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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
macrolides
QT prolongation
25
metronidazole
disulfiram-like reaction w/ ethanol
26
nitrofurantoin
methemoglobinemia w/ G6PD
27
quinolones
QT prolongation, tendinopathy
28
rifampin
CYP450 inducer (decreases other drug potencies), dark urine
29
sulfonamides
photosensitivity, methemoglobinemia in G6PD, SJS
30
vanco
ototoxicity, nephrotoxicity, red man syndrome -> benadryl, slow rate
31
quinines
hypokalemia
32
primaquine
induces methemoglobin
33
phenothiazines (chlorpromazine, prohclorperazine)
similar to TCAs -> QRS widening, prolonged QT movement disorders
34
haldol/droperidol
dystonia NMS: rigidity, hyperthermia, rhabdo, death tx w/ cooling, benzos, intubation (no dantrolene)
35
carbon monoxide
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
digoxin
visual/GI sxs, hyperkalemia, AV blocks Fab fragments
37
clonidine
resembles opioids: miosis, resp depression, brady, hypotensive
38
CCB/BB
BB causes hypoglycemia** CCB causes hyperglycemia tx: IV fluids, pressors, glucagon, calcium, high dose insulin, whole bowel irrigation
39
cholinergics
organophosphates, carbamates SLUDGE, bradycardia, miosis tx: high dose atropine (20-30mg) -> titrate to end of bronchorrhea benzos for seizures pralidoxime -> just for organophosphates
40
lead poisoining
anemia, chronic abd pain, wrist drop, pica, lead lines tx: BAL (dimercaprol), IV EDTA (after BAL), oral succimer
41
rodenticides
strychnine -opisthotonus vit K antagonists -outpatient f/u of INR
42
caustic acids
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
caustic alkalis
liquefactive necrosis
44
hydrocarbons
destroys surfactants lower viscosity = more dangerous acute: VT -> treat with beta blockers **
45
inhaled irritants
chlorine: pool supplies, yellow/green gas phosgene: fresh mown hay -> converted to hydrochloric acid in lungs *ARDS inhaled sodium chloride
46
local anesthestics
toxic doses: lido: 4mg/kg without epi 7mg/kg with epi *perioral numbness tx: intralipidsm
47
marine envenomations
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
snake bites
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
spiders
black widow (lactrodectus) -abdominal spasm, HTN, priapism -tx: benzos, opioids brown recluse (loxosceles) -necrotic wound -systemic: hemolysis, DIC (less common)
50
scorpions
centuroides (bark scorpion) -pain, HTN, tachy, cholinergic, opsoclonus, resp weakness -tx: supportive care, benzos/opioids, antivenom
51
mushrooms
amanita phalloides (death cap) -hepatotoxicity > treat with NAC gyromitra (false morels) - like INH -tx with B6 coprinus -disulfiram-like reaction w/ ethanol
52
Anti-muscarinic plants
Jimson weed, angels trumpet -physostigmine
53
cardiac glycoside plants
foxglove, oleander, lily of the valley -bradycardia, hypotension, N/V, hyperK -tx: Fab fragments
54
st johns wort
serotonergic and weak MAOI
55
serotonin syndrome
clonus, hyperreflexia, muscle rigidity (lower>upper) -tx: benzos, cyproheptadine
56
NMS
NO clonus, bradyreflexia, lead-pipe rigidity, hyperthermia -tx: benzos, cool
57
malignant hyperthermia
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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