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Rosh Review > Tox > Flashcards

Tox Flashcards

1
Q

how to dose naloxone drip

A

2/3 dose required to reverse resp depression

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2
Q

long acting mu receptor antagonist

A

naltrexone (effect for 72 hours)

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3
Q

estimated lethal dose of salicylates

A

> 500mg/KG

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4
Q

how to obtain labs in patient with salicylate tox

A

obtain level followed by q2h levels if levels continue to rise

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5
Q

goal of urination in salicylate toxicity

A

alkalinize the urine

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6
Q

salicylate doses that indicate need for HDS in acute and chronic toxicity

A
  1. acute= 100mg/dl

2. chronic= 50mg/dl

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7
Q

for every 50mL NaHCO3, how much serum pH increase by?

A

by 0.1

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8
Q

3 things you can take salicylate tox from

A
  1. aspirin
  2. wintergreen
  3. bismuth subsalicylate
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9
Q

mixed resp alkalosis and anion gap metabolic acidosis

A

salicylate toxicity

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10
Q

VSA that can occur with clonidine overdose

A

hypertension

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11
Q

hallmark feature of cyanide poisoning

A

severe metabolic acidosis

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12
Q

hyperventilation, bradycardia, hypotension after smoke exposure

A

cyanide poisoning

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13
Q

pits of apricots, bitter almond, cherry, and peach can cause

A

cyanide poisoning

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14
Q

mechanism of cyanide poisoning

A

within the mitochondria, cessation of electron transport chain and oxidative phosphorylation inhibiting cellular respiration and decreasing ATP

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15
Q

BM suppression, hepatotoxicity, pancreatitis from immunosuppressant drug- toxicity?

A

azathioprine

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16
Q

hyperkalemia, nephrotoxicity can occur from what rejection drug toxicity

A

cyclosporine

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17
Q

level of elemental iron that warrants deferoxamine

A

500mcg/dl

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18
Q

indications for deferoxamine for iron toxicity

A
  1. level >500mcg/fdl
  2. shock
  3. vomiting/diarrhea
  4. altered mental status
  5. elevated anion gap MA
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19
Q

prognosis of patients with iron toxicity that don’t vomit within first 6 hours

A

good prognosis

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20
Q

tinnitus in aspirin toxicity- reversible or irreversible

A

reversible

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21
Q

toxic metabolite of methanol

A

formic acid

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22
Q

ingestion + visual snowstorm

A

methanol

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23
Q

formula for expected serum osmolality

A

2xNA + BUN/2.8 + glu/18+ ethanol/4.6

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24
Q

bilateral cranial neuropathies and symetric descending muscle weakness

A

botulism

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25
Q

inhibits ACh release at presynaptic receptors- tox

A

botulism

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26
Q

MC valve involved in endocardititis

A

tricuspid

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27
Q

MC pathogen involved in native valve endocarditis (not from drugs)

A

streptococci, mitral valve

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28
Q

MC pathogen in endocarditis from IVDU

A

s. aureus, tricuspid

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29
Q

GI malignancy + endocarditis

A

s. bovis

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30
Q

how do TCAs cause cardiac toxicity

A

blocking fast inward sodium channels

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31
Q

managment of TCA with widened QRS

A

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

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32
Q

inhibition of Na-K ATPase channel is how what drug works

A

digitalis

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33
Q

cough medicine that presents similar to TCA overdose

A

benzonatate

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34
Q

cold medicine with similar effects to PCP

A

dextremethorphan

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35
Q

bacterial organism associated with iron toxicity

A

yersinia (feeds on iron)

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36
Q

physical appearance of brown recluse

A

violin shaped mark on thorax, 3 pairs of eyes

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37
Q

hyper-reflexia in lower>upper extremities

A

Serotonin syndrome

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38
Q

fluoxetine and dextromethorpan together can cause

A

serotonin syndrome

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39
Q

treatment of serotonin syndrome

A

BZDs, cyproheptadine

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40
Q

lead pipe rigidity

A

neuroleptic malignant syndrome

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41
Q

treatment of malignant hyperthermia

A

dantrolene

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42
Q

toxic metabolites of ethylene glycol

A

oxalic acid

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43
Q

osmolar gap with normal anion gap

A

isopropanol

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44
Q

blurry yellow vision with nausea, vomiting, and abdominal pain

A

digoxin toxicity

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45
Q

cardiac arrest with digoxin toxicity- treatment

A

20 vials of digoxin antibody

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46
Q

poor prognostic indicator in digoxin toxicity

A

hyperkalemia

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47
Q

PVCs, PAT with AV block, bidirectional ventricular tachycardia- toxicity

A

digoxin

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48
Q

what electrolyte abnormality increases risk of digoxin toxicity

A

hypokalemia

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49
Q

treatment for lead toxicity

A

succimer

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50
Q

BLL (lead)>70 is indication for what

A

inpatient treatment for lead toxicity

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51
Q

inpatient treatment for lead toxicity

A

dimercaprol followed by CaNa2EDTA

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52
Q

outpatient treatment for lead toxicity

A

oral succimer

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53
Q

herbicide that is activated by sunlight and affects the lungs, causing pulmonary fibrosis and respiratory failure

