Tox Flashcards
1
Q
how to dose naloxone drip
A
2/3 dose required to reverse resp depression
2
Q
long acting mu receptor antagonist
A
naltrexone (effect for 72 hours)
3
Q
estimated lethal dose of salicylates
A
> 500mg/KG
4
Q
how to obtain labs in patient with salicylate tox
A
obtain level followed by q2h levels if levels continue to rise
5
Q
goal of urination in salicylate toxicity
A
alkalinize the urine
6
Q
salicylate doses that indicate need for HDS in acute and chronic toxicity
A
- acute= 100mg/dl
2. chronic= 50mg/dl
7
Q
for every 50mL NaHCO3, how much serum pH increase by?
A
by 0.1
8
Q
3 things you can take salicylate tox from
A
- aspirin
- wintergreen
- bismuth subsalicylate
9
Q
mixed resp alkalosis and anion gap metabolic acidosis
A
salicylate toxicity
10
Q
VSA that can occur with clonidine overdose
A
hypertension
11
Q
hallmark feature of cyanide poisoning
A
severe metabolic acidosis
12
Q
hyperventilation, bradycardia, hypotension after smoke exposure
A
cyanide poisoning
13
Q
pits of apricots, bitter almond, cherry, and peach can cause
A
cyanide poisoning
14
Q
mechanism of cyanide poisoning
A
within the mitochondria, cessation of electron transport chain and oxidative phosphorylation inhibiting cellular respiration and decreasing ATP
15
Q
BM suppression, hepatotoxicity, pancreatitis from immunosuppressant drug- toxicity?
A
azathioprine
16
Q
hyperkalemia, nephrotoxicity can occur from what rejection drug toxicity
A
cyclosporine
17
Q
level of elemental iron that warrants deferoxamine
A
500mcg/dl
18
Q
indications for deferoxamine for iron toxicity
A
- level >500mcg/fdl
- shock
- vomiting/diarrhea
- altered mental status
- elevated anion gap MA
19
Q
prognosis of patients with iron toxicity that don’t vomit within first 6 hours
A
good prognosis
20
Q
tinnitus in aspirin toxicity- reversible or irreversible
A
reversible
21
Q
toxic metabolite of methanol
A
formic acid
22
Q
ingestion + visual snowstorm
A
methanol
23
Q
formula for expected serum osmolality
A
2xNA + BUN/2.8 + glu/18+ ethanol/4.6
24
Q
bilateral cranial neuropathies and symetric descending muscle weakness
A
botulism
25
inhibits ACh release at presynaptic receptors- tox
botulism
26
MC valve involved in endocardititis
tricuspid
27
MC pathogen involved in native valve endocarditis (not from drugs)
streptococci, mitral valve
28
MC pathogen in endocarditis from IVDU
s. aureus, tricuspid
29
GI malignancy + endocarditis
s. bovis
30
how do TCAs cause cardiac toxicity
blocking fast inward sodium channels
31
managment of TCA with widened QRS
give sodium bicarb in 50mEq until QRS complex narrows, then continuous infusion of 15mEq in 1L D5W at a rate of 2-3 times maintenance; follow K
32
inhibition of Na-K ATPase channel is how what drug works
digitalis
33
cough medicine that presents similar to TCA overdose
benzonatate
34
cold medicine with similar effects to PCP
dextremethorphan
35
bacterial organism associated with iron toxicity
yersinia (feeds on iron)
36
physical appearance of brown recluse
violin shaped mark on thorax, 3 pairs of eyes
37
hyper-reflexia in lower>upper extremities
Serotonin syndrome
38
fluoxetine and dextromethorpan together can cause
serotonin syndrome
39
treatment of serotonin syndrome
BZDs, cyproheptadine
40
lead pipe rigidity
neuroleptic malignant syndrome
41
treatment of malignant hyperthermia
dantrolene
42
toxic metabolites of ethylene glycol
oxalic acid
43
osmolar gap with normal anion gap
isopropanol
44
blurry yellow vision with nausea, vomiting, and abdominal pain
digoxin toxicity
45
cardiac arrest with digoxin toxicity- treatment
20 vials of digoxin antibody
46
poor prognostic indicator in digoxin toxicity
hyperkalemia
47
PVCs, PAT with AV block, bidirectional ventricular tachycardia- toxicity
digoxin
48
what electrolyte abnormality increases risk of digoxin toxicity
hypokalemia
49
treatment for lead toxicity
succimer
50
BLL (lead)>70 is indication for what
inpatient treatment for lead toxicity
