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Poision Flashcards

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1
Q

Triad Of Arsenic Poisoning

A

Garlic breath with watery diarrhea

Prolong QTC

Depigmentation with stock glove neuropathy

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2
Q

How to dx and manage Arsenic Poisoning?

A

Dx through urine arsenic levels

Tx::Dimercaprol / DMSA

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3
Q

Classification of Hypothermia

A

Mild (35-32’c)with tachycardia And tachypnea / increased shivering

Moderate ( 32-28’c) bradycardia with decrease shivering

Severe (<28’c) coma / ventricular arrthymia

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4
Q

How to t/m Hypothermia in General?

A

Warm IV fluids for low BP

ETT if comatose patient

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5
Q

How to manage mild Hypothermia?

A

Passive external warming that is remove wet clothing And the patient body is cover with blanket

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6
Q

How to manage moderate Hypothermia?

A

Active external warming that is warm blanket with heating pads and warm bath

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7
Q

How to manage severe Hypothermia?

A

Active internal rewarming that is warm pleural Or peritoneal irrigation

Warm humidified O2

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8
Q

How acidosis occur in Hypothermia?

A

Meta-acidosis due to decrease tissue perfusion

Resp Acidosis due to hypoventilation

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9
Q

How azotemia and hyperkalemia occur in Hypothermia?

A

Azotemia due to decrease renal perfusion

Hyperkalemia due to cell lysis

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10
Q

How hyperglycemia and low wbc/PLTs occur in Hypothermia?

A

High glucose due to loss of insulin effect esp in temp less than 30*c
Low wbc/PLTs due to splenic squestration

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11
Q

How high Hematocrit and coagulopathy occur in Hypothermia?

A

High Hematocrit due to hemoconcentration

Coagulopathy due to impaired coagulation pathway

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12
Q

How lipase level increased in Hypothermia?

A

Cold induced pancreatitis

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13
Q

What to do if patient have persistent Hypothermia despite giving IV warm fluid?

A

IV fluids and rewarming ineffective in restoring normal BP—> inotropic support with dopamine

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14
Q

Triad of Heat Exhaustion

A

Body temp less than 104’F

Not significant CNS dysfunction

Loss of fluid and electrolytes with physical activity leads to Exhaustion

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15
Q

Triad of MARIJUANA

A

Conjunctival injection with Slow reaction time

affecting the ability to operate automobiles and increasing the risk of motor vehicle accidents.

Increased appetite

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16
Q

Triad of methanol ketoacidosis

A

High osmole gap with high anion gap

Visual SxS

Alter mental status

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17
Q

Lab finding of alcohol ketoacidosis

A

High osmole gap with high anion gap

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18
Q

Triad of ETHYLENE GLYCOL POISONING

A

High osmole gap with high anion gap

Renal Sxs with stones

Neuro Sxs like cranial nerve palsy / tetani

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19
Q

Triad of Isopropyl alcohol ingestion

A

High osmole gap without anion gap

CNS depression

Disconjugate gate with absent ciliary reflex

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20
Q

How FLUPHENAZINE cause HYPOTHERMIA?

A

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

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21
Q

Triad of PCP

A

Multidirectional nystagmus

Ataxia

Aggressive behavior

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22
Q

Important point of opioid treatment

A

Methadone and buprenorphine—long acting opioid agonists not used in acute intoxication rather used for withdrawal

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23
Q

What are the reliable SxS of Opioid intoxication?

A

Bradycardia with low BP and low RR

Decrease Bowel sound with Hypothermia due to histamine

Miosis but not so reliable

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24
Q

What is treatment of choice for lithium intoxication?

A

Hemodialysis is the treatment choice for severe lithium toxicity because it is the most dialyzable toxin.

