Tox (metals, poisons, uppers&downers)

Question 1

Patient ate rat poison.What drug? How do you treat?

Answer 1

warfarin - treat with vit K unless pt is actively hemorrhaging then give fresh frozen plasma (vit K won’t work for 6+ hours with a peak affect after 24)

Question 2

Patient working in the plastic and jewelry manufacturing industry presents with transient CNS stimulation with hyperpnea and headache followed by hypoxic convulsions. What were they exposed to? Most likely cause of death? treatment?

Answer 2

cyanide
- respiratory arrest

treat with cyanide antidote kit - hydroxocobalamin which reacts with cyanide to form cyanocobalamin which can be excreted in the urine
(avoid methemoglobin production like in the old kits with sodium nitrite and sodium thiosulfate)

Question 3

how does cyanide poisoning work?

Answer 3

it has a high affinity for Fe+3 so it binds to the heme of cytochrome A and A3 in mitochondria which inhibits cellular respiration -> cytotoxic hypoxia

Question 4

patient ate lots of cassava root and apricot seeds, what should you

Answer 4

cyanide poisoning

Question 5

What compound can return methemoglobin to its ferrous form?

Answer 5

methylene blue

Question 6

How do you treat most poisoning with heavy metals? How do they cause toxicity?

Answer 6

treat with chelating agents

- cause toxicity by reacting with functional groups essential for normal physiological functions

Question 7

Patient presents with wrist drop, anemia, and GIT symptoms. What toxin was he most likely exposed to? what type of anemia?

Answer 7

chronic lead poisoning - plumbismnormo/microcytic hypochromic

Question 8

Treatment of lead poisoning?

Answer 8

diazepam for seizures
mannitol and dex for cerebral edema
chelation with edetate calcium disodium (IV), dimercaprol (IM), or succimer (oral)

Question 9

Southerner comes in after drinking contaminated moonshine. What toxicity are you concerned about? treatment?

Answer 9

arsenic

- chelation with unithiol IV or dimercaprol IM

Question 10

Patient presents with ricewater diarrhea, dehydration, shock and you notice a sweet, garlicky odor in his breath and stools. What are you concerned about?

Answer 10

arsenic poisoning

Question 11

Patient presents with raindrop pattern of hyperpigmentation and hyperkeratosis of his hands and feet. He also has hair loss and bone marrow depression. What is the cause of this? What are you worried about long term?

Answer 11

arsenic poisoning

- cancer can appear years after exposure (lung, skin, liver, kidney, bladder)

Question 12

How do you treat arsine gas poisoning?

Answer 12

say sorry - chelating agents for arsenic dont work

Question 13

Poisoning by what compound can lead to life-threatening hemorrhagic gastroenteritis followed by renal failure?

Answer 13

mercury

Question 14

Patient presents with tremor, neuropsychiatric disturbance, and gingivostomatitis. What toxin are you concerned about? How do you treat?

Answer 14

mercury

- treat acute exposure with unithiol (oral or IV), dimercaprol (IM), or succimer (oral)

Question 15

Child presents with painful erythema of extremities, HTN, diapohresis, anorexia, and miliarial rash. Name of this condition? what causes it?

Answer 15

Acrodynia

- mercury poisoning

Question 16

what drug should you NOT use to treat chronic mercury exposure? why?

Answer 16

IM dimercaprol

- redistributes mercury to the CNS from other tissues

Question 17

child presents with vomiting, GI bleeding, lethargy, and gray cyanosis. What happened to them? How do you treat? What treatment is ineffective?

Answer 17

ate a bunch of iron tablets (iron is NOT an environmental poison)treat with deferoxamine (iron chelator)activated charcoal does NOT work

Question 18

Patient presents with dilated pupils, sweaty skin, and tachycardia. What class of drug did he take?

Answer 18

amphetamine/stimulant

Question 19

what is important to remember when treating tachyarrhythmias of amphetamine intox?

Answer 19

dont give beta blockers without alpha blockage first!

Get unopposed alpha-1 action (vasoconstriction) and BP elevates

Question 20

Patient presents with flushed skin, hyperthermia, dry mucous membranes, blurred vision, pupillary dilation, delirium, and tachycardia. What drug(s) are they on?

Answer 20

anticholinergics (red as a beet, hot as a hare, dry as a bone, blind as a bat, mad as a hatter)

Question 21

How do you treat intox with anticholinergics? Under what condition should you NOT give this treatment? why?

Answer 21

physostigmine

• don’t treat if TCA overdose
• can aggravate cardiotoxicity and result in heart block

Question 22

Patient presents with seizures, bradycardia, hypotension, hypoglycemia. What drug did they OD on?

Answer 22

Propranolol

- most toxic B-blocker (if seizures then probably this one)

Question 23

Patient presents with overdose of propranolol. How do you treat and why?

Answer 23

give IV glucagon (can inc cAMP in cardiac myocytes without the beta-receptor)
- normal agents used to raise BP like B-agonists and atropine generally are ineffective

Question 24

Patient presents with depressed sinus node automaticity and slow AV node conduction, along with reduced CO and BP. what did they overdose on? How do you treat?

Answer 24

calcium channel blockers

- treat with IV calcium to restore depressed cardiac contractility