51
inpatient treatment for lead toxicity
dimercaprol followed by CaNa2EDTA
52
outpatient treatment for lead toxicity
oral succimer
53
herbicide that is activated by sunlight and affects the lungs, causing pulmonary fibrosis and respiratory failure
paraquat
54
opiate that causes mydriasis in overdose
meperidine
55
HD indications for aspirin toxicity
```
level >100
coma
rising levels despite alkalinization
renal failure
pulm edema
altered mental status
clinical deterioration
```
56
"silo filler's" disease
methemoglobinemia
57
endpoint for treatment of organophosphate poisoning with atropine
drying of secretions
58
Fe 3+ in which hgb cannot bind O2
methemoglobinemia
59
how does pralidoxime work
regenerates cholinesterace activity at neuromuscular sites
60
dapsones, antimalarials, nitrates, "-aines" cause what toxicity
methemoglobinemia
61
hyperammonemia is suggestive of
VPA toxicity
62
management of valproic acid toxicity
l-carnitine
63
indications for HD With valproic acid toxicity
severe (level > 1300 mg/L, cerebral edema, shock) or is cases of acute hyperammonemic encephalopathy, pH < 7.10, and coma or respiratory depression.
64
indications for HD with lithium toxicity
renal failure, inability to handly aggressive hydration, severe CNS toxicity, level >4 in acute toxicity, level >2 in chronic toxicity
65
to prevent nitrogen narcosis, what depth do basic training for diving allow people to dive to
60feet
66
confusion altered mental status with descent in a diver
nitrogen narcosis
67
rotten egg odor with cyanide like affect
hydrogen sulfide
68
hay odor in textiles
phosgene
69
general side effect of toxic fumes, gases, and vapors
pulmonary edema
70
TCAs have what effects
anticholinergic
71
anticholinergic effects
mydriasis, dry, hot, flushed skin, tachycardia, decreased or absent bowel sounds, and urinary retention
72
mechanism of TCAs on heart
Na channel blockade
73
TCA toxicity is worsened by what acid base status
acidosis
74
lead pipe rigidity
NMS
75
compare serotonin syndrome vs NMS
serotonin-clonus, NMS- lead pipe
76
treatment for akathisia
benadryl, benztropine
77
how to calculate osmolar garp
measured- calculated osm
78
what is considered a positive osmolar gap
>10
79
ketosis without acidosis
isopropanol
80
toxic metabolite in tylenol toxicity
NAPQI (normally broken down by glutathione)
81
manic symptoms, mydriasis, tachycardia, nystagmus, visual hallucinations
dextromethorpan overdose
82
blood pressure in clonidine overdose
transient hypertension from alpha effects and then central effects cause hypotension, etc
83
muscle rigidity + elevated CK
NMS
84
toxic dose of ASA
200-300mg/kg
85
ASA level indicating need for dialysis
>100
86
what two co-factor adjuncts should be given in ethylene glycol ingestion
thiamine and pyridoxine
87
indications for HD with ethylene glycol ingestion
ethylene glycol>50
anion gap >20
initial pH less than 7.3
88
what to think about in a patient with isolated tachypnea
salicylate toxicity
89
define hypothermia
core body temp < 35
90
at what temperature shoudl hypothermic patients be warmed to to asess if they should be resuscitated
32C (89F)
91
patient is 32C and remains asystolic- management
call it, unlikely to be revived in asystole
92
how does iron cause damage
uncoupling of oxidative phosphorylation causes anaerobic metabolism
93
management of dystonia for haldol
benztropine or benadryl
94
first line treatment for beta blocker overdose
glucagon bolus followed by a drip
95
BB vs CCB overdose
bb- normal glucose
| CCB- hyperglycemia
96
musty hay or freshly grown grass
phosgene
97
main injury from phosgene
turns into hydrochloric acid and causes delayed pulonary injury leading to edema and inflammation
98
anticholinergic mnenomic
```
Mad as a hatter
Blind as a bat (mydriasis)
Red as a beet
Hot as a hare
Dry as a bone
```
99
cholinergic mnemonic
```
Salivation
Lacrimation
Urination
Diarrhea
Diaphoresis
GI upset
Emesis
