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FAMILY MEDICINE > Poisons and Antidotes > Flashcards

Poisons and Antidotes Flashcards

1
Q

What is poisoning

A

Poisoning is contact with a substance that results in toxicity

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2
Q

Causes of poisoning

A

Ingestion or exposure to poisonous substances
Young children mostly out of curiosity
Elderly due to confusion, poor sight, mental impairment, multiple prescriptions.
Suicide
Homicide or disabling/raping
Munchhausen syndrome by proxy

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3
Q

Pathogenesis

A

GIT - Liver - Kidney
Some form bezoars

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4
Q

List of anticholinergic symptoms

A

Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium

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5
Q

Causes of anticholinergic symptoms

A

Antihistamines, Atropine, Belladonna Alkaloids, Jimson weed Mushrooms (some), Psychoactive drugs (many), Scopolamine Tricyclic antidepressants

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6
Q

List of cholinergic muscarinic symptoms

A

SLUDGE syndrome (Salivation, Lacrimation, Urination, Defecation, GI cramps and emesis),
Miosis
Bronchorrhea,
wheezing,
bradycardia

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7
Q

Causes of cholinergic muscarinic symptoms

A

Carbamates
Mushrooms (some) Organophosphates
Physostigmine
Pilocarpine
Pyridostigmine

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8
Q

List of cholinergic nicotinic symptoms

A

Tachycardia,
hypertension,
fasciculations,
Abdominal pain,
paresis

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9
Q

Causes of cholinergic nicotinic

A

Black widow spider bites, Carbamates Insecticides (some) Nicotine

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10
Q

Sympathomimetic symptoms

A

Tachycardia, hypertension, mydriasis, agitation, seizures, diaphoresis, hyperthermia, psychosis (after chronic use

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11
Q

Causes of Sympathomimetic poisoning

A

Amphetamines
Caffeine
Cocaine
Ephedrine
MDNA
Phenylpropanolamine
Theophylline

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11
Q

List of withdrawal symptoms

A

Tachycardia
Hypertension
Mydriasis
Restlessness
Seizures
Hyperreflexia
Piloerection
Yawning
Abdominal cramps
Lacrimation
Hallucination

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12
Q

Substances that can lead to withdrawal symptoms

A

Alcohol
Barbiturates
Benzodiazepines
Opioids
Sedative

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13
Q

Opioid symptoms

A

Hyperventilation
Hypotension
Miosis
Sedation
Possibly
Hypothermia

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14
Q

List of available opioids

A

Diphenoxylate
Fentanyl
Heroin
Methadone
Morphine
Pentazocine
Propoxyphene

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15
Q

General Mgt of Poisoning Hxs

A

An informant in children, suicidal, comatose or psychotic pt
Rescue personnel
PMH
Drug and substance use
FH/ SH/ Psychiatric hxs

16
Q

General Mgt of Poisoning PE

A

General exams
Check for signs suggestive of particular types of substance
Toxidromes
Breath odour
Needle tracts
Stigmata of chronic alcohol use

17
Q

General Mgt of Poisoning Investigation

A
  1. Blood levels in PCM, ASPIRIN
  2. Altered consciousness or abnormal vital signs do BUN, Serum Osmolality, Plasma Glucose and ABG
  3. Plain abd xray in body packers - iron, lead, arsenic or metals, packs of cocaine et all
  4. ECG and Cardiac monitoring
  5. Investigate for a bezoar
18
Q

General mgt - Tx

A

Initial stabilization:
General overview+ ABC
Airway- intubate
Breathing - Supplemental oxygen or mechanical ventilation
Circulation - IVF, Blood
Altered consciousness check RBS, IF low- IV dextrose 50mls of 50% A, 2-4mls/kg of 25%.
Hypotension: IVF, Vasopressors norepinephrine 0.5 -1 ug IV

19
Q

General tx - others

A

Topical decontamination: Large amount of H20 or Saline
Activated Charcoal: 1-2g/kg C or 50-100g in A. 4-6hrly as a slurry in water or soft drinks. Adsorption, consider NG tube.
Gastric emptying: via gastric lavage within 1 hr of a life-threatening ingestion. Risk of pneumonitis in caustic subs ingestion. Ipecac

Whole bowel irrigation: flushes the Git, decrease transit time for pills and tablets. Sustained released preparations, heavy metals pack of cigarette or suspected bezoar.

Give polyethylene glycol and electrolyte at 1-2l A, 25-40mll/kg/hr

Til clear effluent

20
Q

Supportive measures

A

Allaying anxiety
TC of hypotension/ Hyper
Tx of hypothermia and hyper
Tx arrhythmias

21
Q

Acetaminophen poisoning

A

N-acetyl -p- benzo quinone imitation is the toxic metabolite.
Produced by cytochrome p450 and detoxified by glutathione in the liver.
Toxic dose 7.5g/15 tabs a day

22
Q

Stages of acute alcohol overdose1 - >244

A

Stage 10-24 hrs anorea, nausea, vomiting.
24-72 heaRUQ pain, ASLT, ALT, BIlirubin, and PT elevated
72- 96 hrs vomiting and symptoms of hepatic failure, ast, alt,

FAMILY MEDICINE (9 decks)

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