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Clinical Medicine LAB - Professor Sample > Psych/ Neuro I > Flashcards

Psych/ Neuro I Flashcards

1
Q

_________ weight/volume not considered intoxicated

A

< 0.05%

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2
Q

Salicylate OD tx: Correction of acid-base disturbances

by ?

A

IV crystalloid solution

Sodium bicarbonate

Hemodialysis

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3
Q

Acetaminophen notes ?

A

Antipyretic and analgesic -> works at CNS level not peripheral

Since at CNS it has very limited anti-inflammatory effects

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4
Q

When is a Urine toxicology (UTOX) used ?

A

Pt with altered mental status

Determining capacity to make decisions

Before giving meds to certain patients

Legal implications

Psych evaluations

** anxious depressed suicide, want to make sure they dont have a drug addiction problem and make sure there is not a drug causing the psychosis and we need to know what is in there system before labs are run **

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5
Q

Nomogram for prediction ?

A

of acetaminophen hepatotoxicity following acute overdosage.

**assume a one time large scale ingestion of acetaminophen
helps you decide if you need to treat them with NAC or not

5 hours at 30 is not toxic

grey area inbetween the two line : in grey grey area and above we treat it

rule of 150 with acetaminophen**

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6
Q

Phenytoin caution ?

A

renal failure patients

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7
Q

When is ETOH used ?

A

To determine the blood alcohol content

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8
Q

Lithium: Therapeutic range ______ mmol/L

A

0.6 - 1.2

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9
Q

Lithium OD tx: Gastric Lavage within _ hr

A

1

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10
Q

THC intoxication sxs: Acute ?

A

relaxation, mild euphoria, resembles mild to moderate ETOH intox

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11
Q

Acetaminophen (APAP) molecule ?

A

N-Acetyl-Para-AminoPhenol (APAP)

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12
Q

Valproic Acid is used as a ?

A

psych med (i.e. Bipolar),

seizure disorder, and

migraine med

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13
Q

THC intoxication sxs: Chronic ?

A

associated with “amotivational syndrome” and maturational dysfunction

Harrison’s Ch. 394

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14
Q

Cocaine UTOX detects what ?

A

Benzoylecgonine (Benzo-lek-GO-neen)

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15
Q

Tylenol metabolism is mostly by the ______ ( mi=ostly effects the liver)

A

liver

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16
Q

Acetaminophen OD may be ______ in early ingestion or have _____ ?

A

asxs.

A/N. RUQ pain

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17
Q

Opiates UTOX how long does it last ?

A

2 hrs – 3 days

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18
Q

Phenytoin trade ?

A

Dilantin

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19
Q

Lithium: May cause ?

A

kidney disease (monitor BUN and creatinine)

hypothyroidism (monitor TSH)

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20
Q

Poison help # ?

A

1-800-222-1222

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21
Q

______ is considered intoxicated in most states

A

> 0.10%

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22
Q

Lithium is a _____________ that does not bind to charcoal; therefore, activated charcoal has NO role

A

monovalent cation

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23
Q

What is Ethanol (ETOH) ?

A

Serum test showing the level of alcohol in the blood

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24
Q

Opiates Intoxication sxs. ?

