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EM > Tox > Flashcards

Tox Flashcards

0
Q

Toxins most frequently dialyzed

A

ASA, Li, methanol, ethylene glycol, theophylline

drugs that are dialyzable:
blist med
barbituates, lithium, inh/iron, salycilates, thophylline, methanol, ethylene glycol, depakoate

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1
Q

Multi dose activated charcoal

A

GI dialysis
For drugs w/ large volume of distribution
Theophylline, phenobarbital, carbamazepine
-Quinine, salicylates, sustained release formulas

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2
Q

Serum osm

A
  • Should be done in the setting of persistent acidosis
  • Useful if elevated
  • Difference between measured osm and calculated osm >10 is always significant.
  • Abnormal osmolal gap does NOT rule out toxic alcohol ingestion
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3
Q

Methanol metabolism

A

MeOH -(via ADH)-> formaldehyde -Aldehyde dehydrogenase)-> formic acid -(Folate cofactor)-> CO2 + H2O

causes blindness and
basal ganglia necrosis -> parkinsonian

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4
Q

Physostigmine

A
  • anticholinergic antidote
  • indications: central & peripheral effects
  • contraindications: h/o severe bronchospasm, low heart rate, abnormal cardiac conduction
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5
Q

Indication for HD in toxic alcohols

A

presence of toxic metabolites of ethylene glycol and methanol

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6
Q

drugs assoc w/ hypoglycemia

A 
Tylenol
Salicylates
Insulin
Alcohol
Oral hypoglycemics
Check a glucose on all pts w/ AMS!!
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7
Q

indications for activated charcoal

A

if ingestion occurs w/in 1 hour & a rapid deterioration is expected (eg TCAs), or if a small decrease in toxin may be critical

1-2g/kg
optimal charcoal:toxin ratio is 10:1 by weight

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8
Q

contraindications to charcoal?

A
  • Contraindicated in ingestion of HYDROCARBONS, b/c toxicity from gastric absorption not a major concern
  • Caustics, acids or alkalis - b/c tox from burns
  • Trivial ingestions
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9
Q

indications for urine alkalinization in overdose

A

salicylates, phenobarb, INH
target urine pH of 7-8
Replace K to alkalinize urine - needed for HCO3 to be excreted

NO urine acidifications or forced diuresis - don’t work!

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10
Q

indications for HD in overdose

A

water soluable, small Vd
low protein binding
low molecular weight

eg: salicylates, toxic alcohols, Li, theophylline, phenobarbital

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11
Q

antidote for tylenol

A

NAC

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12
Q

antidote for arsenic

A

NAD, DMS

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13
Q

antidote for ASA

A

alkaline diuresis w/ IV NaHCO3

hyperventilate if intubated to keep alkalotic

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14
Q

antidote for BB

A

glucagon

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15
Q

antidote for barbituate

A

alkaline diuresis, HD

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16
Q

antidote for CCB

A

Ca, glucacon, glucose/insulin

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17
Q

antidote for carbamate

A

atropine

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18
Q

antidote for CO

A

100% O2, hyperbaric O2

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19
Q

antidote for warfarin

A

FFP, Vit K

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20
Q

antidote for cyanide

A

sodium nitrite, sodium thiosulfate or

hydroxycobalamin

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21
Q

antidote for digitalis

A

digibind, fab fragments

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22
Q

antidote for ethylene glycol

A

EtOH, dialysis, 4-MP

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23
Q

antidote for heparin

A

protamine

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24
Q

antidote for hydrofluoric acid

A

Ca, Mg

25
Q

antidote for Fe

A

deferoxamine

26
Q

antidote for INH

A

Vit B6 (pyridoxine)