A

paraquat

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54
Q

opiate that causes mydriasis in overdose

A

meperidine

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55
Q

HD indications for aspirin toxicity

A 
level >100
coma 
rising levels despite alkalinization
renal failure
pulm edema
altered mental status
clinical deterioration
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56
Q

“silo filler’s” disease

A

methemoglobinemia

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57
Q

endpoint for treatment of organophosphate poisoning with atropine

A

drying of secretions

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58
Q

Fe 3+ in which hgb cannot bind O2

A

methemoglobinemia

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59
Q

how does pralidoxime work

A

regenerates cholinesterace activity at neuromuscular sites

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60
Q

dapsones, antimalarials, nitrates, “-aines” cause what toxicity

A

methemoglobinemia

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61
Q

hyperammonemia is suggestive of

A

VPA toxicity

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62
Q

management of valproic acid toxicity

A

l-carnitine

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63
Q

indications for HD With valproic acid toxicity

A

severe (level > 1300 mg/L, cerebral edema, shock) or is cases of acute hyperammonemic encephalopathy, pH < 7.10, and coma or respiratory depression.

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64
Q

indications for HD with lithium toxicity

A

renal failure, inability to handly aggressive hydration, severe CNS toxicity, level >4 in acute toxicity, level >2 in chronic toxicity

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65
Q

to prevent nitrogen narcosis, what depth do basic training for diving allow people to dive to

A

60feet

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66
Q

confusion altered mental status with descent in a diver

A

nitrogen narcosis

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67
Q

rotten egg odor with cyanide like affect

A

hydrogen sulfide

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68
Q

hay odor in textiles

A

phosgene

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69
Q

general side effect of toxic fumes, gases, and vapors

A

pulmonary edema

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70
Q

TCAs have what effects

A

anticholinergic

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71
Q

anticholinergic effects

A

mydriasis, dry, hot, flushed skin, tachycardia, decreased or absent bowel sounds, and urinary retention

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72
Q

mechanism of TCAs on heart

A

Na channel blockade

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73
Q

TCA toxicity is worsened by what acid base status

A

acidosis

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74
Q

lead pipe rigidity

A

NMS

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75
Q

compare serotonin syndrome vs NMS

A

serotonin-clonus, NMS- lead pipe

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76
Q

treatment for akathisia

A

benadryl, benztropine

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77
Q

how to calculate osmolar garp

A

measured- calculated osm

78
Q

what is considered a positive osmolar gap

79
Q

ketosis without acidosis

A

isopropanol

80
Q

toxic metabolite in tylenol toxicity

A

NAPQI (normally broken down by glutathione)

81
Q

manic symptoms, mydriasis, tachycardia, nystagmus, visual hallucinations

A

dextromethorpan overdose

82
Q

blood pressure in clonidine overdose

A

transient hypertension from alpha effects and then central effects cause hypotension, etc

83
Q

muscle rigidity + elevated CK

84
Q

toxic dose of ASA

A

200-300mg/kg

85
Q

ASA level indicating need for dialysis

86
Q

what two co-factor adjuncts should be given in ethylene glycol ingestion

A

thiamine and pyridoxine

87
Q

indications for HD with ethylene glycol ingestion

A

ethylene glycol>50
anion gap >20
initial pH less than 7.3

88
Q

what to think about in a patient with isolated tachypnea

A

salicylate toxicity

89
Q

define hypothermia

A

core body temp < 35

90
Q

at what temperature shoudl hypothermic patients be warmed to to asess if they should be resuscitated

91
Q

patient is 32C and remains asystolic- management

A

call it, unlikely to be revived in asystole

92
Q

how does iron cause damage

A

uncoupling of oxidative phosphorylation causes anaerobic metabolism

93
Q

management of dystonia for haldol

A

benztropine or benadryl

94
Q

first line treatment for beta blocker overdose

A

glucagon bolus followed by a drip

95
Q

BB vs CCB overdose

A

bb- normal glucose

CCB- hyperglycemia

96
Q

musty hay or freshly grown grass

97
Q

main injury from phosgene

A

turns into hydrochloric acid and causes delayed pulonary injury leading to edema and inflammation

