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Tox Flashcards

1
Q

ethylene glycol

A

(antifreeze)
toxidrome: metabolizes to glycolic / oxalic acids -> renal failure
antidote: fomepizole or ethanol, HD + mag/ca/pyridoxine (B6)

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1
Q

hydrofluoric acid

A

calcium, mag

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2
Q

isoniazid

A

pyridoxine (B6)

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3
Q

methanol

A

windshield washer / moonshine
toxidrome: metabolizes to formic acid (can cause blindness)
antidote: fomepizole or ethanol, HD; folic acid

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4
Q

TCA

A

sodium bicarb

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5
Q

beta blocker

A

glucagon, calcium, insulin, intralipids

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6
Q

CCB

A

calcium, glucagon, insulin, intralipids

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7
Q

heavy metals

A

BAL, then EDTA

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8
Q

iron

A

toxidrome:
stage 1: GI sxs (0-6hrs)
stage 2: quiescent phase (6-24hrs) labs worsen
stage 3: shock, metabolic acidosis, organ failure (24-72hrs)
stage 4: liver failure (48-96hrs)
stage 5: gastric strictures (2-8 weeks)
tx: deferoxamine (level b/w 350-500), whole bowel irrigation

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9
Q

cyanide

A

hydroxycobalamin, sodium nitrate, amyl nitrate, sodium thiosulfate

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10
Q

wernicke vs korsakoff

A

wernickes: ophthalmoplegia, gait disturbance, AMS
korsakoffs: confabulation, amnesia, apathy/lack of insight

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11
Q

isopropanol

A

metabolized to acetone
-no acidosis
-fruity odor

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12
Q

acetaminophen

A

NAPQI is toxic metabolite -> depletes glutathione
toxic dose = 150mg/kg (7-10g in adult)
stage 1: N/V (0-24h)
stage 2: RUQ pain, transaminitis, INR inc (24-48hr)
stage 3: encephalopathy, jaundice, organ failure (72-96h)
transplant if: pH <7.3, Cr >3, INR >3, encephalopathy

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13
Q

NSAIDS

A

HD for massive poisonings

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14
Q

salicylates

A

aspirin, wintergreen, pepto bismol
uncouples oxidative phosphorylation
toxidrome:
acute: hyperthermia, tinnitus, N/V
chronic: confusion, dehydration
-mixed resp alkalosis with metabolic acidosis
antidote: HD for acute >100, chronic >60

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15
Q

anticholinergics

A

red as a beet, dry as a bone, blind as a bat (large pupils/mydriasis)
jimson weed, antihistamines
antidote: supportive care w/ benzos, physostigmine (careful)

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16
Q

TCA

A

amitriptyline, desipramine
-tachy, seizure, acidosis, QRS widening (Na channel blockage), hypotension
antidote: sodium bicarb (want serum pH 7.45-7.55), benzos

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17
Q

MAOI

A

isocarboxazid, phenelzine, selegiline, and tranylcypromine
hypertension -> hypotension
think serotonin syndrome too

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18
Q

aminoglycosides

A

ototoxicity, nephrotoxicity, prolonged neuromuscular blockade

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19
Q

cephalosporins

A

crystalluria, prolonged bleeding time

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20
Q

chloamphenicol

A

grey baby syndrome

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21
Q

dapsone

A

methemoglobinemia, hemolysis if G6PD

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22
Q

ethambutol

A

optic neuritis, peripheral neuropathy

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23
Q

isoniazid

A

seizures (gaba inhibition), methemoglobinemia, inhiits CYP450
antidote: pyridoxine (B6)

24
Q

macrolides

A

QT prolongation

25
Q

metronidazole

A

disulfiram-like reaction w/ ethanol

26
Q

nitrofurantoin

A

methemoglobinemia w/ G6PD

27
Q

quinolones

A

QT prolongation, tendinopathy

28
Q

rifampin

A

CYP450 inducer (decreases other drug potencies), dark urine

29
Q

sulfonamides

A

photosensitivity, methemoglobinemia in G6PD, SJS

30
Q

vanco

A

ototoxicity, nephrotoxicity, red man syndrome -> benadryl, slow rate

31
Q

quinines

A

hypokalemia

32
Q

primaquine

A

induces methemoglobin

33
Q

phenothiazines (chlorpromazine, prohclorperazine)

