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Tox Flashcards

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1
Q

pt with tinnitus, hyperventilation, altered mental status, renal toxicity, which medication have they taken ?

A

aspirin

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2
Q

what is the metabolic abnormality in asa overdose?

A

respiratory alkalosis progressing to metabolic acidosis

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3
Q

mechanism of metabolic acidosis in asa overdose

A

asa uncouples oxdative phosphorlyatin results in anaerobic glucose metabolism, and lactic acidosis

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4
Q

treatment of asa overdose

A

alkalinizing the urine, which increases excretion

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5
Q

best initial test in TCA overdose

A

ECG

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6
Q

treatment of TCA overdose

A

sodium bicarbonate to protect against arrhythmia

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7
Q

management of caustic ingestion, eg. drain cleaner,

A

use water in high volumes to flush out the caustics; never reverse alkali with acid or vice versa = exothermic run and more damage

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8
Q

complication of caustic ingestion, eg. drain cleaner

A

mechanical damage to the oropharynx, esophagus and stomach including perforation

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9
Q

what exposure associated with carbon monoxide

A

gas heaters or wood-burning stoves, automobile exhaust particularly in closed environment

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10
Q

best initial therapy for carbon monoxide poisoning

A

100% oxygen, detaches CO from Hb and shortens half life of carboxyhemoglobin

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11
Q

treatment of severe carbon monoxide poisoning (severe = CNS, cardiac symptoms or metabolic acidosis)

A

hyperbaric oxygen

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12
Q

drugs associated with methemoglobinemia

A

benzocaine, nitrites and nitroglycerin, dapsone

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13
Q

symptoms of methemoglobinemia

A

SOB and cyanosis, headache, confusion, seizures, metabolic acidosis

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14
Q

best initial therapy for methemoglobinemia

A

100% O2

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15
Q

most effective therapy for methemoglobinemia

A

methylene blue

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16
Q

cyanosis + normal PO2

A

methemoglobinemia

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17
Q

abnormal brown blood is seen in which condition

A

methemoglobinemia

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18
Q

best initial therapy in organophosphate poisoning with salivation, lacrimation, urination,defecation and SOB

A

atropine

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19
Q

adjuvant therapy in organophosphate poisoning

A

pralidoxime

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20
Q

what electrolyte abnormality predisposes patients to digoxin toxicity

A

hypokalemia because K and dig compete for the binding at the same site on Na/K ATPase and therefore less K = more dig bound

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21
Q

GI: N,V, abdo pain, hyperkalemia, confusion, visual disturbance: yellow halos around objects, rhythm disturbance: any arrhythmia on ECG = toxicity of ____

A

digoxin toxicity

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22
Q

best initial tests in digoxin toxicity

A

ECG and K

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23
Q

treatment of digoxin toxicity

A

digoxin-specicif c antbidoes

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24
Q

symptoms in lead poisoning (5)

A
  1. abdominal pain (lead colic)
  2. ATN (renal tubule toxicity)
  3. sideroblastic anemia
  4. peripheral neuropathies ie. wrist drop
  5. CNS abnormalities: memory loss and confusion
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25
Q

most accurate test in lead poisoning

A

lead level

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26
Q

best initial test in lead poisoning

A

increased level of free erythrocyte protoporphyrin

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27
Q

most accurate test for sideroblastic anemia

A

Prussian blue stain - detects increased iron built up in RBC mitochondria

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28
Q

treatment of lead poisoning

A

succimer is PO, EDTA and dimerparpol are IV chelating agents

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29
Q

mercury toxicity

A

orally ingested: neuro problems, inhaled: lung toxicity that presents as interstitial fibrosis; neuro problems include nervous, jittery, twitchy and sometimes hallucinations