98
Q

anticholinergic mnenomic

A 
Mad as a hatter
Blind as a bat (mydriasis)
Red as a beet
Hot as a hare
Dry as a bone
99
Q

cholinergic mnemonic

A 
Salivation
Lacrimation
Urination
Diarrhea
Diaphoresis
GI upset
Emesis
killer bs- bronchoospasm, bronchorrea, bradycardia
100
Q

treatment of anticholinergic toxicity

A

supportive of physostigmine

101
Q

how long after cessation of alcohol do alcohol seizures occur

A

6-48 hours after stopping but can occur up to five days after

102
Q

EMTALA is part of what law

A

consolidated Omnibus Budget Reconciliation Act of 1985

103
Q

who cannot recieve methylene blue

A

G6PD defic- causes anemia

104
Q

treatment for metHgb in patients with G6PD

A

blood tranfusions to dilute blood with metHgb

105
Q

feared side effect from fentanyl for procedural sedation

A

chest wall rigidity, needs neuromuscular blockade, narcan won’t work

106
Q

treatment of CCB overdose

A

glucagon/insulin, calcium lipid emulsion, ECMO

107
Q

antidote for valproate toxicity

108
Q

BG in CCB toxicity

A

hyperglycemia

109
Q

three contraindications of physostigmine

A
  1. asthma (causes bronchoconstriction)
  2. seizures- lowers seizure threshold
  3. slows conduction (contraindicated in AV block, NA channel blockers)
110
Q

when to use physostigmine

A

in patients who are very altered from anticholinergic toxicity and you need to help distinguish what is going on

111
Q

what is pyridozxine an antidote for

A
  1. INH

2. ethylene glycol

112
Q

what does quinine do

A

causes ototoxicity and blindness

113
Q

3 indications to use digifab

A
  1. ventricular dysthryhtmias
  2. 3rd degree av block
  3. hyperkalemia >5
114
Q

what is leucovorin used as an antidote for

A
  1. methotrexate

2. methanol toxicity

115
Q

what is glucarpidase an antidote for

A

MTX toxicity

116
Q

antidote for cesium

A

prussian blue

117
Q

when should sodium nitrite not be used for cyanide poisoning

A

if CO may be on board because the MetHgb may bind to CO more strongly

118
Q

what is considered the antiviral for pox virus

A

tecovirimat

119
Q

what is obiltoxaximab used for

A

inhalation anthrax

120
Q

treatment of body packers

A

whole bowel irrigation with polyethylene glycol, if ruptures-> OR

121
Q

withdrawal of dopamine agonists can cause what

A

neuroleptic malignant syndrome

122
Q

antibiotic that can can cause tyramine reaction

123
Q

what numbing medication can be used on open wounds

124
Q

what numbing medication is used for intact skin

125
Q

max dose of lidocaine

126
Q

max dose of lidocaine w. epi

127
Q

concentration of 1% lidocaine

128
Q

what type of medication is succinylcholine

A

depolarizing neuromuscular blocker

129
Q

3 conditions in which a lower dose of succinylcholine is needed

A
  1. organophosphate toxicity
  2. eaton lambert
  3. hypothyroidism
130
Q

what condition is a bigger dose of succinylcholine warranted

131
Q

garlic smell

A

arsine gas poisoning

132
Q

semiconductor facility toxic fumes

A

arsine gas poisoning

133
Q

classic triad of arsine poisoning

A
  1. abdominal pain
  2. hematuria
  3. jaundice
134
Q

first line antidote for iron overdose

A

deferoxamine

135
Q

medications that reduce immunosuppressant effect of cyclosporine and why

A

phenytoin, nafcillin, phenobarbital, rifampin-> induce CYP45 enzymes which reduces half life of cyclosporine

136
Q

what medication may be able to be given in severe brown recluse bites

A

dapsone- but really only prevents worsening of local infection, and there is no antivenin

137
Q

how does fomepizole work

A

competitive antagonist of alcohol dehydrogenase which is the rate-limiting emzyme involved in the conversion of ethylene glycol into toxic metabolites

138
Q

toxic metabolite of ethylene glycol

A

oxalic acid

139
Q

shape of crystals in urine with ethylene glycol toxicity

A

maltese cross

140
Q

what level of radiation is needed to be at risk for acute radiation syndrome

A

> 200 rads (2 Gy)