killer bs- bronchoospasm, bronchorrea, bradycardia
```
100
treatment of anticholinergic toxicity
supportive of physostigmine
101
how long after cessation of alcohol do alcohol seizures occur
6-48 hours after stopping but can occur up to five days after
102
EMTALA is part of what law
consolidated Omnibus Budget Reconciliation Act of 1985
103
who cannot recieve methylene blue
G6PD defic- causes anemia
104
treatment for metHgb in patients with G6PD
blood tranfusions to dilute blood with metHgb
105
feared side effect from fentanyl for procedural sedation
chest wall rigidity, needs neuromuscular blockade, narcan won't work
106
treatment of CCB overdose
glucagon/insulin, calcium lipid emulsion, ECMO
107
antidote for valproate toxicity
carnitine
108
BG in CCB toxicity
hyperglycemia
109
three contraindications of physostigmine
1. asthma (causes bronchoconstriction)
2. seizures- lowers seizure threshold
3. slows conduction (contraindicated in AV block, NA channel blockers)
110
when to use physostigmine
in patients who are very altered from anticholinergic toxicity and you need to help distinguish what is going on
111
what is pyridozxine an antidote for
1. INH
| 2. ethylene glycol
112
what does quinine do
causes ototoxicity and blindness
113
3 indications to use digifab
1. ventricular dysthryhtmias
2. 3rd degree av block
3. hyperkalemia >5
114
what is leucovorin used as an antidote for
1. methotrexate
| 2. methanol toxicity
115
what is glucarpidase an antidote for
MTX toxicity
116
antidote for cesium
prussian blue
117
when should sodium nitrite not be used for cyanide poisoning
if CO may be on board because the MetHgb may bind to CO more strongly
118
what is considered the antiviral for pox virus
tecovirimat
119
what is obiltoxaximab used for
inhalation anthrax
120
treatment of body packers
whole bowel irrigation with polyethylene glycol, if ruptures-> OR
121
withdrawal of dopamine agonists can cause what
neuroleptic malignant syndrome
122
antibiotic that can can cause tyramine reaction
linezolid
123
what numbing medication can be used on open wounds
LET gel
124
what numbing medication is used for intact skin
EMLA
125
max dose of lidocaine
5mg/kg
126
max dose of lidocaine w. epi
7mg/kg
127
concentration of 1% lidocaine
10mg/ml
128
what type of medication is succinylcholine
depolarizing neuromuscular blocker
129
3 conditions in which a lower dose of succinylcholine is needed
1. organophosphate toxicity
2. eaton lambert
3. hypothyroidism
130
what condition is a bigger dose of succinylcholine warranted
MG
131
garlic smell
arsine gas poisoning
132
semiconductor facility toxic fumes
arsine gas poisoning
133
classic triad of arsine poisoning
1. abdominal pain
2. hematuria
3. jaundice
134
first line antidote for iron overdose
deferoxamine
135
medications that reduce immunosuppressant effect of cyclosporine and why
phenytoin, nafcillin, phenobarbital, rifampin-> induce CYP45 enzymes which reduces half life of cyclosporine
136
what medication may be able to be given in severe brown recluse bites
dapsone- but really only prevents worsening of local infection, and there is no antivenin
137
how does fomepizole work
competitive antagonist of alcohol dehydrogenase which is the rate-limiting emzyme involved in the conversion of ethylene glycol into toxic metabolites
138
toxic metabolite of ethylene glycol
oxalic acid
139
shape of crystals in urine with ethylene glycol toxicity
maltese cross
140
what level of radiation is needed to be at risk for acute radiation syndrome
>200 rads (2 Gy)
141
what is the first system to show injury in acute radiation syndrome
hematopoeitic
142
when should lymphocyte level be measured after acute radiation exposure
at 48 hours
143
what lymphocyte count indicates poor prognosis 48 hours after radiation exposure
ALC<1500-> poor prognosis
144
ketosis without acidosis
isopropyl alcohol
145
what is responsible for the elevated osmolar gap in isopropyl alcohol toxicity