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30
Q

treatment of mercury toxicity

A

no therapy for reverse lung toxicity; chelating agents

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31
Q

intoxication and metabolic acidosis and increased anion gap

A

toxic alcohosl- methanol or ethylene glycol

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32
Q

wood alcohol, cleaning solutions, paint thinner may be source of ___

A

methanol

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33
Q

antifreeze contains ___

A

ethylene glycol

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34
Q

toxic metabolite of methanol

A

formic acid/formaldehyde

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35
Q

initial diagnostic abnormality in methanol poisoning

A

retinal inflammation

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36
Q

complication of methanol poisoning

A

ocular toxicity

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37
Q

toxic metabolite of ethylene glycol

A

oxalic acid/oxalate

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38
Q

complication of ethylene glycol poisoning

A

renal rtoxicity

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39
Q

initial diagnostic abnormality in ethylene glycol poisoning

A

hypocalcemia, envelope-shaped oxalate crystals in urine

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40
Q

best initial therapy for methanol/ethylene glycol poisoning

A

fomepizole - inhibits alcohol dehydrogenase and formation of toxic metabolite

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41
Q

definitive therapy for toxic alcohol ingestion

A

dialysis is only way to remove from body

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42
Q

death from snake bites due to 2 things

A
  1. hemolytic toxin: hemolysis and DIC

2. neurotoxin: respiratory paralysis, ptosis, dysphagia, diplopia

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43
Q

treatment of snake bites

A

pressure, immobilization decreases movement of venom, antivenin

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44
Q

black widow spider bite presentation

A

abdominal pain, muscle pain, hypocalcemia

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45
Q

treatment of black widow spider bite

A

calcium, antivenin

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46
Q

brown recluse spider bite presentation

A

local skin necrosis, bull, and blebs

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47
Q

treatment of brown recluse spider bite

A

debridement, steroids, dapsone

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48
Q

treatment of dog, cat or human bites

A

amoxicillin/clavulanate, tetanus booster

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49
Q

bacteria in cat bites

A

Pasteurella multocida

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50
Q

bacteria in human bites

A

Eiekenella corrodens

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51
Q

indication for rabies vaccine

A

animal has altered mental status or bizarre behaviour; attack was unprovoked by a stray dog that cannot be observed or diagnosed

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52
Q

agents causing mitosis of pupils

A 
COPS
cholinergic, clonidine, carbamates
opioids, organophosphates
phenothiazines, pilocarpine, pontine hemorrhage
sedative-hypnotic
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53
Q

agents causing mydriasis of pupils

A

SAW
sympathomimetics
anticholinergics
withdrawal syndromes

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54
Q

agents causing coma

A 
LETHARGIC
lead, lithium
ethanol, ethylene glycol, ethchlorvynol
TCA, thallium, toluene
heroin, hemlock, hepatic encephalopathy, heavy metals, hydrogen sulphide, hypoglycaemia
arsenic, antidepressants, anticonvulsants, antipsychotics, antihistamines
rohypnol, risperidone
GHB
isoniazid, insulin
CO, CN, clonidine
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55
Q

agents causing seizures

A 
OTIS CAMPBELL
organophosphates, oral hypoglycemias
TCAs
isoniazid, insulin
sympathomimetics, strychnine, salicylates

camphor, cocaine, CO, CN, chlorinated hydrocarbons
amphetamines, anticholinergics
methylxanthines (theophylline, caffeine), methanol
PCP, propranolol
benzo withdrawal, botanicals (water hemlock, nicotine), bupropion, GHB
EtOH withdrawal, ethylene glycol
lithium, lidocaine
lead, lindane

56
Q

agents causing diaphoretic skin

A 
SOAP
sympathomimetics
organophosphates
asa, other salicylates
PCP
57
Q

agents causing dry skin

A

antihistamines

anticholinergics

58
Q

agents causing bullies lesions or blisers

A

barbiturates and other sedative-hypnotics
mustard gas
snakes and spiders

59
Q

agents causing flushed or red skin

A

anticholinergics, nicchia
boric acid
CO
CN

60
Q

agents causing cyanosis

A 
ergotamine
nitrates
nitrites
aniline dyes
phenazopyridine
dapsone
agent causing hypoxemia, hypotension or methemoglobinemia
61
Q

agents causing acneiform rash

A

bromides

chlorinated aromatic hydrocarbons

62
Q

tox source associated with odor of bitter almonds

A

cyanide

63
Q

tox source associated with odor of carrots

A

cicutoxin

64
Q

tox source associated with odor of fruity

A

DKA, isopropanol

65
Q

tox source associated with odor of garlic

A

organophosphates, arsenic, DMSO, selenium

66
Q

tox source associated with odor of gasoline

A

petroleum distillates

67
Q

tox source associated with odor of mothballs

A

naphthalene, camphor

68
Q

tox source associated with odor of pears

A

chloral hydrate

69
Q

tox source associated with odor of pungent aromatic

A

ethchlorvynol

70
Q

tox source associated with odor of oil of wintergreen

A

methylsalicylate

71
Q

tox source associated with odor of rotten eggs

A

SO2, hydrogen sulfide

72
Q

tox source associated with odor of freshly mowed hay

A

phosgene

73
Q

cholinergic toxidrome - muscarinic symptoms

A

DUMBELLS

  • diarrhea, diaphoresis
  • urination
  • miosis
  • bradycardia
  • bronchorrhea
  • emesis
  • lacrimation
  • lethargic
  • salivation
74
Q

