Pharmacology - Drug Toxiciology I & II - Christine Stork-Medicis

Question 1

Dx:
Pinpoint pupils;
Decreased bowel sounds;
Altered mental status;
Slow HR, BP down, temp down

Answer 1

Opioid Toxidrome

Question 2

What is the half life of Naloxone?

Answer 2

15 minutes

Question 3

Class: Naloxone

Answer 3

Mu/delta/kappa opioid receptor antagonist

Question 4

MOA: Naloxone

Answer 4

Competitive inhibitor of mu, delta, kappa opioid

Question 5

What is the toxidrome for benzodiazepines?

Answer 5

No respiratory depression if not mixed;

Mental status depression

Question 6

MOA: Flumazenil

Answer 6

Competitive non-selective benzodiazepine receptor antagonist

Question 7

Use: Flumazenil

Answer 7

Benzo OD;

Anti-Rohypnol

Question 8

What are the symptoms of Stage I Acetaminophen toxicity?

Answer 8

Asymptomatic,

Mild GI irritation

Question 9

What are the symptoms of Stage II Acetaminophen toxicity?

Answer 9

24-72 hours

LFT and renal fx abnormalities +/- RUQ pain

Question 10

What are the symptoms of Stage III Acetaminophen toxicity?

Answer 10

72-96 hours

Hepatic necrosis +/- renal failure

Question 11

What are the symptoms of Stage IV Acetaminophen toxicity?

Answer 11

4 days to 2 weeks

Resolution of organ fx

Question 12

What is the antidote for acetominophen poisoning?

Answer 12

N-acetylcysteine (NAC)

Give within 8 hours of OD

Question 13

MOA: N-acetylcysteine

Answer 13

Resupplies glutathione stores

Question 14

What are signs of late Acetominophen toxicity?

Answer 14

Prothrombin time > 200s
Serum creatinine > 3.3
Hepatic encephalopathy
Blood pH 30

Question 15

What toxidrome is being described?
No bowel sounds;
Dry flushed skin;
Dilated pupils;
Obtunded/altered;
Tachycardic;
Increased temperature

Answer 15

Anti-cholinergic toxidrome

Question 16

What ECG findings are common in tricyclic OD?

Answer 16

Widened QRS complex

Question 17

What is the antidote for wide QRS complex, as seen with tricyclic antidepressant OD?

Answer 17

Sodium bicarbonate

Question 18

What is the antidote for anti-cholinergic OD?

Answer 18

Physostigmine

Administer slowly to prevent seizures

Question 19

When is using Physostigmine as an antidote contraindicated?

Answer 19

After TCA exposure - cases of asystole reported

Can use benzodiazepines to sedate the patient until a decision can be made.

Question 20

Name the toxidrome:
Salivation, lacrimation, urination, defecation, Pupils contricted, CNS excitation, muscle fasciculations, breathing spasm

Answer 20

Cholinergic toxidrome

Muscarinic and nicotinic

Question 21

What is the antidote for cholinergic toxidrome, as with heavy pesticide exposure?

Answer 21

Pralidoxime

Enzyme regenerator;
Decreases atropine requirement

Question 22

What is the antidote for methanol ingestions?

Answer 22

Fomepizole;

Dialysis

Question 23

What is the antidote for ethylene glycol?

Answer 23

Dialysis

Question 24

OD on Verapamil or Diltiazem can cause:

Answer 24

Bradycardia, Hypotension, Negative inotropy;

Question 25

What is a unique antidote for calcium channel blocker OD?

Answer 25

High dose insulin

Other treatments include fluid replacement and vasopressors