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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
Q

Salicylate OD: Toxicity occurs at levels ? And serum levels of what are significant ?

A

> 150 mg/kg (that is ingested)

Serum levels >30 mg/dL are significant

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26
Q

Caveat: This scale assumes a ___________ ingestion. It does not account for ________ overdose or comorbidities such as liver failure

A

SINGLE LARGE

chronic

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27
Q

Lithium OD tx: Fluids for what ?

A

to enhance elimination

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28
Q

The total phenytoin reference range varies by age: Toxic phenytoin levels are defined as greater than ?

A

30 µg/mL

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29
Q

Opiates OD tx ?

A

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

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30
Q

Acetaminophen: Rule of 150: Give NAC at 150 mg/kg __ ?

A

IV

140 mg/kg PO)

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31
Q

Valproic Acid has a __________ TW ?

A

very narrow

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32
Q

TDM: Peak level = ?

A

highest concentration

early on ( 30 min - 1 hours after dose is given)

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33
Q

Valproic Acid The toxic level is greater than _____ ?

A

150 µg/mL.

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34
Q

Salicylate OD tx ?

A

Charcoal early

Whole bowel irrigation

Correction of acid-base disturbances

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35
Q

Amphetamines UTOX lasts how long ?

A

3 hrs - 2 days

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36
Q

ETOH level of >100 mg/dL sxs. ?

A

CNS depression

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37
Q

Acetaminophen: Rule of 150: ____ mg/kg is toxic ?

A

150

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38
Q

Lithium OD tx: Why NO charcoal ?

A

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

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39
Q

Salicylate OD notes ?

A

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
Q

TDM: Trough level = ?

A

lowest concentration

right before next dosing ( so draw these levels right before next dose)

41
Q

It is formed in the liver by the metabolism of cocaine ?

A

Benzoylecgonine (Benzo-lek-GO-neen)

42
Q

Lithium OD tx: Gastric Lavage ?

A

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
Q

________ in Ohio is intoxicated

A

> 0.08%

44
Q

THC notes ?

A

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
Q

Salicylate OD: early OD sxs ?

A

N V

46
Q

The total phenytoin reference range varies by age: Children and adults ?

A

10-20 µg/mL

47
Q

Salicylate OD: __________ is prominent in children

A

Hypoglycemia

48
Q

Cocaine intoxication sxs. ?

A

Increased temp., enhanced mood, increased HR and BP

Hyperprolactinemia, galactorrhea, amenorrhea, infertility, loss of libido (chronic)

** they are hot increased HR and BP **

49
Q

How is ETOH tested ?

A

Peripheral blood in a live patient

Drawn from aorta of an expired patient

50
Q

The total phenytoin reference range varies by age: The reference range of free phenytoin is ?

A

1-2.5 µg/mL.

51
Q

Above Therapeutic Range is ?

A

toxic

52
Q

Lithium: Serum draw ____after last dose

A

12 hrs

** monitor levels in the serum!**

53
Q

Cocaine UTOX lasts how long ?

A

1hr – 3 days

54
Q

OTC meds that contain APAP

A

OTC medication : ASA and tylenol ( acetomenophel and sailcylates)

55
Q

The total phenytoin reference range varies by age: Neonates ?

A

8-15 µg/mL

56
Q

Lithium trade ?

A

Lithobid, Eskalith

57
Q

Valproic Acid OD tx ?

A

ABC’s

Activated charcoal if within 1 hour

Whole bowl irrigation

58
Q

Acetaminophen: Rule of 150: max dose Peds ?

A

75 mg/kg/day

250 mg/kg is toxic

59
Q

What is a Urine toxicology (UTOX) ?

A

Urine test to determine presence of certain substances

Done from urine specimen

60
Q

Ethanol (ETOH) is used to dx ?

A

intoxication

61
Q

TDM determines _______ dose and prevents ________.

A

effective

toxicity

**cause we want to make sure they are woking and that they are in therapeutic range **

62
Q

Phenytoin ( Dilantin) OD tx ?

A

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
Q

Nonogram: The ________ defines serum acetaminophen concentrations known to be associated with _________ .

A

upper line

hepatotoxicity

64
Q

Lithium OD tx: ABC’s ?

A

airway breathing circulation

65
Q

Lithium has many ?

A

drug-drug and supplement interactions so use extreme caution

66
Q

OTC cold meds and weight loss meds may contain ___________ ?

A

amphetamines

67
Q

The _________ defines serum levels __% below those expected to cause hepatotoxicity. To give a margin for error, the lower line should be used as a ?

A

lower line

25%

guide to treatment

68
Q

Acetaminophen: Rule of 150: max dose adults ?

A

4 g/day

69
Q

ETOH level of >80 mg/dL sxs. ?

A

Impaired vision

Flushing

Slowed reflexes

70
Q

Amphetamines Notes ?

A

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
Q

Lithium OD tx ?

A

ABC’s

Gastric Lavage

Fluids

NEVER activated charcoal

72
Q

Marijuana (THC) UTOX lasts how long ?

A

1 hr – 3 days

Even passive inhalation can be detected

73
Q

Valproic Acid trade ?

A

Depakene

74
Q

ETOH level of >400 mg/dL sxs. ?

A

Could be fatal

75
Q

Valproic Acid may cause

A

liver disease

so monitor LFT

this one we want to monitor LFTs

76
Q

Valproic Acid: The therapeutic range for valproic acid (total) is _________

A

50-125 µg/mL.

  • *(Note some will report “free” levels so use caution when interpreting)
  • *
77
Q

Phencyclidine (PCP) UTOX how long does it last ?

A

6 hrs – 3 days

78
Q

Below Therapeutic Range is ?

A

ineffective

79
Q

___________ is antidote if indicated for APAP OD ?

A

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
Q

Use the ________________ nomogram to predict level of Acetaminophen toxicity

A

Rumack-Matthew

81
Q

Lithium: Has a ___________ therapeutic window

A

very narrow

82
Q

very drunk people live in the ???

A

200 range

83
Q

ASA - metabolism mostly by the ________ ( why you get acid base disturbances with is OD)

A

kidneys

84
Q

Therapeutic drug monitoring (TDM) measures ______ drug levels

A

blood

85
Q

ETOH critical values ?

A

> 300

86
Q

Lithium is used as ?

A

psych med (i.e. Bipolar)

87
Q

Phenytoin used as ?

A

abortive and preventive medication in seizure management

88
Q

Phencyclidine (PCP) is NL used as a ?

A

Vet tranquilizer

89
Q

Benzoylecgonine can also bet detected in blood for what ?

A

to give exact last time of use

90
Q

Salicylate OD: ________ Alkalosis is replaced with a severe ________ acidosis

A

respiratory

metabolic

91
Q

Phencyclidine (PCP) intoxication sxs. ?

A

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
Q

The total phenytoin reference range varies by age: Lethal levels are defined as greater than ?

A

100 µg/mL

93
Q

Amphetamines SEVERE intoxication sxs ?

A

HTN

arrhythmia

SAH

CVA

coma

94
Q

Acetaminophen OD ______ is given early

A

Activated charcoal

  • *charcoal will bind to tylenol and inactivate it and make it not cause damage -
  • *
95
Q

Amphetamines Intoxication sxs. ?

A

Euphoria,

decreased fatigue ( can stay up for days )

96
Q

Acetaminophen: Rule of 150: Give NAC is level is >____ mag/ml _ hrs post ingestion

A

150

4

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