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toxicology 101 Flashcards

1
Q

when to give whole bowel irrigitation

A

when ingestiton of long acting and deadly and large qte
- buproprion , lithium, salicylate

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2
Q

poorly absorbed toxins contraindications to decontamination

A
  1. salts ( K, NA, Mg)
  2. alcohols
  3. metals( iron,pb, lithium)
  4. hydrocabrons
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3
Q

which drugs can be dialable drugs ?

A

(small, charged, not protein bound, small volume of distribution)

Toxic alcohols, ASA, Lithium, Acetaminophen, metformin, CCBs, BBs

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4
Q

which drugs can be eliminated by multidose activated charcoal

A

drugs cleared by enterohepatic circulation

  • Phenobarbitol
  • Carbamazepine
  • Theophylline
  • Caffeine
  • Phenytoin
  • ASA
  • Quinine
  • Dapsone
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5
Q

acetaminophen antidote

A

NAC

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6
Q

ASA antidote

A

hco3

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7
Q

bb/ccb antidote

A

calcium
glucoacon
insulin
intralipid

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8
Q

benzo antidote

A

flumazenil

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9
Q

cyanide antidote

A

hydroxycobalamin
sodium thiosulfate

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10
Q

irona ntidote

A

defroxamin

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11
Q

isoniazide antidote

A

pyridoxine

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12
Q

local anest antidote

A

intralipid

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13
Q

lipid soluble drugs ( atenolol, buproprion, ccb, amitriptyline) antidote

A

intralpid

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14
Q

methmeglobinemia

A

methylene blue

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15
Q

organophosphate

A

atropine
pralidoxime

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16
Q

TCA antidote

A

hco3
intralipid

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17
Q

toxic etoh antidote

A

fomepizole
thiamine
folate

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18
Q

valproate acid antidote

A

l carnitidine

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19
Q

sulfonylurea antidote

A

octreotide

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20
Q

ANTICHOLINERGIC PRESENTATION

A
  • mad as hatter = confused
  • hot as dessert = hyperthermia
  • dry as bone = dry mouth, urinary retention
  • stuffed like a turnip = no bowel sounds, constipation
  • blind as bat = mydriasis
  • tachycardia
  • red as beet
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21
Q

TCA treatment toxicity

A

decontamination with activated charcoal
no increased elimination
no antidote

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22
Q

TCA vs seizure, what to give and what to avoid and why

A
  • benzos
  • propfol infusion if refractory
  • barb

NO PHENYTOIN AS IT CAN ENHANCE CARDIAC TOXICITTY

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23
Q

TCA VS TREATMENT OF ARRYTHMIA

A

NABICARB 1-2 meq –> when qrs gets narrow , start infusion 3 amsp in a bag of 250 ml/h

if fails –> mgso4
if fails –> lidocaine bolus tehn 1-4mg/min
if fails –> lipid emulsion, VA ecmo