cholinergic toxidrome - nicotinic symptoms

A

MTWTFSS

  • mydriasis
  • tachycardia
  • weakness
  • tremors
  • fasciculations
  • seizures
  • somnolent
75
Q

anticholinergic toxidrome

A
  • dry skin
  • hyperthermia
  • flushed
  • mydriasis
  • psychosis
  • urinary retention
  • tachycardia
  • hot as a hare (hyperthermia)
  • dry as a bone (dry skin, urinary retention)
  • blind as a bat (mydriasis)
  • mad as a hatter
76
Q

opioid toxidrome

A

miosis
hypoventilation
depressed mental status/coma

77
Q

opioid withdrawal

A 
diarrhea
mydriasis
goose flesh
tachycardia
lacrimination
hypertension
yawning
cramps
hallucinations
seizures (with EtOH and benzo withdrawal)
78
Q

sympathomimetic toxidrome

A 
hyperthermia
mydriasis
tachycardia
hypertension
diaphoresis
flushed
agitated
seizures
79
Q

serotonin syndrome

A 
AMS
hyperthermia
agitation
hyperreflexia
clonus
diaphoresis
80
Q

NMS

A 
AMS
hyperthermia
agitation
muscle rigidity
decreased reflexes
81
Q

DDX for altered mental status

A 
AEIOU TIPS 
alcohol, acidosis
electrolytes - hyponatremia, etc
infectious/sepsis
opioids, overdose
uremia

trauma
insulin (hypoglycaemia, hyperglycaemia)
psychosis
seizure/stroke

structural:

  • bleed: SDH, SAH, ICH, etc.
  • pus: meningitis, encephalitis
  • water: hydrocephalus
  • mass effect: tumor
  • bullet/fb
82
Q

tox causes of bradycardia

A

PACED
propranolol, poppies (opioids), propoxyphene, physostigmine
anti-cholinesterase drugs, antiarrhythmics
clonidine, CCBs
ethanol, other alcohols
digoxin, digitalis

83
Q

tox causes of tachycardia

A

FAST
free base cocaine, freon
amphetamines, anticholinergics, antihistamines, antipsychotics
sympathomimetics, solvent abuse, strychnine
theophylline, TCAs, thyroid hormone

84
Q

tox causes of hypothermia

A 
COOLS
CO
opioids
oral hypoglycemics, insulin
liquor (EtOH)
sedative/hypnotic
85
Q

tox causes of hyperthermia

A

NASA
NMS
antihistamines, alcohol withdrawal
salicylates, sympathomimetics, serotonin syndome
anticholinergics, antidepressants, antipsychotics

86
Q

tox causes of hypotension

A

CRASH
clonidine, CCBs
rodenticides (containing arsenic, cyanide)
antihypertensives, aminophylline, antidepressants
sedative-hypnotics
heroin, other opioids

87
Q

tox causes of hypertension

A 
CT SCAN
cocaine
thyroid supplements
sympathomimetics
caffeine
anticholinergics, amphetamines
nicotine
88
Q

tox causes of rapid respiration

A 
PANT
PCP, parquet, pneumonitis, phosgene
asa, other salicyaltes
noncardiogenic pulmonary edema, nerve agents
toxin induced metabolic acidosis
89
Q

tox causes of slow respiration

A 
SLOW
sedative hypnotics
liquor (ETOH)
opioids
weed
90
Q

substances causing wide anion gap metabolic acidosis

A

general KULT (ketoacidosis, uremia, lactate, tox)

MUDPILESCAT
methanol, metformin, massive ingestions
uremia
DKA
paraldehyde, phenformin
iron, INH, ibuprofen
lactate
ethylene glycol
salicylates
cyanide, CO, colchicine
alcoholic ketoacidosis, acetaminophen
toluene
91
Q

tox ECG finding of absent P wave

A

digoxin
cholinergics
hyperkalemia

92
Q

tox ECG finding of notched P wave

A

quinidine

93
Q

tox ECG finding of prolonged PR interval

A

BBs
CCBs
Mg

94
Q

tox ECG finding of prolonged QRS interval

A

Type 1 antidysrhythmics
cocaine
diphenhydramine
TCAs

95
Q

tox ECG finding of scooped ST segment

A

digoxin

96
Q

tox ECG finding of prolonged QT

A 
TCA
antipsychotics
citalopram
HF
ondansetron
HF
methadone
ethylene glycol
97
Q

tox finding peaked T wave

A

HF (hyperkalemia)