A

Somnolence, dysarthria, euphoria

Respiratory depression
OD and stop breathing

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25
Salicylate OD: Toxicity occurs at levels ? And serum levels of what are significant ?
>150 mg/kg (that is ingested) Serum levels >30 mg/dL are significant
26
Caveat: This scale assumes a ___________ ingestion. It does not account for ________ overdose or comorbidities such as liver failure
SINGLE LARGE chronic
27
Lithium OD tx: Fluids for what ?
to enhance elimination
28
The total phenytoin reference range varies by age: Toxic phenytoin levels are defined as greater than ?
30 µg/mL
29
Opiates OD tx ?
OD: give them narcan they wake up and they are angry have N and they want to fight does not have the sedating properties that other opioids have ( so you can give alot of it ) it is still an opioid has a higher affinity and is a bigger molecule than the opioids to the Mu receptors
30
Acetaminophen: Rule of 150: Give NAC at 150 mg/kg __ ?
IV 140 mg/kg PO)
31
Valproic Acid has a __________ TW ?
very narrow
32
TDM: Peak level = ?
highest concentration early on ( 30 min - 1 hours after dose is given)
33
Valproic Acid The toxic level is greater than _____ ?
150 µg/mL.
34
Salicylate OD tx ?
Charcoal early Whole bowel irrigation Correction of acid-base disturbances
35
Amphetamines UTOX lasts how long ?
3 hrs - 2 days
36
ETOH level of >100 mg/dL sxs. ?
CNS depression
37
Acetaminophen: Rule of 150: ____ mg/kg is toxic ?
150
38
Lithium OD tx: Why NO charcoal ?
Lithium is a monovalent cation that does not bind to charcoal; therefore, activated charcoal has NO role
39
Salicylate OD notes ?
150 sig. in tylenol serum 150 with ASA is only in ingested dosage can give charcoal early and full bowel irrigation if it has been hours or days - not much you can do , supportive tx . and hope for the best - monitor glucosee and acid base balance
40
TDM: Trough level = ?
lowest concentration right before next dosing ( so draw these levels right before next dose)
41
It is formed in the liver by the metabolism of cocaine ?
Benzoylecgonine (Benzo-lek-GO-neen)
42
Lithium OD tx: Gastric Lavage ?
cause charcoal does not work you need to wash stomach out and hopefully get pills with it and only within 1 hours so the pills are not broken down
43
________ in Ohio is intoxicated
>0.08%
44
THC notes ?
Significant decrements in pulmonary vital capacity found in regular daily use May precipitate angina – strongly caution those with cardiovascular disease to NOT use this substance Impaired fetal growth if used during pregnancy Rapidly develop tolerance and may smoke it more frequently ** 2 weeks sometimes in chronic, fat and hair in high levels it leakes out, the more they smoke the more it leaks into tissues and longer it stays in system **
45
Salicylate OD: early OD sxs ?
N V
46
The total phenytoin reference range varies by age: Children and adults ?
10-20 µg/mL
47
Salicylate OD: __________ is prominent in children
Hypoglycemia
48
Cocaine intoxication sxs. ?
Increased temp., enhanced mood, increased HR and BP Hyperprolactinemia, galactorrhea, amenorrhea, infertility, loss of libido (chronic) ** they are hot increased HR and BP **
49
How is ETOH tested ?
Peripheral blood in a live patient Drawn from aorta of an expired patient
50
The total phenytoin reference range varies by age: The reference range of free phenytoin is ?
1-2.5 µg/mL.
51
Above Therapeutic Range is ?
toxic
52
Lithium: Serum draw ____after last dose
12 hrs ** monitor levels in the serum!**
53
Cocaine UTOX lasts how long ?
1hr – 3 days
54
OTC meds that contain APAP
OTC medication : ASA and tylenol ( acetomenophel and sailcylates)
55
The total phenytoin reference range varies by age: Neonates ?
8-15 µg/mL
56
Lithium trade ?
Lithobid, Eskalith
57
Valproic Acid OD tx ?
ABC’s Activated charcoal if within 1 hour Whole bowl irrigation
58
Acetaminophen: Rule of 150: max dose Peds ?
75 mg/kg/day | 250 mg/kg is toxic
59
What is a Urine toxicology (UTOX) ?
Urine test to determine presence of certain substances Done from urine specimen
60
