Tox (psyche, opiods, etoh)

Question 1

Overdose of this class of drugs leads to antimuscarinic effects, vasodilation, as well as slowed conduction in the heart and depressed cardiac contractility. What is this drug? How do you treat? what is important to remember?

Answer 1

TCAs - treat with Norepi for hypotension and sodium bicarb for cardiac toxicityDON’T GIVE PHYSOSTIGMINE to overcome antimuscarinic effects!!!!!

Question 2

Patient taking MAOIs presents with hyperthermia, muscle rigidity, myoclonus and hyperreflexia. What is the name of this condition? how do you treat it?

Answer 2

serotonin syndromegive Cyproheptadine (5HT2 receptor antagonist) + benzos for seizures and agitation

Question 3

Schizophrenic patient presents with muscle rigidity, hyperthermia, metabolic acidosis, and confusion. What drugs were they taking? Name of this condition? Treament?

Answer 3

antipsychotics leading to neuroleptic malignant syndrometreat with Bromocriptine (antidote) and dantrolene (helps with profound muscle rigidity)

Question 4

Patient presents with fever, encephalopathy, unstable vitals, elevated CPK, and rigid muscles. What drugs caused this?

Answer 4

antipsychotics - neuroleptic malignant syndromeThis is the mnemonic: FEVER (Fever, Encephalopathy, Vitals unstable, Elevated CPK, Rigid muscles)

Question 5

Respiratory depression, apnea, and small pupils. Drug intox? treatment?

Answer 5

opiods!Naloxone or Nalmefene

Question 6

Patient on oral antidiabetic drugs presents with hypoglycemia. What two agents are most likely responsible? treatment?

Answer 6

sulfonylureas and meglitinides (secretagogues)give concentrated glucose bolus - if that doesn’t work give IV octreotide (antagonizes insulin release) - Diazoxide is an alternative, does the same thing

Question 7

Of the 5 major sources of air pollution, what accounts for over half? Name the other 4

Answer 7

Carbon monoxide (52%)sulfur oxideshydrocarbonsnitrogen oxidesparticulate matter

Question 8

Which substance is responsible for the most deaths due to poisoning in the US?

Answer 8

carbon monoxide

Question 9

which direction does Carbon monoxide shift the oxygen saturation curve?

Answer 9

LEFT! - CO causes relaxed conformation causing O2 to bind with high affinity (can’t deliver O2 to tissues)

Question 10

patient presents with headache, confusion, trouble seeing, tachycardia, tachypnea and soon dies from respiratory failure - what drug most likely caused this? treatment?

Answer 10

carbon monoxide100% O2 for 80 min or 20 min with hyperbaric O2

Question 11

Patient presents with cough, stridor, and wheezing and you suspect contact with an irritant gas (like chlorine, ammonia, nitrogen oxides etc). How do you treat?

Answer 11

100% oxygen

Question 12

Patient presents with disinhibition, lethargy, ataxia, stupor, and impaired judgment. What substance is he taking? What is seen in blood work? How do you treat?

Answer 12

ethanol - increased anion gab metabolic acidosisthiamine to prevent Wernicke-Korsakoff syndrome, IV dextrose, correction of electrolyte balanceIf just acute ingestion, just maintain vitals and prevent aspiration

Question 13

Patient presents with severe acidosis, retinal damage, and blindness. You find high levels of formic acid in his blood. Drug intox? Most common cause of death? treatment?

Answer 13

methanol (formic acid is metabolite)death from sudden cessation of respirationtreat with ethanol (saturates alcohol dehydrogenase and reduces production of formic acid), or Fomepizole (inhibits the enzyme directly)bicarb for acidosis and hemodialysis may be necessary

Question 14

Patient presents with severe acidosis and renal damage. You find high levels of oxalate in his blood. Drug intox? treatment?

Answer 14

ethylene glycol (antifreeze) - metabolized to toxic aldehydes and oxalatetreat with ethanol or fomepizole

Question 15

Patient with osmolar gap is most likely taking what two substances? What other substances can cause it?

Answer 15

methanol or ethylene glycolalso acetone, ethanol, isopropanol

Question 16

What is the method of action of a drug that can be used in terrorist attack?

Answer 16

cholinesterase inhibitors (like insecticides)

Question 17

Patient presents with diarrhea, inc urination, miosis, bradycardia, emesis, lacrimation and salivation. What drugs did he most likely take? treatment?

Answer 17

organophosphates (insecticides) -> muscarinic overactivation (DUMBELS)Atropine in large doses or Pralidoxime if given before ageing

Question 18

How is treatment different for carbamate insecticides vs organophosphates?

Answer 18

carbamates just get treated with atropine because unlike organophosphates, the inhibition of acetylcholinesterase is short lived and spontaneously reversible