acetone
146
treatment of isopropyl alcohol ingestion
supportive
147
what substance is responsible for toxic effects of methanol
formic acid
148
what can be used to reverse dabigatran if praxbind isn't available
hemodialysis
149
what types of anesthetics are more allergics- esters or amides
esters because they are broken down to PABA which is a known allergen
150
examples of amides
lidocaine, bupivicaine (two Is)
151
most cardiotoxic of all topical anesthetics
bupivicaine
152
what is the toxin in rodenticide
brodifacoum (long-acting anticoagulant)
153
management of small unintentional ingestion of rodenticide
coag studies 48 hours after ingestion
154
indications for oral vitamin K after rodenticide ingestion
INR 5.0 to 9.0 without significant bleeding
155
management of NSAID ingestion
<100mg/kg-> discharge home
| >100mg/kg-> observation x4h
156
level that is considered a massive overdose of NSAIDs
>400mg/kg (about 140 tablets for 70kg human)
157
side effects of NSAID ingestion
mild GI and CNS side effects
158
ingestion of hemlock causes what symptoms
nausea, vomiting, and sympathomimetic effects such as tachycardia, diaphoresis, and anxiety-> parasympathetic findings and paralysis. Severe toxicity from water hemlock can cause intractable seizures and can lead to death.
159
Anthrax treatment
Obiltoxaximab
160
Treatment of stingray bite
Hot water (113F)
161
Treatment of jellyfish bites
Place in vinegar- helps deactivate the nematocysts
162
Elevated lactate + WAGMA- consider what toxicity
Cyanide
163
Bidirectional vtach
Digoxin
164
Febrile illness, headache, myalgia, rash, chills; leukopenia , thrombocytopenia
Ehrlichiosis- treat with doxy
165
XR in HAPE
Patchy infiltrates, usually in right middle lobe
166
Treatment for high altitude cerebral edema
Descent, dexamethasone, hyperbaric
167
Most common cause of death from high altitude illness
HAPE
168
What kind of drug is rocuronium
Nondepolarizing neuromuscular blocker
169
most immediate cause of death in mushroom toxicity
Hypoglycemia
170
Prognosis after toxic mushroom ingestion
Symptoms last >6 hours
171
indications for active rewarming in hypothermia
Indicators for active rewarming include cardiovascular instability, temperature ≤ 32°C (89.6F), impaired thermogenesis, impaired thermoregulation, traumatic or toxicologic peripheral vasodilation, and failure to rewarm by 0.5°C to 2°C per hour
172
type 1 decompression illness
pain in joints and extremities, skin mottling
173
type 2 decomrpession
lungs, heart, CNS, vestibular system, spinal cord
174
type 3 decompression
all of type 2 plus stroke like symptoms from arterial air embolism
175
seizure medicine that causes nystagmus, somnolence, dizziness, GI disturbance at toxic levels
phenytoin
176
seizure medication taht can aso be used antiarrhythmic
phenytoin (class 1b)
177
what is phenytoin bound to
protein bound
178
in which patients should you definitely check a phenytoin level
those suspected to have low albumin
179
phenytoin may be useful for dysrhythmias cuased by what medicaion
digoxin
180
medication that can help with phenytoin toxicity
MDAC
181
Treatment of VPA toxicity
Activated charcoal, L-carnitine, hemodialysis
182
Hard edema and clear blisters- degree of frostbite
Second degree
183
When to stop rewarming in second degree frostbite
Warm until edema is softer and there is only mild erythema
184
Severe pain with rewarming- degree of frost bite
Third degree
185
Nystagmus, coma, ataxia, drowsiness- seizure medication toxicty
Phenytoin
186
Found down in sewage plant
Hydrogen sulfide
187
MC finding in digoxin toxicity
PVC
188
what medication is contraindicated in digoxin toxicity
No calcium for hyperkalemia
189
treatment for venemous fish and stingrays
hot watter immersion (113F), remove spines, leave wounds open for delayed primary closure
190
side effects of octopus bite
paresthesias, flaccid paralysis, and eventual respiratroy failure- supportive care