141
Q

what is the first system to show injury in acute radiation syndrome

A

hematopoeitic

142
Q

when should lymphocyte level be measured after acute radiation exposure

A

at 48 hours

143
Q

what lymphocyte count indicates poor prognosis 48 hours after radiation exposure

A

ALC<1500-> poor prognosis

144
Q

ketosis without acidosis

A

isopropyl alcohol

145
Q

what is responsible for the elevated osmolar gap in isopropyl alcohol toxicity

146
Q

treatment of isopropyl alcohol ingestion

A

supportive

147
Q

what substance is responsible for toxic effects of methanol

A

formic acid

148
Q

what can be used to reverse dabigatran if praxbind isn’t available

A

hemodialysis

149
Q

what types of anesthetics are more allergics- esters or amides

A

esters because they are broken down to PABA which is a known allergen

150
Q

examples of amides

A

lidocaine, bupivicaine (two Is)

151
Q

most cardiotoxic of all topical anesthetics

A

bupivicaine

152
Q

what is the toxin in rodenticide

A

brodifacoum (long-acting anticoagulant)

153
Q

management of small unintentional ingestion of rodenticide

A

coag studies 48 hours after ingestion

154
Q

indications for oral vitamin K after rodenticide ingestion

A

INR 5.0 to 9.0 without significant bleeding

155
Q

management of NSAID ingestion

A

<100mg/kg-> discharge home

>100mg/kg-> observation x4h

156
Q

level that is considered a massive overdose of NSAIDs

A

> 400mg/kg (about 140 tablets for 70kg human)

157
Q

side effects of NSAID ingestion

A

mild GI and CNS side effects

158
Q

ingestion of hemlock causes what symptoms

A

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
Q

Anthrax treatment

A

Obiltoxaximab

160
Q

Treatment of stingray bite

A

Hot water (113F)

161
Q

Treatment of jellyfish bites

A

Place in vinegar- helps deactivate the nematocysts

162
Q

Elevated lactate + WAGMA- consider what toxicity

163
Q

Bidirectional vtach

164
Q

Febrile illness, headache, myalgia, rash, chills; leukopenia , thrombocytopenia

A

Ehrlichiosis- treat with doxy

165
Q

XR in HAPE

A

Patchy infiltrates, usually in right middle lobe

166
Q

Treatment for high altitude cerebral edema

A

Descent, dexamethasone, hyperbaric

167
Q

Most common cause of death from high altitude illness

168
Q

What kind of drug is rocuronium

A

Nondepolarizing neuromuscular blocker

169
Q

most immediate cause of death in mushroom toxicity

A

Hypoglycemia

170
Q

Prognosis after toxic mushroom ingestion

A

Symptoms last >6 hours

171
Q

indications for active rewarming in hypothermia

A

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
Q

type 1 decompression illness

A

pain in joints and extremities, skin mottling

173
Q

type 2 decomrpession

A

lungs, heart, CNS, vestibular system, spinal cord

174
Q

type 3 decompression

A

all of type 2 plus stroke like symptoms from arterial air embolism

175
Q

seizure medicine that causes nystagmus, somnolence, dizziness, GI disturbance at toxic levels

176
Q

seizure medication taht can aso be used antiarrhythmic

A

phenytoin (class 1b)

177
Q

what is phenytoin bound to

A

protein bound

178
Q

in which patients should you definitely check a phenytoin level

A

those suspected to have low albumin

179
Q

phenytoin may be useful for dysrhythmias cuased by what medicaion

180
Q

medication that can help with phenytoin toxicity

181
Q

Treatment of VPA toxicity

A

Activated charcoal, L-carnitine, hemodialysis

182
Q

Hard edema and clear blisters- degree of frostbite

A

Second degree

183
Q

When to stop rewarming in second degree frostbite

A

Warm until edema is softer and there is only mild erythema

184
Q

Severe pain with rewarming- degree of frost bite

A

Third degree

185
Q

Nystagmus, coma, ataxia, drowsiness- seizure medication toxicty

186
Q

Found down in sewage plant

A

Hydrogen sulfide

187
Q

MC finding in digoxin toxicity

188
Q

what medication is contraindicated in digoxin toxicity

A

No calcium for hyperkalemia

189
Q

treatment for venemous fish and stingrays

A

hot watter immersion (113F), remove spines, leave wounds open for delayed primary closure

190
Q

side effects of octopus bite

A

paresthesias, flaccid paralysis, and eventual respiratroy failure- supportive care

Rosh Review (17 decks)

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