Poision Flashcards
Triad Of Arsenic Poisoning
Garlic breath with watery diarrhea
Prolong QTC
Depigmentation with stock glove neuropathy
How to dx and manage Arsenic Poisoning?
Dx through urine arsenic levels
Tx::Dimercaprol / DMSA
Classification of Hypothermia
Mild (35-32’c)with tachycardia And tachypnea / increased shivering
Moderate ( 32-28’c) bradycardia with decrease shivering
Severe (<28’c) coma / ventricular arrthymia
How to t/m Hypothermia in General?
Warm IV fluids for low BP
ETT if comatose patient
How to manage mild Hypothermia?
Passive external warming that is remove wet clothing And the patient body is cover with blanket
How to manage moderate Hypothermia?
Active external warming that is warm blanket with heating pads and warm bath
How to manage severe Hypothermia?
Active internal rewarming that is warm pleural Or peritoneal irrigation
Warm humidified O2
How acidosis occur in Hypothermia?
Meta-acidosis due to decrease tissue perfusion
Resp Acidosis due to hypoventilation
How azotemia and hyperkalemia occur in Hypothermia?
Azotemia due to decrease renal perfusion
Hyperkalemia due to cell lysis
How hyperglycemia and low wbc/PLTs occur in Hypothermia?
High glucose due to loss of insulin effect esp in temp less than 30*c
Low wbc/PLTs due to splenic squestration
How high Hematocrit and coagulopathy occur in Hypothermia?
High Hematocrit due to hemoconcentration
Coagulopathy due to impaired coagulation pathway
How lipase level increased in Hypothermia?
Cold induced pancreatitis
What to do if patient have persistent Hypothermia despite giving IV warm fluid?
IV fluids and rewarming ineffective in restoring normal BP—> inotropic support with dopamine
Triad of Heat Exhaustion
Body temp less than 104’F
Not significant CNS dysfunction
Loss of fluid and electrolytes with physical activity leads to Exhaustion
Triad of MARIJUANA
Conjunctival injection with Slow reaction time
affecting the ability to operate automobiles and increasing the risk of motor vehicle accidents.
Increased appetite
Triad of methanol ketoacidosis
High osmole gap with high anion gap
Visual SxS
Alter mental status
Lab finding of alcohol ketoacidosis
High osmole gap with high anion gap
Triad of ETHYLENE GLYCOL POISONING
High osmole gap with high anion gap
Renal Sxs with stones
Neuro Sxs like cranial nerve palsy / tetani
Triad of Isopropyl alcohol ingestion
High osmole gap without anion gap
CNS depression
Disconjugate gate with absent ciliary reflex
How FLUPHENAZINE cause HYPOTHERMIA?
cause hypothermia by inhibiting the body’s shivering mechanism and/or inhibiting autonomic thermoregulation.
For this reason, patients taking antipsychotic medications should be advised to avoid prolonged exposure to extreme temperatures.
Under such conditions, they can develop extreme hypothermia
Triad of PCP
Multidirectional nystagmus
Ataxia
Aggressive behavior
Important point of opioid treatment
Methadone and buprenorphine—long acting opioid agonists not used in acute intoxication rather used for withdrawal
What are the reliable SxS of Opioid intoxication?
Bradycardia with low BP and low RR
Decrease Bowel sound with Hypothermia due to histamine
Miosis but not so reliable
What is treatment of choice for lithium intoxication?
Hemodialysis is the treatment choice for severe lithium toxicity because it is the most dialyzable toxin.
How to t/m fits due to TCA?
Seizures b/c TCA caused by inhibition of GABA—hence treated with GABA agonist like benzodiazepines instead of Na+-channel blocking agents like phenytoin (as it can cause hypotension and arrhythmia)
Important point of DIPHENHYDRAMINE
Antihistamine as well as anticholinergic properties
How to assess caustic ingestion through imaging?
Serial chest and abdominal x-ray: look for perforation
suspected perforation: upper GI x-ray with water soluble contrast
Upper GI endoscopy within 12-24 hours in the absence of perforation and severe respiratory distress in hemodynamically stable patient
What ABGs changes occur in iron poisoning?
