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Toxicology > Toxicdromes > Flashcards

Toxicdromes Flashcards

1
Q

What are the symptoms of Cholinergic toxidrome?

A

CNS depression, Syncope,Coma, Miosis (Pinpoint pupil), Bronchospasm, Wheezing, Pulmonary edema, Bradycardia, Hypotension, Hyper salivation, Vomiting, Diarrhea, Constipation, Urine retention, Sweating, Hyperthermia

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2
Q

What are examples of Cholinergic agents?

A

Organophosphorus compounds, Carbamate, Nicotine, Mushrooms

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3
Q

What does DUMBLES stand for?

A

Diarrhea, Urination, Miosis, Bronchospasm, Lacrimation, Salivation

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4
Q

What are the symptoms of Anti-Cholinergic toxidrome?

A

Agitation, Restlessness, Seizures, Mydriasis (Dilated pupil), Tachycardia, Hypertension, Decreased bowel sounds, Urine retention, Hyperthermia

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5
Q

What are examples of Anti-Cholinergic agents?

A

Atropine, TCA, Neuroleptics (Phenothiazines), Carbamazepine

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6
Q

What are the symptoms of Sympathomimetic toxidrome?

A

Agitation, Restlessness, Seizures, Mydriasis (Dilated reactive pupil), Tachycardia, Hypertension, Hyperactive bowel sounds, No urine retention

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7
Q

What are examples of Sympathomimetic agents?

A

Theophylline, Cocaine, Amphetamine

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8
Q

What are the differences between Anti-Cholinergic and Sympathomimetic toxidromes?

A

Anti-Cholinergic: Dry skin, Urine retention, Dilated unreactive pupil. Sympathomimetic: Diaphoresis (sweating), Reactive pupil, No urine retention

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9
Q

What is Opioid Toxicity?

A

A condition resulting from excessive use of opioids, leading to severe physiological effects.

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10
Q

What does CPR + 3H stand for in Opioid Toxicity?

A

CPR + 3H refers to the C/p of Opioid Toxicity, including Coma, pinpoint pupil,Respiratory depression, Hypoxia, hypotension,hyporeflexia

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11
Q

What are the classifications of opioids?

A

Opioids can be classified as • • •Endogenous (e.g., Endorphins), •Exogenous:1-Natural (e.g., Opium), 2-Semi-synthetic (e.g.,Heroin&oxycodone)
3-Synthetic (e.g., Tramadol,Methadone& Mepridine)

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12
Q

What are the uses of opioids?

A

Opioids are used for strong pain relief, anti-diarrheal agents(e.g., Di-phenoxylate), and as anti-tussives(e.g., Codeine)

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13
Q

What is the mechanism of action of opioids?

A

Opioids act on opioid receptors in the brain and spinal cord to produce analgesia.
•Mu: spinal & brain analgesia + euphoria + constipation + respiratory distress
•kappa: spinal analgesia + meiosis & diuresis
•delta: spinal & brain analgesia + cough depression
•sigma

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14
Q

What is the differential diagnosis for opioid toxicity?

A

1-Pinpoint pupil:
•OPC/carbamate”cholinergic”
•pontine hge: hyperpyrexia & Quadriplegiq
2-C/P:
•hypo(glycemia/thermia/oxia)
•CNS depression as alcohol & sedative hypnotics
•Infection
•Trauma

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15
Q

What causes pupillary dilation in opioid toxicity?

A

1-Hypoxic brain
2-Opiod é no miotic as Mepridine & propoxyphene & pentazocine & tramadol
3-Di-phenoxylate + atropine
4-Adulterants+heroin+cocaine

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16
Q

What is the effect of opioids on the respiratory system?

A

Opioids can cause respiratory depression, bradypnea, or apnea due to hypoxia which causes:
1-seizure
2-Mydriasis
3-Arrythmia
4-NCPE

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17
Q

What is the significance of pink frothy sputum in opioid toxicity?

A

Pink frothy sputum can indicate pulmonary edema, which may occur in severe cases.

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18
Q

What are the gastrointestinal effects of opioids?

A

Opioids can cause constipation and may lead to dyspnea and spasms.

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19
Q

When do withdrawal symptoms occur?

A

Within 6 hours of cessation.

20
Q

What are some clinical manifestations of opioid withdrawal?

A

Anxiety, inc. respiratory rate+HR+BP, yawning, increased fluid loss that cause dehydration&collapse in form of lacrimation, rhinorrhea, vomiting, diarrhea.

21
Q

What investigations are done for opioid toxicity?

