Obj. 9 - drug overdoses & poisonings

Question 1

Give activated charcoal for ethanol overdose.

T/F

Answer 1

False.

Alcohol is absorbed too quickly for activated charcoal to be effective.

Question 2

Patients unconscious due to ethanol get ____ to prevent Wernicke’s encephalopathy.

Answer 2

thiamine

Question 3

What will be the acid-base status of a patient with salicylate overdose?

Answer 3

anion gap metabolic acidosis

Question 4

What 4 things will you do/give for salicylate overdose?

Answer 4

1. activated charcoal
2. gastric lavage
3. sodium bicarb
4. glucose

Question 5

What 2 things can be given for acetaminophen overdose, and what is the timeline for these?

Answer 5

Within 1-2 hours of ingestion: activated charcoal

Within 8-10 hours of ingestion: N-acetylcysteine (antidote)

Question 6

What 2 things are you NOT going to do in a case of alkali poisoning?

Answer 6

DON’T induce vomiting (reinjures esophagus)

DON’T give neutralizing agents (exothermic rxn = burns)

Question 7

What will you give immediately for acid ingestion?

Answer 7

8 oz water, to dilute

Question 8

What are the effects of organophosphates?

Answer 8

cholinergic, basically:
DUMBBELS
~defecation
~urination
~miosis
~bronchospasm
~bradycardia
~emesis
~lacrimation
~salivation

Question 9

There are 2 main reasons you may not want to induce emesis in some overdoses/poisonings. What are the reasons and what are some example substances?

Answer 9

1. avoid reinjuring the esophagus (e.g. alkali)

2. to avoid aspiration due to depressed CNS (benzos, organphosphates)

Question 10

What 2 drugs will you administer in a case of organophosphate poisoning?

Answer 10

1. atropine to dry bronchial secretions

2. pralidoxime

Question 11

What are the effects of tricyclic antidepressant overdose?

4

Answer 11

1. anticholinergic effects (mydriasis, dry mouth)
2. QRS widening (ventricular arrhythmias)
3. seizures
4. hyperthermia

Question 12

What can be given for elevated serum iron after an iron overdose?

Answer 12

deferoxamine

Question 13

Which drug OD will have hypoglycemia appear on the workup?

Answer 13

Ethanol

Question 14

What is more accurate for ethanol OD, serum or breath levels?

Answer 14

serum

Question 15

Why is someone with an ASA OD hyperpneic?

Answer 15

because they’re in metabolic acidosis and they’re compensating by increasing respirations

Question 16

What is the major cause of death from PCP OD?

Answer 16

HYPERTENSIVE CRISIS

Question 17

How does PCP OD lead to liver failure?

Answer 17

Rhabdomyolysis

Question 18

When are the symptoms usually present for acetaminophen toxicity?

Answer 18

24-48 hours after ingestion (also when hepatic aminotransferase labs start to rise too)

Question 19

What can alkali ingestion cause?

Answer 19

liquefactive necrosis

Question 20

What is considered the “narcan of the benzos”?

Answer 20

Flumazenil

Question 21

In which OD do we hear decreased bowel sounds/gastroparesis?

Answer 21

Opiates

Question 22

What EKG findings are characteristic for Methadone OD?

Answer 22

QT prolongation and torsades

Question 23

What kind of poisoning should you suspect if I say: Miosis + Sweating + Hyperperistalsis?

Answer 23

Organophosphate

Question 24

Do you give beta-blockers to Amphetamine OD to lower their BP?

Answer 24

NO, absolutely not! Can lead to paradoxical hypertension