27
Q

antidote for Pb

A

BAL, DMS, EDTA

28
Q

antidote for MERCURY

A

BAL, DMS

29
Q

antidote for methemoglobin

A

methylene blue

30
Q

antidote for methanol

A

EtOH, dialysis, 4MP

31
Q

antidote for nitrites

A

methylene blue

32
Q

antidote for opiates

A

naloxone

33
Q

antidote for organophosphates

A

atropine, 2-PAM

34
Q

antidote for oral hypoglycemic agents

A

glucose, glucagon, octreotide

35
Q

antidote for TCA

A

Sodium bicarbonate

If seizing give benzodiazepine

36
Q

causes of elevated anion gap metabolic acidosis

A 
Ketones
Uremia
Lactic acid
Toxic alcohols
Salycilates
37
Q

gastric lavage

A

only useful if <1H on in large overdoses where chargcoal wont work

c/i: caustics, hydrocarbons, AMS w/o airway control, pt refusal

38
Q

whole bowel irrigation

A

golytely to prevent intestinal absomrption

dose 2L/hr per NGT until clear rectal effluent

heavy metals, drug packers, sustained-release meds

c/i: gi bleed, bowel obstruction/perf

39
Q

gi decon

A

decontaminate before symptoms appear

40
Q

Rumack-Matthew nomogram

A

acute Tylenol only

the likelihood of hepatic toxicity given an acetaminaophen level and time

Below nomogram line, hepatotoxicity unlikely to occur
Above nomogram line, hepatotoxicity is probable and NAC is inidicated
bt the two nomogram lines hepatotox is possible and clinical judgement is required

150–200

4 hour post ingestion level is the most important and accurate initial point for the nomogram line

41
Q

NAC

A

repletes glutathione stores

oral or iv forms available

virtually 100% protection if given w/in 8 hours of ingestion

42
Q

tylenol metabolization

A

Tylenol metabolized in liver to sulfate and glucuronide conjugates

as these pathways become saturated, more APAP gets shunted towards the P450 pathway resulting in increasedd NAPQI

detox of NAPQI depletes glutathione stores

low glutathione stores leads to nonspecific action of NAPQI and damages cell

NAC repletes glutathione stores thus preventing hepatotoxic effects of NAPQI

43
Q

indications for HD in ASA overdose

A

AMS, cerebral/pulmonary edema, renal failure

salicylate >100 mg/dL in acute overdose

44
Q

where can ethylene glycol be found

A

antifreeze

45
Q

where can methanol be found

A

wood alcohol

windshield wiper fluid

46
Q

toxic alcohols

A

EtOH, isopropanol, MeOH, EtOH

all cause an abnormal osmolar gap
all are metabolized by ADH

metabolism of isopropanol does not cause an elevated anion gap

47
Q

toxic metabolites of ethylene glycol

A

glyoxylic acid

oxalic acid

48
Q

indications for digibind

A

1 rhythm/conduction disturbance
2 K >5 mEq/dL
3 serum dig >10-15 in an acute ingestion 6 hours post ingestion
or >4 in a chronic ingestion
4 acute dig ingestion of >10 mg (4 mg in a child)
5 empirically for undiagnosed bradycardia (clinical judgement)

empiric tx for acute overdose is 10 vials (adult or child)
empiric tx for chronic overdose is 5 vials in adult

49
Q

Sulfonylurea poisoning

A

Dextrose then octreotide

Octreotide a synthetic somatostatin analog, antagonizes release of insulin

50
Q

Isopropanol

A

metabolized to acetone by ADH (alcohol dehydrogenase)

causes ketosis w/o acidosis

minimal toxicity

51
Q

Glucagon

A

Insulin antagonist

Relaxes smooth muscle of gi tract

52
Q

Clonidine in overdose

A

Centrally acting alpha 2 agonist.

Expressed level of consciousness
Respiratory depression
Mitosis

May closely mimic opioid overdose

53
Q

EKG changes in TCA OD

A

QRS widening
Terminal R in aVR
S in lead I

54
Q

GHB OD

A

Intermittent bouts of agitation with quick return to coma

Rapid full return to consciousness from comatose state

55
Q

Linezolid

A

Has MAOI properties

56
Q

Anticholinergic plants

A

Jimsonweed

57
Q

Effexor in overdose

A

SNRI

Has Na channel blocking properties

Significant overdose can present with
QRS prolongation
Seizures

Presentation and tx similar to TCA overdose

58
Q

HF burn

A

Where do u find it?

Silver cleaner

What does burn look like?

Mgmt?

59
Q

Indications for 4MP in toxic alcohols

A

ethylene glycol and methanol ingestions

EM (15 decks)

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