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Oral Boards > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Tox: smell of bitter almonds

A

cyanide

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2
Q

Tox: smell of garlic

A

organophosphates, arsenic

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3
Q

Nerve agents e.g. sarin cause what toxidrome

A

Cholinergic

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4
Q

Examples of anticholinergic agents

A

atropine, antihistamines, antiparkinson’s meds (benztropine)TCAs, Jimson weed, nightshade

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5
Q

Sympathomimetic medications

A

decongestants (ephedrine, pseudoephedrine), theophylline, ephedra (chinese medicinal)

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6
Q

Calculate AG

A

Na - (HCO3 + Cl)

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7
Q

ABCDEF of Tox

A

airway, breathing, circ, decontamination (skin, eyes - irritgate until neutral pH, clothing), enhanced elimination, focused therapy (antidote)

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8
Q

Activated charcoal; administer within ___. Dose

A

1 hr, 1 g/kg

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9
Q

Charcoal contraindications (4)

A

Non-intact GI tract, unprotected airway, caustic ingestion, hydrocarbon ingestion

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10
Q

Could consider gastric lavage under what circumstances

A

<1 hr since ingestion, fatal amt, no antidote

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11
Q

When can you use urine alkalinization? How is this done?

A

weak acids e.g. salicylates. Sodium bicarb (3 amps in 1L D5W

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12
Q

Toxins amenable to dialysis

A

“I STUMBLE” isopropanol, salicylates, theophylline, uremia, methanol, barbituates, lithium, ethylene glycol

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13
Q

Antidote for methanol and ethylene glycol

A

fomepizole

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14
Q

Antidote for benzos

A

flumazenil

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15
Q

Antidote for anticholinergics

A

physostigmine

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16
Q

Antidote for organophosphates

A

atropine or pralidoxime

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17
Q

Antidote for cyanide

A

nitrites and thiosulfate

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18
Q

Antidote for Iron

A

deferoxamine

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19
Q

Antidote for arsenic or lead

A

BAL (chelator)

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20
Q

Antidote for digoxin

A

digifab

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21
Q

Antidote for rattlesnake bite

A

Crofab

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22
Q

Antidote for beta blockers

A

glucagon

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23
Q

Antidote for TCAs

A

sodium bicarb

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24
Q

Antidote for CCBs

A

calcium, insulin/dextrose

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25
Q

Medication that can cause seizures and its antidote

A

isoniazid -> give pyridoxine

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26
Q

Pediatric ativan and versed dosing for seizure/status

A

ativan 0.1 mg/kg up to 4 mg. Versed 0.2 mg/kg up to 10 mg.

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27
Q

Toxic level of tylenol at 4 hrs

A

150 mg/mL or greater

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28
Q

When can the Rumack-Matthew nomogram not be used

A

chronic toxicity or >24hrs since ingestion

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29
Q

Want NAC to be given within what time frame? What do you do if they’re past that time frame?

A

8 hrs. For presentation >8 hrs, give NAC right away before level comes back.

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30
Q

Dispo for delayed, large APAP OD

A

ICU at a TRANSPLANT center

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31
Q

Febrile + seizure in tox world

A

Salicylates

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32
Q

Indications for dialysis with salicylate OD (4)

A

salicylate >100 mg/dl acutely (60 subacute), noncardiogenic pulmonary edema, seizure, AMS

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33
Q

Ongoing labs for salicylate ingestion

A

q2H
BMP: replace K+ as needed
ABG: ?adequate alkalinization, goal pH 7.5
Salicylate levels: sporadic absorption d/t bezoars

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34
Q

Kid takes grandma’s “heart med” or antihypertensive, or ingestion comes in brady and hypotensive… most likely meds they’ll test and associated lab

A

BB (BG may be low), CCB (BG may be elevated), digoxin (check dig level), clonidine

35
Q

Escalating treatment of BB/CCB OD

A

charcoal, fluids, atropine, glucagon (BB)/calcium (CCB), high dose insulin (0.5-1 U/kg/hr = 10x DKA treatment), pacing, intra-aortic balloon pump

36
Q

yellow vision change = toxic effect of _____

A

digoxin

37
Q

bidirectional V-tach pathognomonic for what

A

cardiac glycoside (e.g. digoxin) toxicity

38
Q

Empiric dosing of digifab

A

10-20 vials (same for adult or child)

39
Q

What is different about managing hyperkalemia in digoxin OD?

A

Avoid CALCIUM. Can –> “Stone heart”. Treat hyperkalemia with digifab (indicated for K >5.0)

40
Q

Escalating treatment of TCA OD

A

Charcoal. Sodium bicarb (1-2 mEq/kg push), repeat until normal QRS. Hold if pH >7.55. Intubation if needed. Benzos for seizures.

41
Q

Toxic effects on antipsychotics and associated treatments

A

HypoTN (fluids), anticholinergic, antidopaminergic (EPS - dystonia, NMS -> give benadryl or benztropine), sodium channel blockade -> long QRS (give NaHCO3)

42
Q

Symptoms of iron toxicity

A

Early 2-6 hrs: corrosive, vom/dia - possibly bloody
Improvement over 12 hrs
Later: get worse, coma, shock, seizure, acidosis, liver failure, death

43
Q

Lead toxicity sx

A

Neuro: lethargy, coma, seizure, ataxia, foot and wrist drop
GI : abd pain, constipation, anorexia
Heme: anemia
Renal: nephropathy

44
Q

Lead toxicity - chelation treatment needs

A

Often once chelator is stopped (which bound serum lead), source of lead within the body continues leaching and levels rise again –> need for OP f/up for repeat lead level, possible need to repeat chelation

45
Q

Clues to methemoglobinemia

A

Pt appears cyanotic, chocolate brown blood (occurs at 15-20% methgb, pulse ox 85%. At 50+% -> dysrhythmias, seizures, coma

46
Q

Triggers for methemoglobinemia

A

benzocaine, dapsone, pyridium, nitrates, aniline dye

47
Q

Methylene blue contraindicated with ____

A

G6PD deficiency (causes hemolysis)

48
Q

Escalating treatments for methemoglobinemia

A

oxygen, methylene blue (20% and symptomatic or 30%+).

