Tox Flashcards
1
Q
Charcoal aspiration carries a risk of:
A
Severe pneumonitis
2
Q
Gastric lavage is contraindicated for ingestion with:
A
hydrocarbons
caustic ingestions
3
Q
How to differentiate between sympathomimetic ingestion and anticholinergic ingestion?
A
Sweating (present in sympathomimetic)
4
Q
ASA or salicylate toxicity can cause increased respiratory drive due to:
A
Stimulation of the respiratory medullary center
5
Q
Symptoms of anticholinergic toxicity, for example, Belladonna
A
Flushed Hypoactive BS Warm Psychotic Mydriatic Dry
6
Q
Symptoms of DTs
A
Tachycardia Hypertension Arrhythmias Hallucinations \+/- Seizures
7
Q
Symptoms of Heroin withdrawal:
A
Piloerection
N/V/D
Yawning
8
Q
Pathophysiology of TCA OD:
A
- Sodium channel blockade –> prolonged phase 0 of the cardiac action potential
- GABA-A antagonism
- Inhibition of amine (NE, serotonin) reuptake
- Alpha-adrenergic blockade
- Anti-muscarinic/anti-histamine effects
- Potassium channel blockade
9
Q
Toxicity Pearl:
A
Lithium levels do not correlate well with symptoms or prognosis. Use the clinical condition instead of the lithium levels to guide therapy.
10
Q
Recommended tx for lithium toxicity
A
Hemodialysis
11
Q
Best use for flumazenil:
A
Reversal of BZD-induced iatrogenic oversedation.
12
Q
Best tx for cocaine toxicity
A
Benzodiazepine
13
Q
Why should you avoid haloperidol and benadryl in cocaine toxicity patients?
A
Risk for hyperthermia
14
Q
Dramatic multidirectional nystagmus;
Substance?
A
PCP
15
Q
Respiratory alkalosis, PCO2 up or down?
A
Down
16
Q
What causes hepatotoxicity in acetaminophen OD?
A
NAPQI, after glutathione stores are depleted
17
Q
Toxic dose of acetaminophen
A
140 mg/kg
18
Q
What guides therapy in acetaminophen OD?
A
Rumack-Matthew nomogram - draw level 4-20 hours after ingestion
19
Q
Weakness Fatigue N/V/D Confusion Yellow-green halos; Toxicity
A
Digoxin
20
Q
Effect of nifedipine on the heart
A
Bradycardia
21
Q
Antidote for iron toxicity
A
Deferoxamine, IM or IV
22
Q
Methemoglobinemia antidote
A
Methylene blue
23
Q
Antidote for Isoniazid toxicity
A
Pyridoxine
24
Q
Antidote for Insulin OD
A
Glucagon
25
Why is charcoal contraindicated in drain cleaner ingestion?
It obscures the endoscopic evaluation (and does not bind caustic substances)
26
Neurological deficit seen in severe lead toxicity
Wrist drop
27
Bluish lines on gingiva;
Colicky abdominal pain;
Memory loss
Toxicity?
Lead toxicity
28
Common causes of methemoglobinemia:
Nitrates/nitrites;
Local anesthetics;
Dapsone;
Phenazopyridine
29
Why is pulse ox not reliable in methemoglobinemia?
It cannot differentiate oxyhemoglobin from methemoglobin
30
N/V with dysrythmias
| Medication toxicity?
Digoxin
31
Hypertension --> hypotension
Bradycardia
Miotic pupils
Medication toxicity and receptor type?
Clonidine
Alpha 2 agonist --> sympathetic
Mu agoinist --> pupils
32
Clonidine OD mgmt
Charcoal early and IVF
33
What eye finding is seen in clonidine toxicity?
Miosis
34
Oil of wintergreen causes what kind of poisoning?
Salicylism, wide anion gap metabolic acidosis w/ respiratory alkalosis
35
Early signs of salicylism include
N/V, diaphoresis, tinnitus, deafness, vertigo
36
Moderate signs of salicylism include
Tachypnea
Tachycardia
AMS --> warrants prompt HD
37
Severe signs of salicylism include
Coma
Hyperthermia
Seizures
38
Tx of salicylism
Prompt volume resuscitation and sodium bicarb therapy, even before obtaining levels
39
Common sources causing salicylate toxicity
ASA
Pepto-Bismol
Oil of wintergreen
40
Terminal R wave in aVR, pathognomonic for a
Na channel blocking drug
41
Physostigmine is the antidote for
Anticholinergic OD, ie benadyrl
42
What is the significance of QRS>160 in TCA OD?
Likelihood of QRS widening and tachydysrythmia
43
Tx for TCA OD?
Sodium bicarb bolus and infusion to combat Na channel blockade
44
In addition to causing seizures in patients with chronic benzodiazepine dependence, what other major side effect does flumazenil have?
Increases ICP
45
Lethargy and respiratory depression w/ no change in pupil size, toxicity?
Benzos
| Tx w/ flumazenil only if benzo naive
46
What is the toxic metabolite of methanol?
Formic acid
47
Most commonly ingested alcohol after ethanol:
Isopropyl alcohol
48
Ketosis without acidosis, toxicity?