Anion gap metabolic acidosis
How to approach ACETAMINOPHEN toxicity if level is more than 7.5g?
If less than 4 hours of ingestion—> add charcoal and then check level
If more than 10 or timing of ingestion unknown give NAC
How to t/m severe lead poisoning?
Level more than 70mcg/dl
Give Dimercaprol plus EDTA
How to t/moderate lead poisoning?
Level 45-69mcg/dl
Give DMSA
How to t/m mild lead poisoning?
Level 4-44mcg/dl
No treatment
Repeat level of lead in a month
Triad of METHEMOGLOBINEMIA
cyanosis
bluish discoloration of skin and mucous membranes
Mimics to CO Poisoning
Triad of cyanide poisoning
metabolic acidosis
Bitter almond breath is characteristic
Markedly elevated lactate (typically >10 mEq/L)
Name the high potency Anti psychotic medication
Remember (HTF)
Haloperidol
TriAuoperazine
Fluphenazine
more neurologic side effects (eg, extrapyramidal symptoms [EPS)).
Name the low potency first generation antipsychotic
Chlorpromazine
Thioridazine
(anticholinergic, antihistamine, Alpha-blockade effects)
What are the ophthalmologic complications of first generation antipsychotic?
Chlorpromazine-Corneal deposits
Thioridazine-reTinal deposits.
How to t/m acute dystonia due to antipsychotic?
benztropine
diphenhydramine.
How to t/m Akathisia (restlessness) and Parkinsonism (bradykinesia)?
Both with benztropine
In case of Akathisia ——> benzodiazepines
In case of Parkinsonism—-> amantadine
How to t/m Tardive dyskinesia?
atypical antipsychotics (eg, clozapine)
valbenazine
deutetrabenazine.
What are the atypical antipsychotic?
Aripiprazole
asenapine
clozapine
olanzapine
quetiapine
iloperidone
paliperidone
risperidone
lurasidone
ziprasidone.
Name the atypical antipsychotic causing hyperprolactinemia
Risperidone
Important point of clozapine
Use clozapine for treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia.
What is the MOA of Buspirone and use of it?
Stimulates serotonin receptors.
Use in GAD
Name the d/f SSRI
Fluoxetine
fluvoxamine
paroxetine
sertraline
escitalopram
citalopram.
What are the clinical uses of SSRI?
ABPD
Anxiety disorder
bulimia binge-eating disorder
PTSD /premature ejaculation / premenstrual dysphoric disorder.
Depression
What are the specific S.E of SSRI?
SIADH
sexual dysfunction
Important point
If depression patient develop HTN think of SNRI
What are the d/f SNRI?
Venlafaxine
desvenlafaxine
duloxetine
levomilnacipran
milnacipran.
Name the substance causing lithium toxicity
In acute case overdose of lithium
Or
In chronic condition causing dehydration / ACEI, NASIDs, Thiazide diuretic
Name the medication given for extra pyramidal SxS Occur due to antipsychotic
Acute dystonia —>Benztropine / diphenhydramine
Akathasia —->BB / benzo / Benztropine
Parkinsonism—->Benztropine/amantadine
Triad of Ectasy (MDMA//Molly)
Sxs like Serotonin syndrome with low sodium and Amphetamine
Important point::
Inhalants are depressive
Bath salts are synetic amphetamine; it also leads to Serotonin syndrome
In which condition Succinylcholine avoided?
Hyperkalemia condition like GBS, tumor lysis syndrome
Rhabdomyolysis
Burns
*in case of deranged LFT use low dose of drug
What are the consequences of high voltage Electrical injuries?
Rnhabdomylosis
Heme pigment induced AKI
Acute compartment syndrome from intra compartmental muscle swelling
How to Rx high voltage electrical injuries?
Potassium sparing IV fluid as muscles injury result hyperkalemia
What are the common features of Neuroleptic malignant syndrome and serotonin syndrome?