98
Q

tox finding ECG flattened T wave

A

lithium

99
Q

tox finding ECG of U wave

A 
barium
beta agonists (ventolin)
lithium
methylxanthines (Caffeine, theophylline)
toluene
100
Q

potentially lethal toxins which may need early charcoal administration

A 
the killer C's
cyanide
colchicine
CCBs
cyclic antidepressants
cardioglycosides
cyclopeptide mushrooms (amanita phalloides)
cocaine
cicutoxin (water hemlock)
salicylates
101
Q

substances that do not bind to activated charcoal

A 
pesticides
heavy metals 
acids/alkalis
iron
lithium
solvents
102
Q

toxins that are dialyzable

A 
STUMBLED
salicylates
theophylline
uremia
metformin/methanol
barbituates
lithium
ethylene glycol
depakote (valproic acid)
103
Q

substances amenable to MDAC

A 
ABCDQ
aminophylline/theophylline
barbituates
carbamazepine/concretion forming drugs( eg. salicylates)
-dapsone
-quinine
104
Q

how to dose MDAC

A

activated charcoal to xenobiotic ratio of 10:1, subsequent doses of 50% initial dose q4-6h for up to 24 hours
-can D/C when serum levels no longer in toxic range

105
Q

how to order meds for serum alkalinization

A
  • goal of serum pH 7.5, urine pH 8.0
  • check K before alkalization because will increase K reabsorption
  • 150mEq (3amps) of NaHCo3 into 1L D5W plus 20-40mEq of K, with rate below 250cc/hour
106
Q

how to order intralipid

A

-dose: initial bolus of 1.5mL/kg of 20% lipid solution given over 2-3 minutes followied by an infusion of 0.25mL/kg/min

107
Q

complications of intralipid

A

extreme lipemia interfering with lab tests, acute pancreatitis, ARDS

108
Q

antidote for acetaminophen

A

N-acetylcysteine

109
Q

antidote for methanol/ethylene glycol

A

fomepizole/ EtOH

110
Q

antidote for CO

A

oxygen, hyperbarics

hydroxocobalamin

111
Q

antidote for opioids

A

naloxone

112
Q

antidote for anticholinergics

A

physostigmine

113
Q

antidote for organophosphates

A

atropine

2-PAM

114
Q

antidote for methemoglobinemia

A

methylene blue

115
Q

antidote for cyanide

A

nitrites

hydroxycobalamin

116
Q

antidote for iron

A

deferoxamine

117
Q

antidote for arsenic, lead

A

dimercaprol (BAL)

118
Q

antidote for lead, mercury

A

succimer (DMSA)

119
Q

antidote for lead

A

Ca-EDTA

120
Q

antidote for digoxin, crotalids

A

Fab fragments

121
Q

antidote for BBs

A

glucagon

122
Q

antidote for CCBs

A

calcium

insulin/ glucose

123
Q

antidote for salicylates, TCAs

A

bicarbonate

124
Q

antidote for oral hypoglycemias

A

glucagon, octreotide, pyridoxine (B6)

125
Q

antidote for local anesthetic systemic toxicity

A

intralipid

126
Q

false positive screen for amphetamines on urine tox

A 
amantadine
bupropion
labetalol
promethazine
ranitidine
trazodone
127
Q

false negative for amphetamines for urine tox

A

designer amphetamines

128
Q

false positive for benzos for urine tox screen

A

sertraline

oxaprozin

129
Q

false negative for benzos for urine tox screen

A

alprazolam
flurazepam
midazolam
Z drugs (zoo-idem, zap,lon, zoplicone, eszoplicaone)

130
Q

false positive for opioids on urine tox

A

dextromethorphan

diphenhydramine

131
Q

false negative for opioids for urine tox

A

synthetic opioids: demerol, fentanyl, methadone, propoxyphene
semisynthetic opioids: hydromorphone ,hydrocodone, oxycodone - may have some cross-reactivity

132
Q

false positive for cannibinoids for urine tox

A

dronabinol
efavirenz
PPI

133
Q

false negative for canninbinoids for urine tox

A

synthetic marijuna: K2/Spice

134
Q

false positive for PCP for urine tox

A 
quinolones
dextromethorphan
diphenhydramine 
ibuprofen
tramadol
135
Q

false positive for cocaine for urine tox

A

coca leaf tea

Emergency (3 decks)

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