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Tox Flashcards

1
Q

What is the MOA of NAC in tylenol OD?

A

Restores glutathione

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2
Q

What is the first lab test that changes with tylenol overdose?

A

INR, not LFTs

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3
Q

What happens with INR when giving NAC?

A

Increases slightly

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4
Q

What is the active medication in Jimson weed?

A

Atropine

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5
Q

What is the treatment for anticholinergic overdoses?

A

Benzos
GSC
Foley for urinary retention

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6
Q

What is the major risk of giving physostigmine in the treatment of anticholinergic poisoning?

A

Increased risk for seizures

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7
Q

What is the MOA of botulism?

A

Prevents the release of acetylcholine

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8
Q

Who do you call to get anti botulinum toxin?

A

CDC

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9
Q

What other property does propranolol have that make it different from other beta blockers in overdose?

A

Na channel blockade

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10
Q

Why isn’t glucagon effective in the treatment of CCB overdoses?

A

Glucagon works by working around the cAMP beta agonist, but if there is no Ca to go around, it will not work

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11
Q

Why isn’t pacing as effective in the treatment of beta blocker overdose?

A

Do not have the Ca for ionotropy

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12
Q

Which has hyper and which has hypoglycemia: beta blockers vs CCBs?

A

Beta blockers have hypoglycemia whereas CCBs have hyperglycemia

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13
Q

Foxglove causes what intoxication?

A

Digitalis

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14
Q

What is the only arrhythmia that you cannot have with Digitalis?

A

Rapidly conducted SVT

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15
Q

Does dig cause hyper or hypokalemia? Which causes a more potent effect with dig?

A

causes hyperkalemia, but more potent effect with hypokalemia

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16
Q

What is the major issue with transvenous pacing with digitalis intoxication?

A

Since digitalis causes an irritable myocardium, there is a risk of a fatal arrythmia

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17
Q

What is the role of tachycardia with QTc prolongation?

A

Protective, since it shortens the QTc

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18
Q

What is the role of phenytoin in the treatment of TCA overdose?

A

Do not give, ineffective

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19
Q

What is the biggest tox killer?

A

CO

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20
Q

How can methylene chloride cause CO poisoning? What is it used for?

A

Wood stripping agent that gets converted into CO in the body

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21
Q

What is the clinical presentation of CO poisoning?

A

Flu like symptoms

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22
Q

Who gets hyperbaric oxygen therapy for CO poisoning?

A

Pregnant

Cardiac or neuro s/sx

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23
Q

What is the MOA of imidazolines, and what is the common suffix?

A

alpha agonists (oxymetaoline, tetrahydrolozine)

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24
Q

Opioid toxidrome with bradycardia, hypotension, and not responsive to narcan = ?

A

Clonidine overdose

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25
Q

What is the toxin that smells like bitter almonds?

26
Q

What is the toxin that smells like rotten eggs?

A

Hydrogen sulfide

27
Q

Blackened coins in a tox vitim = ?

A

Hydrogen sulfide

28
Q

What is the MOA of cyanide?

A

Inhibit oxidative phosphorylation, causing severe lactic acidosis

29
Q

What is the MOA of hydrogen sulfide?

A

Inhibit oxidative phosphorylation, causing severe lactic acidosis

30
Q

Arterialization of venous gas = which toxin?

A

Cyanide or hydrogen sulfide

31
Q

How does a victim of cyanide poisoning present?

A

Sudden syncope/seizure

32
Q

What is the treatment for cyanide poisoning? MOA? (2)

A
  • Amyl nitrite induces methemoglobinemia

- Hydroxocobalamin, Vit B12 precursor

33
Q

How do inhalants (hydrocarbons) cause intoxication? Treatment?

A

Myocardial sensitization

Beta blockers

34
Q

What is the major cause of death and damage with hydrocarbon (like gasoline) ingestion?

A

Aspiration, since will damage surfactant in lungs and cause ARDS. Otherwise not typically dangerous

35
Q

What is the presentation of hydrofluoric acid contamination?

A

Pain out of proportion to exam

36
Q

What is the treatment for hydrofluoric acid contamination/ingestion?

37
Q

What is the toxic and lethal dose of Fe?

A

20 mg/kg toxic

60 mg/kg lethal

38
Q

What is the active form of Fe in tablets that is toxic?

A

The elemental form

39
Q

What is the treatment for Fe intoxication? (2, early, definitive)

A

-Whole bowel irrigation if early

Deferoxamine

40
Q

Why does isoniazid cause seizures? Treatment?

A
  • Inhibits production of GABA

- Treat with B6 (pyridoxine)

41
Q

How safe if pyridoxine in the treatment of isoniazid overdose?

A

Very. Extremely unlikely to overdose on B6 in the acute setting

42
Q

What are the s/sx of Li intoxication?

A

Tremors, coma, seizures. Rarely cardiac arrhythmias

43
Q

What is the treatment for Li poisoning?

A

IVFs, dialyze.

44
Q

Why is there a rebound effect of Li levels after dialysis?

A

Large volume of distribution

45
Q

What is metal fume fever?

A

Welder who gets sick monday morning and improves throughout the week

46
Q

What is the underlying MOA of methemoglobinemia?

A

Fe2+ to Fe3+

47
Q

What is the treatment for methemoglobinemia

A

Methylene blue

48
Q

What are the causes of methemoglobinemia?

A

Nitrites,
Aniline dyes
Dapsone

49
Q

People with what genetic disorder cannot get methylene blue for methemoglobinemia?

A

G6PD deficiency

50
Q

What is the six hour rule with mushrooms?

A

If sick within 6 hours, will be fine.

51
Q

Gyrometra species of mushrooms cause what intoxication?

A

Like isoniazid tox–seizures that are treated with B6

52
Q

How do you titrate atropine in a organophosphate poisoning?

A

Until secretions dry

53
Q

True or false: tachycardia is a contraindication to the use of atropine in the treatment of organophosphate poisoning?

A

False–give even if very tachy

54
Q

What is the treatment for ASA poisoning?

A

WBI

Alkalinize the urine

55
Q

What are the indications for dialysis with ASA tox?

A
  • Pulmonary or cerebral edema
  • Renal failure
  • Severe acidemia
  • Level over 60 if chronic or 100 if acute
56
Q

What is the role of activated charcoal in the treatment if ASA?

A

Can be used if early

57
Q

What is the presentation of Strychnine intoxication? Why?

A

Opisthoclonus

Tox like tetanus

58
Q

What agent may help with sulfonylureas overdose?

A

Octreotide

59
Q

What is the presentation of theophylline OD?

A
  • Refractory Seizure since adenosine is blocked in brain

- Refractory V-tach

60
Q

Why do beta blockers work in the treatment of theophylline toxicity?

A

Theophylline is a beta agonist

61
Q

True or false: theophylline is amenable to dialysis

Hippos (23 decks)

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