Both show AMS, increase body temperature and autonomic dysregulation
Difference between Neuroleptic malignant syndrome and Serotonin syndrome
NMS::
Dose independent and take times to occur
Severe diffuse muscle rigidity
Serotonin syndrome::
Dose dependent and quick to occur
Clonus, hyer reflexia and tremor
What are the SxS of organophosphate poisoning?
Narrow pupil
Excessive lacrimation and salivation
Bronchospasm with low HR
Excessive emesis and diarrhoea
Lots of urine
How to manage Organophosphate poisoning?
First remove clothes and irrigate skin
Given atropine followed by Pralidoxime
Former only reverse muscarinic SxS and latter both nicotinic and muscarinic
How to manage SEROTONIN SYNDROME?
1) First withdraw all culprit meds followed by supportive care and sedation with benzo
2) Cyproheptadine if above fail
3) if temp > 106f (41.1c) —> stat sedation, paralysis and tracheal intubation
Difference b/w lithium induced physiological tremor and Lithium toxicity tremor
Lithium induced physiological tremor::
Symmetric and limited to hand and upper limbs
Rx:: just observe
Lithium toxicity tremor::
Irregular, coarse tremor
Involved multiple part of body with GIT and neurological SxS
Rx:: dialysis
How phenytoin toxicity occur?
Drugs which inhibit or CYP 450 or displace this drugs from plasma protein leads to increase level of it
Acute toxicity SxS like cerebellar dysfunction
Severe —> like AMS fits death
S’times Rapid IV infusing leads to hypotension and bradyarrhythmia
How Tetrahydrocannabinol poisoning present?
increase appetite with red reflex and slowed reflex
What is the most specific ECG suggest digoxin toxicity?
Atrial tachycardia with type 2A AV block
Former due to increase automaticity and latter due to AV node block.
Name the Antihistamine and Anti Parkinson meds showing Anti cholinergic properties
Anti Histamine::
Diphenhydramine and Cyproheptadine
Anti Parkinson::
Benztropine and Trihexyphenidyl
Name the Psychotropics meds showing Anti cholinergic properties
1st Generation—-> Chlorpromazine and Haloperidol
2nd Generation—-> Clozapine
TCA like Amitriptyline and Clomipramine
Name the plant based which showing Anti cholinergic properties
Jimsonweed
Nightshade species
Muscarinic mushroom species
What are the CNS, CVS and Pulmonary complications of AMIDARONE?
CNS—> Peripheral Neuropathy
CVS—-> sinus brady Or QT prolonged or risk of torsade de pointes
Pulmo—> Chronic interstitial pnemonia
What are the Ocular, GIT and derma complications of AMIDARONE?
Ocular—> Optic Neuropathy or Corneal microdeposit
GIT—> deranged LFT or hepatitis
Derma—> blue gray skin discoloration
How to treat Comedonal acne?
Located at nose, forehead and chin
Remember GAS
Topical retinoids like Glycolic acid, Azelaic, Salicylic
How to manage mild, mod and severe Inflammatory acne?
It shows inflammatory erythematous papules and pustules
If mild give—> Topical retinoids plus benzoyl peroxide
If moderate—> topical ABx like Clindamycin or erythromycin
If severe—> Oral Abx
How to manage moderate, severe and unresponsive Nodular (cystic) acne?
Moderate—-> topical (ABx + benzoyl peroxide) + topical ABx
Severe —-> add oral Abx
Unresponsive—-> Oral isotretinoin
How to manage DELIRIUM non-pharma?
MCPS E
- Mobilise the patient with avoidance of restrain
- Constant observation by family member or professional sitters
- Personal interaction via physical touch or just reassurance
- Sleep facilitation viz Bright day / dim night lighting
- Environment peaceful viz noise reduction or intervention grouping
How to manage DELIRIUM pharma?
Reduce pain but use non opioid
Off label use of antipsychotic
If still in delirium then use of benzo
How to approach Hyponatremia?
Part 1
First check serum Osm
1) If normal or high—>
High glucose, Exogenous osmoles like mannitol, pseudo Hyponatremia (paraproteinmia or hyperlipidemia)
2) If low —>check ECV and urine findings
How to approach Low Serum sodium with low serum osmolality in Hypovolemia and hypervolemia?