A

1-Qualitative urine screen(specific)
2-routine:
•ABG, electrolytes, and glucose.
•ECG&cardiac enzymes
•X-Ray: chest for PE & abdominal for body packers

22
Q

What is the role of Naloxone in opioid toxicity management?

A

Administer the lowest practical dose to avoid precipitating withdrawal.

23
Q

What are the risks associated with emesis in opioid withdrawal?

A

Emesis may lead to aspiration pneumonia in patients who do not regain consciousness.

24
Q

What is the goal of Naloxone administration?

A

Adequate spontaneous ventilation, not complete arousal.

25
Q

What are the dosing guidelines for Naloxone?

A

1-2 mg in adults and 0.1 mg/kg in children, up to 2 mg every 5 minutes.

26
Q

What are some radio-opaque substances visible on X-ray?

A

Chloral hydrate, heavy metals, phenothiazines, and enteric sustained release coated preparations.

27
Q

What is the purpose of decontamination?

A

To prevent absorption according to route of exposure and delay time.

28
Q

What are the types of surface injuries?

A

Dermal injury to the skin (corrosive) and lipid soluble substances.

Examples include OPC and Phenol.

29
Q

What are the steps to manage dermal exposure?

A
  1. Protect yourself.
  2. Remove clothes.
  3. Wash skin with water and soap for at least 15 minutes.
  4. Avoid rubbing or scrubbing.
  5. Cut hair in case of OPC scalp exposure.
30
Q

What should you do in case of eye exposure?

A

Act quickly by washing the eye with copious amounts of water or saline and remove contact lenses.

Refer to an ophthalmologist in serious cases.

31
Q

What are the steps to manage pulmonary (inhalation) exposure?

A
  1. Protect yourself.
  2. Remove the victim from exposure.
  3. Provide respiratory care.
32
Q

What can disturbed consciousness level lead to during gastric lavage?

A

Aspiration pneumonia.

33
Q

What complications can arise from gastric lavage?

A

1-During Introduction:
.Bradycardia(Atropine in digitalis toxicity)
•mechanical gastrointestinal injury
•faulty passage to trachea, •laryngospasm, and cyanosis.
•HTN+Tachycardia in conscious
2-During procedure:
•Hyponatremia
•Aspiration pneumonia

34
Q

What are the indications for performing gastric lavage?

A

Massive overdose or highly toxic substance ingestion

35
Q

What indications of delayed gastric lavage?

A

1-Delayed gastric emptying
2-sedative hypnotics
3-concretions(salicylates & carbamazepine)
4-elimination in git (opiates & methyl alcohol)

36
Q

What are the contraindications for gastric lavage?

A

1-Toxin: Corrosive substances, foaming substances.
2-patient:recent gastric surgery, esophageal varices, active bleeding, and ulcers,disturbances of consciousness,arrhythmia,shock&RF

37
Q

What is the recommended fluid for gastric lavage?

A

Saline is preferred over tap water.

38
Q

What is Activated Charcoal?

A

An extremely effective adsorbent for nearly all poisons.

39
Q

What are the contraindications for Activated Charcoal?

A

PHAILS:
•Pesticides
•Hydrocarbons
•Alcohol, Acids, Alkalis
•Iron, Heavy Metals(lead&mercury),
•Lead&lithium
•Solvents

40
Q

What are the complications of using Activated Charcoal?

A

Adsorption of oral medication, constipation, and intestinal obstruction.

41
Q

Why should alcohol, acid, alkali not be treated with Activated Charcoal?

A

They can:
1-worse mediastinitis and peritonitis, 2-mask views in endoscopy
3-not effective.

42
Q

What are the indications for using hemodialysis?

A

Low:1-Vd 2-PPB 3-Mw + impaired kidney
As:
•Lithium
•ethylene glycol
•theophylline
•Salicylates
•Alcohol
•Potassium
•long acting barbiturates

43
Q

What complications can arise from hemodialysis?

A

Complications include infection, air embolism, and bleeding tendency due to heparin, hypotension, elimination of therapeutic drug

44
Q

What is the indication of urine pH manipulation?

A

Weak acids:
•salicylates
•long acting barbiturates
•poison:hemolysis + rhabdomyolysis

45
Q

What are the precautions for hemodialysis?

A

Precautions include maintaining urine pH between 7.5 - 8, urine output of 300 - 500 ml/hr, and normal kidney function.

Monitoring potassium levels is also essential.

46
Q

What drugs are indications for hemoperfusion?

A

1-low Vd
2-high PPB
3-high Mw

Toxicology (2 decks)

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