Isopropyl alcohol --> acetone --> ketones
49
Indications for fomepizole
Methanol or ethylene glycol poisoning
50
Atropine for
cholingeric toxicity/organophosphate poisoning,
| followed by pralidoxime when respiratory secretions have stopped
51
Physostigmine for
anticholinergic toxicity
52
SLUDGE and Killer B's for organophosphate poisoning
```
Salivation
Lacrimation
Urination
Defecation
GI sx
Emesis
Bradycardia, Bronchospasm, Bronchorrea
```
53
FIRST step in tx of organophosphate poisoning
Decontamination and supportive care
| then atropine, then pralidoxime
54
DUMBBELLSS for organophosphate poisoning
```
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Lethargy
Seizures
Salivation
```
55
BB OD antidote
Glucagon (also treats CCB OD to a lesser degree)
56
Common sources causing cholinergic toxicity
Sarin gas, drugs, insecticides
57
Bradycardia with LOC fluctuating quickly between agitation and depression, toxicity?
GHB
58
Tx for GHB ingestion
Supportive care, airway mgmt
59
What class of medication should be administered for cocaine agitation?
Benzos
60
Visual hallucinations, tachycardia, nystagmus +/- respiratory depression, toxicity?
Dextromethorphan
61
What is the recreational drug with similar mechanism to dextromethorphan?
PCP
| Both are NMDA receptor antagonists
62
Severe dextromethorphan poisoning may cause
Serotonin syndrome
63
Should BB be administered to treat the BP in cocaine toxicity?
No, this can cause unopposed alpha stimulation and lead to cardiovascular collapse
64
Common causes of sympathomimetic toxidrome
Amphetamines, cocaine, decongestants
65
Mgmt of lithium toxicity
HD, esp when lithium level > 4 acutely, or >2.5 with chronic ingestion, any elevated level w/ neurological sxs, renal failure, inability to tolerate IVF
66
Sxs of acute lithium toxicity
GI sxs
| Sometimes QT prolongation, T wave flattening or inversion
67
Acute on chronic lithium ingestion sxs:
GI sxs plus neurologic sxs
| Also, DI w/ elevated Na
68
Chronic lithium toxicity sxs:
Worsening tremors, confusion, hyperreflexia, clonus, coma and seizures
69
Why should activated charcoal never be given for patients with AMS?
Inadvertent aspiration is extremely harmful
70
What are the EKG characteristics of lithium toxicity?
QT prolongation
T wave flattening or inversion
Bradycardia
71
Antidote for malignant hyperthermia
Dantrolene
72
AMS, autonomic instability and increased neuromuscular activity, toxicity?
Serotonin syndrome
73
What cofactor should be administered in a pt with methanol poisoning?
Folinic acid 50 mg IV q4h
74
Main complications of methanol poisoning
Optic neuropathy
Putamen hemorrhage and necrosis
Renal tubular necrosis
75
"Snowy" field of vision; toxicity?
Methanol
76
Tx for methanol poisoning
Ethanol or fomepizole IV
77
Required cofactors in the tx of ethylene glycol poisoning
Pyridoxine and thiamine
78
Common sources of methanol poisoning
Antifreeze, paint thinner, windshield washer fluid
79
Mgmt of MDMA ingestion
Supportive care, IVF, +/- benzos and cooling
80
Clonus and hyponatremia with sympathomimetic sxs suggests what toxicity?
MDMA/ecstasy
81
Most common morbidity in patients with PCP intoxication
Rhabdo
82
Most common physical exam finding in people with PCP ingestion
Nystagmus, any kind
83
Which toxidrome would jimsonweed cause?
Anticholinergic - flushing, dry skin or mucous membranes, altered mental status, mydriasis, and hyperthermia
84
HD should be initiated in pts with serum salicylate levels of
>100
85
Why is Oil of Wintergreen so dangerous?
1 ounce = 171 adult tabs
86
N-acetylcysteine is tx for
Tylenol OD
87
What are the classic visual changes associated with acute digoxin toxicity?
Xanthopsia (yellow-green halos around lights)
88
What is HIT?
thromboembolism, bleeding, and a decrease in platelets which typically develops one to 10 days after heparin is initiated. In heparin-induced thrombocytopenia, heparin should promptly be discontinued and the patient should be assessed for signs of bleeding and thrombosis.
89
What is the best treatment for a benzodiazepine overdose?
Observation and supportive therapy. Flumazenil is not typically indicated in benzodiazepine overdose as it could lead to withdrawal seizures
90
Exposure to what common plant may result in symptoms of anticholinergic toxicity?
Jimson weed
91
Mgmt anticholinergic toxicity
Supportive, benzodiazepines
92
OD of which antihypertensive presents like opiate toxicity?
Clonidine
93
Antidote for ASA
Sodium bicarb
94
Antidote for acetaminophen
NAC
95
Antidote for anticholinergics
Physostigmine
96
Antidote for anticoagulants
Vitamin K, ffp
97
Antidote for BB
Glucagon, insulin
98
Antidote for benzos
flumazenil
99
Antidote for ccb
ca, glucagon, insulin
100
Antidote for CO
o2
101
Antidote for cholinergics
Atropine, pralidoxime
102
Antidote for cyanide
sodium thiosulfate, hydroxycobalamin, amyl nitrate
103
Antidote for digoxin
Digoxin fab
104
Antidote for heparin
Protamine
105
Antidote for HF acid
calcium gluconate
106
Antidote for SSRI
ciproheptadine
107
Antidote for sulfonureas
Octreotide, glucose
