Toxicology 1: Introduction Flashcards

1
Q

Who has most ingestions?

A

Children under 17

but only 10% are fatal (accidental)

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2
Q

Childhood ingestions are usually ___ , ____, and ____

A

Single
Known
Promptly recognized

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3
Q

What are most commonly ingested products in children?

A

1) Plants
2) Cleaning products
3) Cough / cold preps
4) Perfume / colognes

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4
Q

In adolescents and adults, toxic ingestions usually represent ___ or ____

A

Substance abuse

Suicide attempts

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5
Q

Adult/adolescent ingestions are usually ___, ____, ___, and with ___

A

Multiple substances
Intentional
Unknown
Delayed recognition

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6
Q

Most common potential route of toxic exposure?

A

Ingestion, then dermal

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7
Q

What is the basic approach to the patient?

A
  • Substance
  • Amount
  • Route of ingestion
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8
Q

With children, if toxin is unknown what do you do?

A

identify all meds (including OTC) and household products in the vicinity and those taken by caretakers and relatives

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9
Q

What is a toxidrome?

A

a constellation of signs and symptoms deferrable to a single drug overdose

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10
Q

Does a toxic screen cover all the drugs?

A

NO!

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11
Q

What are the 5 methods of treatment principles?

A
  • Provide supportive care
  • Prevent absorption
  • Enhance elimination
  • Interrupt or alter metabolism
  • Provide specific antidotes
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12
Q

If you want to get rid of an acidic toxin, what do you do?

A

Alkalinize the urine

Acid + Base = hydrophilic = goes to kidney to be peed out

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13
Q

Why alter metabolism?

A

if metabolite is extremely toxic, such as anti freeze

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14
Q

What is initial management for toxic overdose?

A

Airway
Breathing
Circulation
Drugs

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15
Q

What is the adult tox drug cocktail?

A
  • Thiamine (avoid wernickes encephalopathy)
  • D5W (for hypoglycemia)
  • Naloxone (for narcotic OD)
  • Flumazenil (for Benzos)
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16
Q

How does ipecac work?

A

Local gastric irritant and stimulator of chemo trigger zone

17
Q

Who benefits from ipecac?

A

Alert patients without contraindications

18
Q

When is ipecac useful?

A

Within 4-6 hours of ingestion

19
Q

What are the 5 relative ipecac contraindications?

A
  • Seizure inducing drugs
  • Hydrocarbons (gasoline, grease)
  • Rapid coma inducing drugs
  • Pregnancy
  • Severe bradycardia
20
Q

What is the absolute contraindications for ipecac?

A

Children under 6 months
Seizing or comatose patients
Corrosive substances (drain-o)

21
Q

What is gastric lavage?

A

Put water in, pull water out

22
Q

How do you gastric lavage with children?

A

Use saline (risk of hyponatremia with kids)

23
Q

What is the absolute contraindication for gastric lavage?

A

Unprotected airway

24
Q

What is the relative contraindication for gastric lavage?

A

Hydrocarbons and corrosives

25
Q

What are the complications of gastric lavage?

A

Aspiration pneumonia and bradycardia

26
Q

Administer activated charcoal cautiously in what patients?

A

Ileus, must check for presence of bowel sounds due to risk of toxic megacolon

27
Q

How does activated charcoal work?

A

High surface area allows adsoroption of toxic substances thus preventing their absorption via the GI tract

28
Q

What is the most common a/e of charcoal?

A

constipation- give with sorbitol (osmotic laxative)

29
Q

Activated charcoal does NOT work with what?

A
  • Heavy metals
  • Alcohols
  • Hydrocarbons

(cyanide, organic solvents, iron, alcohols, lithium, minerals)

30
Q

Cathartics are useful for what?

A

post pyloric sphincter toxins

31
Q

Cathartics are contraindicated with what?

A

Corrosives

32
Q

What are 3 examples of cathartics?

A
  • Magnesium citrate
  • Sorbitol
  • Magnesium sulfate
33
Q

What is most often used cathartic?

A

Polyethylene glycol

34
Q

Cathartics is good for what?

A
  • ingestion of SR products
  • ingestion of small foreign bodies
  • swallowed masses
35
Q

Ideal time for cathartics?

A

4-6 hours post SR drug