Ethanol (ETOH) is used to dx ?
intoxication
61
TDM determines _______ dose and prevents ________.
effective toxicity **cause we want to make sure they are woking and that they are in therapeutic range **
62
Phenytoin ( Dilantin) OD tx ?
ABC’s Multiple dose activated charcoal every 2-6 hours until passage of charcoal stool, loss of bowel sounds, or improved clinical condition is observed. **may have to give it more thn once **
63
Nonogram: The ________ defines serum acetaminophen concentrations known to be associated with _________ .
upper line hepatotoxicity
64
Lithium OD tx: ABC's ?
airway breathing circulation
65
Lithium has many ?
drug-drug and supplement interactions so use extreme caution
66
OTC cold meds and weight loss meds may contain ___________ ?
amphetamines
67
The _________ defines serum levels __% below those expected to cause hepatotoxicity. To give a margin for error, the lower line should be used as a ?
lower line 25% guide to treatment
68
Acetaminophen: Rule of 150: max dose adults ?
4 g/day
69
ETOH level of >80 mg/dL sxs. ?
Impaired vision Flushing Slowed reflexes
70
Amphetamines Notes ?
meth causes "dry mouth" (xerostomia), and without enough saliva to neutralize the mouth's harsh acids, those acids eat away at the tooth and gums, causing weak spots that are susceptible to cavities. sedafed , people make meth out of it side effects: anticholinergic effects dry as a bone etc… opioid use gets this tooo, need saliva for protection of teeth and gums , see this alot in heroin as well
71
Lithium OD tx ?
ABC's Gastric Lavage Fluids NEVER activated charcoal
72
Marijuana (THC) UTOX lasts how long ?
1 hr – 3 days Even passive inhalation can be detected
73
Valproic Acid trade ?
Depakene
74
ETOH level of >400 mg/dL sxs. ?
Could be fatal
75
Valproic Acid may cause
liver disease so monitor LFT **this one we want to monitor LFTs**
76
Valproic Acid: The therapeutic range for valproic acid (total) is _________
50-125 µg/mL. * *(Note some will report “free” levels so use caution when interpreting) * *
77
Phencyclidine (PCP) UTOX how long does it last ?
6 hrs – 3 days
78
Below Therapeutic Range is ?
ineffective
79
___________ is antidote if indicated for APAP OD ?
N-acetylcysteine NAC ** if they come in after a while they they will gove them NAC - it inactivated they bad problems tylenol causes in the liver **
80
Use the ________________ nomogram to predict level of Acetaminophen toxicity
Rumack-Matthew
81
Lithium: Has a ___________ therapeutic window
very narrow
82
very drunk people live in the ???
200 range
83
ASA - metabolism mostly by the ________ ( why you get acid base disturbances with is OD)
kidneys
84
Therapeutic drug monitoring (TDM) measures ______ drug levels
blood
85
ETOH critical values ?
>300
86
Lithium is used as ?
psych med (i.e. Bipolar)
87
Phenytoin used as ?
abortive and preventive medication in seizure management
88
Phencyclidine (PCP) is NL used as a ?
Vet tranquilizer
89
Benzoylecgonine can also bet detected in blood for what ?
to give exact last time of use
90
Salicylate OD: ________ Alkalosis is replaced with a severe ________ acidosis
respiratory metabolic
91
Phencyclidine (PCP) intoxication sxs. ?
Horizontal/vertical nystagmus Disorganized thoughts/distorted body image Anxiety, paranoia, hallucinations Dysarthria Acute psychosis **Wu tang - anderson - cut penis off and jump off building, this is super bad, they get super strong cause they do not feel pain, they are out of there minds **
92
The total phenytoin reference range varies by age: Lethal levels are defined as greater than ?
100 µg/mL
93
Amphetamines SEVERE intoxication sxs ?
HTN arrhythmia SAH CVA coma
94
Acetaminophen OD ______ is given early
Activated charcoal * *charcoal will bind to tylenol and inactivate it and make it not cause damage - * *
95
Amphetamines Intoxication sxs. ?
Euphoria, decreased fatigue ( can stay up for days )
96
Acetaminophen: Rule of 150: Give NAC is level is >____ mag/ml _ hrs post ingestion
150 4

Clinical Medicine LAB - Professor Sample (36 decks)

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