Refractory: HBO, exchange transfusion

49
Q

Work up for suspected CO poisoning

A

CMP, CBC, carboxyhgb level, ECG (evidence of ischemia?), ABG, CK (rhabdo?), pregnancy test (changes threshold), CT head (cerebral edema or basal ganglia defects)

50
Q

Indications for HBO with CO

A

CO >25%, pregnancy with fetal distress, LOC, neuro symptoms other than simple HA, abnl neurocog testing, ischemic ECG or cardiac complication.

51
Q

Management of mild to mod CO poisoning

A

100% O2 e.g. NRB mask (5x as long if preg). Repeat COHb level q2-4H until <5% if pregnant or <10% for everyone else

52
Q

Fire + severe metabolic acidosis –> think ____

A

cyanide

53
Q

Brady or tachy?
CO –>
Cyanide –>

A

CO - tachy

Cyanide - brady, hypotension

54
Q

Cyanide poisoning tx

A

Decontaminate incl skin and clothing
Charcoal
If symptoms + presumed cyanide = treat. Options
- Hydroxocobalamin (binds CN)
- Amyl nitrite inhalation (until IV access)
- sodium nitrite (forms cyanmethemoglobin, binding cyanide)
- Sodium thiosulfate: binds #2 –> less toxic
Cyanocobalamin, secreted

55
Q

Hydrocarbons: MC agents

A

oils: lamp oil, kerosene, gas, mineral seal oil

56
Q

Hydrocarbons: effects (4 main systems)

A

Resp: aspiration, pulmonary edema, respiratory arrest
GI: N/v/abd pain
CNS: Confusion, ataxia, lethargy
Card: myocardial sensitization to catechol - don’t give epi, NE, or scare the pt :) Give BB if dysrhythmias

57
Q

When could you discharge a hydrocarbon ingestion

A

accidental, CXR normal, 6hrs monitoring w/o resp effects or other symptoms. Consider repeat CXR around 6 hrs to look for evolution

58
Q

Work up for all ingestions

A

CMP, CBC, APAP, ASA, ETOH, UPT, UA (?crystals)

?ABG, ?CXR

59
Q

Organophosphate treatment

A

atropine: start 0.5-2mg, titrate to secretions, bronchospasm, bronchorrhea - may give 100mg+ eventually!
pralidoxime: regenerates cholinesterase

60
Q

Intubating a organophosphate OD - remember _____

A

No SUCC! (cannot break it down)

61
Q

Ethylene glycol and methanol tx (multistep)

A

Fomepizole/ethanol. NaHCO3 for profound acidosis, serial rechecks and replacement of electrolytes and glucose. Dialysis.

62
Q

Indications for dialysis with ethylene glycol or methanol

A

Elevated osmolal gap, significant acidosis, serum ethylene glycol or ethanol level >20 mg/dL

63
Q

Max single dose (not cumulative) narcan

A

10 mg

64
Q

Level to start narcan drip at

A

2/3 of successful single dose per hour

65
Q

MC agents for anticholinergic OD

A

benadryl, TCA

66
Q

Anticholinergic-induced dystonia or choreoathetoid movements tx

A

benzo

67
Q

Severe anticholinergic with hyperthermia… next steps

A

intubate, neuromuscular blockade, continuous EEG to ensure no sz while on paralytic

68
Q

Physostigmine indications and contraindications

A

Indications: avoid tube, treat seizures, severe agitation
Contra: TCA OD

69
Q

Labs specific to meth/cocaine OD with hyperthermia

A

CK

70
Q

Serotonin syndrome symptoms

A

hyperthermia, flushing, muscle rigidity, AMS, hyperreflexia, incoordination, myoclonus, diarrhea

71
Q

Serotonin syndrome specific labs

A

CK, UA, DIC labs

72
Q

Causes of serotonin syndrome

A

SSRIs, MAOIs, amphetamines incl ecstasy

73
Q

Serotonin syndrome escalating treatments

A

benzos, cooling, intub/neuromusc blockade

74
Q

Serotonin syndrome vs NMS presentation differences

A

little - just serotonergic vs neuroleptic agents as etiology

75
Q

NMS - can consider this pseudoantidote

A

bromocriptine (treats relative dopamine depletion)

76
Q

Valproic acid OD - check what lab

A

ammonia

77
Q

theophyllin + seizure =

A

dialysis

78
Q

What’s weird about iron toxicity presentation?

A

Quiescent middle phase

79
Q

Lead + encephalopathy = _____ therapy

A

BAL and CaNaEDTA

80
Q

Severely acidemic, comatose chemist: toxicity?

A

cyanide

81
Q

Hypothermia mgmt

A

remove wet clothing, warm, monitor core body temp

82
Q

Hypothermia work up

A

look for precipitant; BG, electrolytes, alc, TSH/T4, ABG, ECG, coags, CT head if AMS/evidence of trauma

83
Q

Hypothermic with cardiac arrest mgmt

A

call for cardiac or thoracic surgeon for cardiopulm bypass to warm

84
Q

Hypothermia + ventricular rhythm - def max # times

A

3

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