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25
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)
26
Important point of DIPHENHYDRAMINE
Antihistamine as well as anticholinergic properties
27
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
28
What ABGs changes occur in iron poisoning?
Anion gap metabolic acidosis
29
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
30
How to t/m severe lead poisoning?
Level more than 70mcg/dl | Give Dimercaprol plus EDTA
31
How to t/moderate lead poisoning?
Level 45-69mcg/dl | Give DMSA
32
How to t/m mild lead poisoning?
Level 4-44mcg/dl No treatment Repeat level of lead in a month
33
Triad of METHEMOGLOBINEMIA
cyanosis bluish discoloration of skin and mucous membranes Mimics to CO Poisoning
34
Triad of cyanide poisoning
metabolic acidosis Bitter almond breath is characteristic Markedly elevated lactate (typically >10 mEq/L)
35
Name the high potency Anti psychotic medication | Remember (HTF)
Haloperidol TriAuoperazine Fluphenazine more neurologic side effects (eg, extrapyramidal symptoms [EPS)).
36
Name the low potency first generation antipsychotic
Chlorpromazine Thioridazine (anticholinergic, antihistamine, Alpha-blockade effects)
37
What are the ophthalmologic complications of first generation antipsychotic?
Chlorpromazine-Corneal deposits Thioridazine-reTinal deposits.
38
How to t/m acute dystonia due to antipsychotic?
benztropine diphenhydramine.
39
How to t/m Akathisia (restlessness) and Parkinsonism (bradykinesia)?
Both with benztropine In case of Akathisia ——> benzodiazepines In case of Parkinsonism—-> amantadine
40
How to t/m Tardive dyskinesia?
atypical antipsychotics (eg, clozapine) valbenazine deutetrabenazine.
41
What are the atypical antipsychotic?
Aripiprazole asenapine clozapine olanzapine quetiapine iloperidone paliperidone risperidone lurasidone ziprasidone.
42
Name the atypical antipsychotic causing hyperprolactinemia
Risperidone
43
Important point of clozapine
Use clozapine for treatment-resistant schizophrenia or schizoaffective disorder and for suicidality in schizophrenia.
44
What is the MOA of Buspirone and use of it?
Stimulates serotonin receptors. Use in GAD
45
Name the d/f SSRI
Fluoxetine fluvoxamine paroxetine sertraline escitalopram citalopram.
46
What are the clinical uses of SSRI? ABPD
Anxiety disorder bulimia binge-eating disorder PTSD /premature ejaculation / premenstrual dysphoric disorder. Depression
47
What are the specific S.E of SSRI?
SIADH sexual dysfunction
48
Important point
If depression patient develop HTN think of SNRI
49
What are the d/f SNRI?
Venlafaxine desvenlafaxine duloxetine levomilnacipran milnacipran.
50
Name the substance causing lithium toxicity
In acute case overdose of lithium Or In chronic condition causing dehydration / ACEI, NASIDs, Thiazide diuretic
51
Name the medication given for extra pyramidal SxS Occur due to antipsychotic
Acute dystonia --->Benztropine / diphenhydramine Akathasia ---->BB / benzo / Benztropine Parkinsonism---->Benztropine/amantadine
52
Triad of Ectasy (MDMA//Molly)
Sxs like Serotonin syndrome with low sodium and Amphetamine
53
Important point::
Inhalants are depressive Bath salts are synetic amphetamine; it also leads to Serotonin syndrome
54
In which condition Succinylcholine avoided?
Hyperkalemia condition like GBS, tumor lysis syndrome Rhabdomyolysis Burns *in case of deranged LFT use low dose of drug
55
What are the consequences of high voltage Electrical injuries?
Rnhabdomylosis Heme pigment induced AKI Acute compartment syndrome from intra compartmental muscle swelling
56
How to Rx high voltage electrical injuries?
Potassium sparing IV fluid as muscles injury result hyperkalemia
57
What are the common features of Neuroleptic malignant syndrome and serotonin syndrome?
Both show AMS, increase body temperature and autonomic dysregulation
58
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
59
What are the SxS of organophosphate poisoning?
Narrow pupil Excessive lacrimation and salivation Bronchospasm with low HR Excessive emesis and diarrhoea Lots of urine
60
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
61
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 > 106*f (41.1*c) —> stat sedation, paralysis and tracheal intubation
62
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
63
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
64
How Tetrahydrocannabinol poisoning present?
increase appetite with red reflex and slowed reflex
65
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.
66
Name the Antihistamine and Anti Parkinson meds showing Anti cholinergic properties
Anti Histamine:: Diphenhydramine and Cyproheptadine Anti Parkinson:: Benztropine and Trihexyphenidyl
67
Name the Psychotropics meds showing Anti cholinergic properties
1st Generation----> Chlorpromazine and Haloperidol 2nd Generation----> Clozapine TCA like Amitriptyline and Clomipramine
68
Name the plant based which showing Anti cholinergic properties
Jimsonweed Nightshade species Muscarinic mushroom species
69
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
70
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
71
How to treat Comedonal acne? Located at nose, forehead and chin Remember GAS
Topical retinoids like Glycolic acid, Azelaic, Salicylic
72
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
73
How to manage moderate, severe and unresponsive Nodular (cystic) acne?
Moderate----> topical (ABx + benzoyl peroxide) + topical ABx Severe ----> add oral Abx Unresponsive----> Oral isotretinoin
74
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
75
How to manage DELIRIUM pharma?
Reduce pain but use non opioid Off label use of antipsychotic If still in delirium then use of benzo
76
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
77
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
78
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
79
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
80
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)
81
``` 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
82
What are the withdrawal sxs of Opioid?
Eye ---> lacrimation and pupil dilated Mouth---> yawing Bowel---> hyperactive Penis---> piloerection
83
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
84
How to manage BB toxicity?
First secure airway Along with IV fluid infusion Not response---->.IV atropine Not response--------> IV glucagon.
85
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
86
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)
87
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
88
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
89
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
90
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
91
Name the drugs which has positive urine drug test even though patient not used amphetamine
Bb like atenolol Or propanolol Bupropion Nasal decongestant
92
Name the drugs which has positive urine drug test even though patient not used phencyclidine
Dextromethorphan Diphenhydramine Doxylamine Ketamine Tramadol Venlafaxine
93
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

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