Pharm clinical toxicology

Question 1

opioid toxidrome

Answer 1

altered mental status, decreased RR, pinpoint pupils, decreased bowel sounds

Question 2

what are the opioids?

Answer 2

heroin, fentanyl, codeine, hydrocodone, meperidien, oxycodone, methadone, buprinorphine

Question 3

what is the competitive opioid receptor antagonist used in overdose?

Answer 3

naloxone (short half life)

Question 4

what are the other opioid receptor antagonist?

Answer 4

nalmefene and naltrerxone (longer half lives)

Question 5

naloxone associated opioid withdrawal

Answer 5

flu like symptoms (nausea, vomiting, diarrhea), piloerection ,yawning, irritability, NORMAL MENTAL STATUS, lasts 15-30 min

Question 6

benzodiazepine toxidrome

Answer 6

depressed mental status, normal vital signs

Question 7

benzodiazepine mechanism and what are they used to treat?

Answer 7

enhance the effect of GABA - treat anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal
-also used to treat toxicity caused by other toxins that cause CNS stimulation such as anticholinergic toxins

Question 8

what is the competitive non-selective benzodiazepine receptor antagonist? (used to treat overdose)

Answer 8

flumazenil

Question 9

flumazenil dangers (benzo overdose drug)

Answer 9

can precipitate acute withdrawal and cause seizures

Question 10

acetaminophen toxicity - mechanism?

Answer 10

hepatic necrosis and renal failure - when too much acetaminophen - broken down into different by product that is toxic to the liver

Question 11

APAP (acetominophen) poisoning treatment

Answer 11

antidote = n-acetylcysteine (NAC) - best given within 8 hours of overdose

Question 12

tricyclic antidepressant toxidrome

Answer 12

anticholinergic, catechol reuptake inhibitor, alpha adrenergic blocker (hypotension), GABA antagonist (seizures), sodium channel blocker (THE KILLER)

Question 13

what effect does sodium channel blocker have?

Answer 13

wide QRS segment for heart action potential

Question 14

antidote for tricyclic antidepressant overdose

Answer 14

sodium bicarbonate (replace sodium to overcome inhibition and alkalinization to reduce TCA affinity to its receptor in the myocardium)

Question 15

anticholinergic toxidrome

Answer 15

mydriasis (dilated), dry, flushed skin, decreased bowel sounds, urinary retention, increased temperature, altered mental status (confusion, hallucinations, seizures)

Question 16

what are the anticholinergics?

Answer 16

atropine, diphenhydramine, scopolamine

Question 17

antidote for anticholinergic overdose

Answer 17

physostigmine (anticholinesterase)

Question 18

cholinergic toxidrome

Answer 18

miosis, salivation, lacrimation, ruination, defecation, CNS excitation, bronchorrhea/spasm, fasciculations

Question 19

what are the cholinergic agents

Answer 19

anticholinesterases (including nerve gases, organophosphates, carbamates, physostigmine, neostigmine) and cholinomimetics (bethanechol)

Question 20

what is the cholinergic overdose antidote?

Answer 20

atropine (anticholinergic) for MUSCARINIC ONLY 
and pralidoxime (enzyme regenerator) for NICOTINIC AND MUSCARINIC!

Question 21

what is the DD for anion gap metabolic acidosis?

Answer 21

MUDPILES!
Methanol
Uremia
Diabetic ketoacidosis (all ketoacidosis)
Paraldehyde, phenformin, metformin
Iron, INH
Lactate (CO, CN, methemoglobinemia)
Ethylene glycol
Salicylate

Question 22

what is used to treat methanol overdose?

Answer 22

femopizole and hemodialysis

Question 23

calcium channel overdose clinical effects

Answer 23

• if nifedipine and other dihydropyridines (blood vessels) peripheral vasodilation, reflex tachycardia, hypotension
• if verapamil or diltiazem (heart and blood vessels) = hypotension d/t vasdilation, bradycardia, negative inotropic effects

Question 24

amphetamines/cocaine toxicity

Answer 24

CNS stimulation, agitation, hallucinations, seizures, increased muscle activity = increased temp, increased CK, kidney injury

Question 25

phencyclidine (PCP)/ketamine/DM toxicity

Answer 25

dissociative anesthetic = depends on dose
low = euphoria
medium = agitation, anesthesia, increased strength
high = CNS anesthesia

Question 26

what are downers?

Answer 26

GABA agonists (GHB, roofies)

Question 27

what do you give to someone too high on PCP/amphetamine like drugs

Answer 27

diazepam = calming effect