A

similar to TCAs -> QRS widening, prolonged QT
movement disorders

34
Q

haldol/droperidol

A

dystonia
NMS: rigidity, hyperthermia, rhabdo, death
tx w/ cooling, benzos, intubation (no dantrolene)

35
Q

carbon monoxide

A

most common cause of poisoning death worldwide
HA, back pain, myalgias, nausea
co-oximetry: nml <5%
hyperbaric for: LOC, carboxyhgb >25%, age >50, persistent metabolic acidosis, neurologic findings
*mimics: cyanide, methylene chloride

36
Q

digoxin

A

visual/GI sxs, hyperkalemia, AV blocks
Fab fragments

37
Q

clonidine

A

resembles opioids: miosis, resp depression, brady, hypotensive

38
Q

CCB/BB

A

BB causes hypoglycemia**
CCB causes hyperglycemia
tx: IV fluids, pressors, glucagon, calcium, high dose insulin, whole bowel irrigation

39
Q

cholinergics

A

organophosphates, carbamates
SLUDGE, bradycardia, miosis
tx: high dose atropine (20-30mg) -> titrate to end of bronchorrhea
benzos for seizures
pralidoxime -> just for organophosphates

40
Q

lead poisoining

A

anemia, chronic abd pain, wrist drop, pica, lead lines
tx: BAL (dimercaprol), IV EDTA (after BAL), oral succimer

41
Q

rodenticides

A

strychnine
-opisthotonus
vit K antagonists
-outpatient f/u of INR

42
Q

caustic acids

A

coagulation necrosis (not as deep as alkali burns)
hydrofluoric acid:
dermal = topical calcium gluconate vs intra-arterial calcium gluconate
ingestion = NGT aspiration, Ca/Mag into NGT to bind acid

43
Q

caustic alkalis

A

liquefactive necrosis

44
Q

hydrocarbons

A

destroys surfactants
lower viscosity = more dangerous
acute: VT -> treat with beta blockers **

45
Q

inhaled irritants

A

chlorine: pool supplies, yellow/green gas
phosgene: fresh mown hay -> converted to hydrochloric acid in lungs
*ARDS
inhaled sodium chloride

46
Q

local anesthestics

A

toxic doses:
lido: 4mg/kg without epi
7mg/kg with epi
*perioral numbness
tx: intralipidsm

47
Q

marine envenomations

A

jellyfish:
-portuguese man o war: pain, muscle spasm, rhabdo
-box jellyfish: severe pain/muscle spasm, CV collapse (antidote in australia)
-irukandji syndrome: pain, muscle cramping, HA, anxiety, HTN, pulmonary edema
tx: hot water immersion, benzos/opioids
Abx for vibrio (cipro), update TDAP

48
Q

snake bites

A

crotalids aka pit vipers (arrow shaped heads, pits, single row of scales)
-local tissue injury, coagulopathy
-tx: antivenom

elapidae (coral snakes) - red on yellow kills a fellow
-neurotoxic with resp depression
-tx: antivenom / admit

49
Q

spiders

A

black widow (lactrodectus)
-abdominal spasm, HTN, priapism
-tx: benzos, opioids

brown recluse (loxosceles)
-necrotic wound
-systemic: hemolysis, DIC (less common)

50
Q

scorpions

A

centuroides (bark scorpion)
-pain, HTN, tachy, cholinergic, opsoclonus, resp weakness
-tx: supportive care, benzos/opioids, antivenom

51
Q

mushrooms

A

amanita phalloides (death cap)
-hepatotoxicity > treat with NAC

gyromitra (false morels) - like INH
-tx with B6

coprinus
-disulfiram-like reaction w/ ethanol

52
Q

Anti-muscarinic plants

A

Jimson weed, angels trumpet
-physostigmine

53
Q

cardiac glycoside plants

A

foxglove, oleander, lily of the valley
-bradycardia, hypotension, N/V, hyperK
-tx: Fab fragments

54
Q

st johns wort

A

serotonergic and weak MAOI

55
Q

serotonin syndrome

A

clonus, hyperreflexia, muscle rigidity (lower>upper)
-tx: benzos, cyproheptadine

56
Q

NMS

A

NO clonus, bradyreflexia, lead-pipe rigidity, hyperthermia
-tx: benzos, cool

57
Q

malignant hyperthermia

A

defect in ryanodine receptor which causes calcium release
-inhaled anesthetics, vigorous exercise/XS heat exposure
tx: dantrolene, 2.5mg/kg IV bolus

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