (major metabolite of azathioprine)
Describe amiodarone induced thyrotoxicosis type 2
Destructive thyroiditis, decreased blood flow & decreased uptake on scan.
Poorly responsive to medication, often burns itself out
Check TPMT activity prior to starting which drugs?
Azathioprine
Mercaptopurine
Symptoms of salicylate toxicity
Bilateral deafness, tinnitus, visual blurring, vomiting
Initially respiratory alkalosis then severe metabolic acidosis
Urinary alkalinisation
Pathophysiology of sodium bicarb in TCA OD
Cardioprotective - reduces TCA binding to myocardium
SOB, abdo pain, hypoxia, hypotension following sodium nitroprusside
Cyanide poisoning
- sodium nitroprusside denatures to form cyanide
Monitoring whilst on azathioprine
FBC, U&E, LFT
When is sodium bicarb indicated in TCA OD?
QTc >100 (decreases risk of seizures/arrhythmias)
Treatment of LA toxicity
20% lipid emulsion (bolus then infusion)
- symptoms of LA toxicity:
peri-oral paraesthesia, slurred speech, altered mental status, seizures