For hypovolemia cut off urine Na is 40
Check ECV and urine findings
1) If Hypervolemic —-> CHF, CLD, nephrotic syndrome
2) If hypovolemia—> check urine Na
If less than 40–>Non renal salt loss
If more than 40–> diuretic or primary adrenal insufficiency
How to approach Low Serum sodium with low serum osmolality in Euvolemia?
Cut off urine osm 100
Check Urine osm
If less than 100 —->beer potomania Or psychogenic polydipsia
If more than 100–> SIADH
What are the causes of post operative Delayed emergence?
In normal situation patient regain conscious within 15 mins after extubation
1) Neuro disorder like stroke, fits or Increase ICP
2) Metabolic disorder like alter temperature, blood glucose, low sodium and Liver disease
3) Drug effect like toxin or heavy dose / prolonged used of anesthesia
Name the drugs and their MOA causing Rhabdomyolysis
FACE (A= S) :. ONE (N = benzo): CA
• Direct Myotoxicity
(Fibrates Statins Colchicine cocaine Ethanol)
• Prolong Immobilisation
( compression ischemia) Opioid Benzo Ethanol
• Vasoconstrictive ischemia
( Ethanol cocaine)
What are the causes of Secondary Priapism? Remember MSN Primary cause (unknown)
Meds like alpha1 blocked or Antidepressants like Trazadone or SSRI,
Sildenafil Or stimulant like Amphetamine or cocaine
Medical issue like SCD, leukemia
S surgery like Perineal or genital trauma
Neurogenic lesion like cauda equina syndrome
What are the withdrawal sxs of Opioid?
Eye —> lacrimation and pupil dilated
Mouth—> yawing
Bowel—> hyperactive
Penis—> piloerection
How BB toxicity present physically and on ECG?
AMS with breathing d/f ( bronchospasm)
Low BP, HR and Glucose
Fits
EKG show Increase PR interval and bradycardia
How to manage BB toxicity?
First secure airway Along with IV fluid infusion
Not response—->.IV atropine
Not response——–> IV glucagon.
Triad of Osler weber rendu syndrome
Autosomal dominant
Recurrent nasal bleeding and clubbing
Ruby colored papules blanch with pressure (telangiectasia)
AV malformation with reactive polycythemia
What are the IMMEDIATE and Delayed cause of Post operative fever?
• IMMEDIATE (within 6hours after surgery)
Tissue trauma
Blood product
Malignant hyperthermia
• DELAYED (After 1month)
Viral Infections
SSI (indolent organism)
What are the Acute Infective and Non Infective cause of Post operative fever?
After 24 hour but before 1
• INFECTIVE::
Nosocomial Infection
SSI (due to Group A strep / C perfringen)
Catheter site Infection
• Non INFECTIVE:
MI
PE and DVT
What are the sub Acute Infective and Non Infective cause of Post operative fever
After 1 week but before 1 month
• INFECTIVE::
Catheter site Infection
Clostridium difficile
• NON INFECTIVE
DVT / PE
Drug fever
What are the typical features of Edward syndrome?
Face—>Hands—>thorax—->Abdomen—->Lower limb
Face shows small jaw with prominent occiput and low set Ears
Clenched hands with Overlapping fingers
Heart and Renal defects
Limited hip abduction and Rocker bottom feet
What are the typical features of Patau syndrome?
Face—>Hand–>thorax with abdomen—>lower limb
Face shows small eye with small head Or holoprosencephaly
Hands shows more than 5 fingers
Cardiac with Renal defects and Umbilical hernia / Omphalocele
Rocker bottom feet
Name the drugs which has positive urine drug test even though patient not used amphetamine
Bb like atenolol Or propanolol
Bupropion
Nasal decongestant
Name the drugs which has positive urine drug test even though patient not used phencyclidine
Dextromethorphan
Diphenhydramine
Doxylamine
Ketamine
Tramadol
Venlafaxine
Name the drugs which has positive urine drug test even though patient not used cannabis and natural opioids
If CANNABIS:
Hemp containing food
If Natural OPIOID:
Poppy seeds
