Poisoning

Question 1

List some common UK poisions

Answer 1

Paracetamol

Hypnotics (diazepam, zopiclone)

Salicylates

Ecstacy

Opiates

Cocaine

Question 2

List some of the things you might find on clinical examination of a patient with poisoning

Answer 2

Alcohol/solvents on the breath

Needle track marks

Blisters

UMN signs- anticholinergics

Coma

Dilated pupils- anticholinergics

Constricted pupils- opiates

Question 3

List some signs that you might see in a patient with opiate toxicity

Answer 3

Confusion, constricted pupils, hypoventilation/respiratory depression, respiratory acidosis

Question 4

What is a classical ECG finding in a patient with digoxin toxicity?

Can you spot it on this ECG?

Answer 4

The reverse tick- slurred ST segments with T wave inversion

Predominantly in the lateral leads

Question 5

Toxicity of what drug can present as an acute MI?

“central crushing chest pain, raised temperature, raised pulse, ST elevation”

Answer 5

Cocaine

Question 6

What is the antidote of cocaine toxicity?

Answer 6

Benzodiazepam

Question 7

What is the antidote for opiate OD?

How is this given and why?

Answer 7

Naloxone

As an IV infusion as it has a very short half life

Question 8

OD of which drug type would require administration of atropine?

Answer 8

beta blockers

Question 9

What physiological changes in the elderly can contribute to changes in PK and PD of drugs?

Answer 9

Impaired first-pass metabolism

Reduced renal clearance

Impaired hepatic clearance

Reduced homeostatic reserve

Reduced receptor sites