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24
Q

ethylene glycol S&S

A
  • flank pain, oliguria, hematuria
  • hypocalcemia
  • cranial nerve palsy
  • tetany
  • decreased LOC
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25
methynol S&S
decreased LOC retinal injury leading blindness pupillary afferent defect mydriasis ( dilatation) retinal sheen hyperemia of optic disc
26
how to treat toxic alcohol
no decontamiantion can do ng aspirate if within 60 minutes give bicarb to avoid anion to get in end organ tissue inhibition of alcohol dehydrogenase ( fomepizole/ethanol )
27
when do you inhibit alcohol dehydrogenase - methanol level - ethylene glycol - other elements
- >6.2 - >3.2 - recent hx of consumption wht OG - suspicion + ph<7.3, bic <20 or OG or urine oxalatge crystals
28
pH level to start think of HD for toxic etoh
pH <7.15
29
indication of dialysis in toxic etoh ?
* End organ dysfunction (eg. Coma, Seizure, Visual defects, Renal failure) * pH≤7.15 * Persistent metabolic acidosis * High AG metabolic acidosis * Very high level of parent alcohol
30
ethanol intoxication level
4-10
31
isopropyl alcohol treatment ?
supportive !
32
which bzd prefered in alcohol witthdrawal?
diazepam
33
salicyklate tx option - decontaminate - enhance elimination
- decontaminate with charcoal and bowel irrigtation - alkalinize the urine+blood
34
toxicity level for salicylate ?
greater than 2.9-3.6
35
when is Dialysis indicated if patient has one of the following in salicylate toxicity
– Salicylate Levels >7.2mmol/L – Hypoxemia requiring supplemental O2 – A change in mental status – Renal failure (and salicylate level >6.5mmol/L) – Progressive deterioration of vital signs – Severe acid –base or electrolyte imbalance despite appropriate treatment (pH <7.2) – Hepatic compromise with coagulopathy – Volume overload preventing admin of sodium bicarb
36
risk fo acetaminophem hepatotoxicity on your story
* Ingestion of greater than 7.5 – 10 g in 24 hours * Ingestion of greater than 4g in 24 hours AND increased risk of susceptibility to hepatotoxicity (ie. Chronic ETOH use) * Abdominal pain, liver tenderness, nausea, vomiting, jaundice * Supratherapeutic serum acetaminophen concentrations (> 130 mmol/L) * Elevated ALT or AST (> 50 U/L) on presentation
37
how can you treat acetamino toxicity
1. charcoal decontamination if consumed >7.5g( >150 mg/kg) within last 4 hrs 2. NAC protocol (obvs plot against the ~RM normogram)
38
how long should you be off opiods to start naltrexone ?
7-10 days
39
how long should you be in withdrawal to initiate suboxone or IM buprenorphine
12-24 h opoid free to initiate it
40
how to treat CO intoxication
with high o2
41
meds that oculd give you methemoglobinemia
dapsone/septra/nitrate
42
high conditioon would you have a pao2 spo2 mismatch wth low spo2 and high pao2 ?
methemoglobinemia
43
if havce bilateral opacities in globus pallidus, what's your intoxication pattern ?
CO
44
cohb level for co intox
10%
45
someone smelling like almod, what do you think ?
cyanide poisoning
46
treatment for cyanide poisoning ( 3 ) . 1 main + 2. when to use the other 2
hydroxycobalamin. nitrite , sodium thiosulfate. when hydroxycobalamin = unavailable
47
nitroprusside can cause what kindd of intoxication
CN methemoglobinaemia
48
methylene blue contraindications
g6pd and serotonin syndrome
49
if dapsone induced methb , what agent to use.
cimetidine
50
therapeutic window for lithium ?
0.6-1.2
51
tx for digoxin toxicity
- digibind/digifab - decontaminate activated charcoal
52
is digoxin dialyzable ?
no
53
organophosphate poisoning S&S
Muscarinic effects: DUMBELS * Diaphoresis, Diarrhea * Urination * Miotic pupils (SMALL) * Bronchospasm, bradycardia, bronchorrhea * Emesis * Lacrimation * Salivation Nicotinic effects: MATCH * Muscle weakness (paralysis)/fasiculations * Adrenergic stimulation...mydriasis (large pupils) * Tachycardia * CNS-lethargy, seizures, coma, resp depression * HTN
54
neuro effecct ion organophosphate
Nicotinic effects “intermediate syndrome” * 24-96h after exposure * Neck flexion, decreased reflexes, CN abnormalities, prox muscle weakness and resp insufficiency + organophopsphate agent induced delayed neuropathy
55
organophosphate antidote?
atropine
56
difference neuro wise between SS and NMS
SS = hyperactive ( myoclonus, hyperreflexia) NMS = rigidity, hypoeflex
57
tx for serotinergic syndrome
benzos and if fails, cyproheptadine
58
tx for NMS
benzos and can use dantrolene and bromocriptine as adjuct
59
tx for Malignant hyperthemia
dantrolene and rapid cooling + suppotive stuff
60

ICU (4 decks)

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