Tox

Question 1

Activated charcoal doesn’t bind

Answer 1

lithium, iron, potassium
cyanide and alcohol only weakly

Question 2

Drugs that can be dialysed

Answer 2

antiepileptic, lithium, ethylene glycol, methanol, metformin, salicylate, theophyline

Question 3

Drugs that can’t be dialysed

Answer 3

amphetamines, antipsychotics, antidepresants, digoxin, benzos, CCBs, metoprolol, opioids

Question 4

Flumazenil

Answer 4

benzo OD - not if seizures, benzo dependence or TCA OD

Question 5

fomepizole

Answer 5

alcohol dehydrogenase inhibitor
use methanol and ethalyne glycol OD

Question 6

Physostigmine

Answer 6

treatment anticholinergic delerium

Question 7

pralidoxime

Answer 7

treatment organophosphate poisoning with atropine

Question 8

Sodium bicarb use

Answer 8

TCA + T1a 1c antarrhytmic OD
Alkalinisation urine e.g. aspirin OD
tx metabolic acidosis e.g. cyanide, ethyline glycol
inc urinary solubility drug e.g. methotrexate

Question 9

contraindications sodium bicarb

Answer 9

hypokalaemia, hypocalcaemia, alkalosis

Question 10

dimercaprol

Answer 10

treatment OD arsenic, lead, mercury

Question 11

d penicillamine

Answer 11

tx OD copper

Question 12

EDTA

Answer 12

tx OD lead

Question 13

ammonium chloride

Answer 13

tx amphetamine OD by acidifying urine

Question 14

MAOI OD

Answer 14

inc BP
serotonin syndrome with SSRI

Question 15

Aspirin OD

Answer 15

200mg/kg
resp alkalosis, then high anion gap metabolic acidosis
hyperthermia from uncoupling oxidative phosphorylation
tx aggressive decontamination, bicarb, haemodialysis

Question 16

Cyanide signs OD

Answer 16

almond breath
SOB, agitation, , inc HR, seizures , coma
high O2 VBG as not taken up by cell
binds cytochrome oxidase in cell stopping O2 use –> lactic acidosis

Question 17

Treatment cyanide OD

Answer 17

charcoal
amyl + sodium nitrite -> metamoglobin -> cyanometHb
Na thiosulphate -> thiocyanate
hydroxycobalamin -> cyanocobalamin

Question 18

Ethelyne glycol byproducts

Answer 18

hippuric acid
oxalic acid
glycolic acid

Question 19

Metanol byproduct

Answer 19

formic acid (blindness)

Question 20

Theophyline toxicity

Answer 20

inc with cimetidine, ciprofloxacin and erythromycin
inc HR, dec BP, dec K, inc BSL, seizures
tx beta blockers and phenobarbital best anti seizure

Question 21

Cocaine

Answer 21

blocks presynaptic catecholamine reuptake
CNS inhibits dopamine reuptake

Question 22

Paraquat

Answer 22

herbicide
single electron reduction to free radicals
haematemesis bloody stools
lung lesions - oxygen can make worse
delayed death 1-2 weeks

Question 23

Treatment sulfonylurea OD

Answer 23

octreotide

Question 24

Defurroxime

Answer 24

for iron overload
increases risk Yersinia infection

Question 25

Rate limiting step alcohol metabolism

Answer 25

Alcohol dehydrogenase

Question 26

Symptoms wernickes encephalopathy

Answer 26

Confusion
Ophthalmoplegia
Ataxia