Toxicology Flashcards

Question

List 4 agents that can cause diaphoretic skin findings

Answer 1

SOAP ``` S= sympathomimetics O= organophosphates A= Acetylsalicylic acid P= Phencyclidine (PCP) ```

Answer 2

ANNE-PADS ``` A =Aniline dye N =Nitrate N= Nitrites E=ergotamine P=phenazopyridine A=agents causing hypoxemia,hypotension,methHb D= dapsone ```

Answer 3

( Remember features of the fight/flight rxn) 1- Altered mental status 2- Elevated vital signs (HR,BP,RR,hyperthermia) 3- Mydriasis 4-Diaphoresis 5- Treatment refractory shock (high doses) 6 -Arrhytmias 7-Seizures 8-Flushed skin

Answer 4

Remember- This is due to the alteration of the homeostatic balance btw the sympathetic and parasympathetic system. The sympathetic side fxns unopposed ``` 1 Delirium (mad as a hatter) 2 Hyperthermia ( Hot as a hare) 3 Mydriasis (blind as a bat) 4 Cutaneous flushing (red as a beet) 5 Dry skin,urinary retention (dry as a bone ) 6 Tachycardia ```

Answer 5

This is due to overstimulation of the parasympathetic part of the ANS,which conrols the rest and digest fxn. Agents of concern are primarily organophosphates and carbamate insecticides The features are due to excessive accumulation of acethylcholine at the NMJ and synapses,causing symptoms of nicotinic and muscarinic toxicity. These include ``` Muscarinic = DUMBBELLS Diaphoresis, diarrhoea Urination Miosis Bradycardia Bronchorrhea Emesis Lacrimation Lethargic Salivation ``` ``` Nicotinic - Days of the week Mydriasis Tachycardia Weakness Tremors Fasciculations Seizures Somnolent (Nicotine poisoning can resemble both sympathomimetic and cholinergic toxidromes -due to its role in the CNS and ANS) ```

Answer 6

``` Miosis/Mydriasis Hypoventilation Diarrhoea Lacrimation Hypertension Hallucinations Seizures ```

Answer 7

``` Altered mental status Agitation Clonus Hyperreflexia Hyperthermia Diaphoresis ```

Answer 8

Due to depletion of dopamine secondary to use of dopamine antagonists eg antipsychotics ``` Rigidity Agitation Altered mental status Hyperthermia Decreased reflexes ```

Answer 9

AEIOU ``` Alcohol/Acidosis Encephalopathy Infection Overdose/opioids Uremia ``` TIPS Trauma Insulin (hypo/hyperglycemia) Psychosis Seizure

Answer 10

``` Labetalol Amantadine Ranitidine Bupropion Trazodone Promethazine ```

Answer 11

Sertraline | Oxaprozin

Answer 12

PPI Efavirenz Dronabinol

Answer 13

Dextromethorphan Quinolones Diphenhydramine

Answer 14

Dextromethorphan Diphenhydramine Ibuprofen Tramadol

Answer 15

Patient is alert and cooperative. Anticipated to remain alert. Within 1 hour of ingestion (within 2 hr for SR,or massive ingestions) Ingestion of highly toxic agent eg killer Cs colchicine CN cocaine cyclic antidepressants CCB cicutoxin ASA Evidence of massive ingestion of toxic agent Effective antidote not available Ingested agent must be amenable to adsorption by AC

Answer 16

Sedated patient Unprotected airway Refusal

Answer 17

``` PHAILS Pesticides Heavy metals Acids/Alkalis Iron Lithium Solvents ```

Answer 18

``` Low molecular weight Low protein binding High water solubility Examples STUMBLED Salicylates Theophylline Uremia Methanol/metformin Barbiturates Lead Etylene glycol Depakote (valproic acid) ```

Answer 19

1 Decreases xenobiotic absorption and elimination half live,when large doses are ingested and dissolution delayed. 2 Creates a hemoperfusion substrate for the gut wall microcirculation,creating a concentration gradient into the stool of certain poisons (gastrointestinal dialysis) 3 Interferes with entero-hepatic circulation,reducing absorption.

Answer 20

``` ABCDQ Aminophylline/theophylline Barbiturates Dapsone Quinine ```

Answer 21

Extreme lipemia -interfering with blood results ARDS Pancreatitis

Answer 22

Sepsis CNS infection Withdrawal symptoms EtOH/DM ketoacidosis

Answer 23

Administer 50 -100mEq of NaHCO3 prior to procedure,irrespective of the pH Adjust post intubation tidal volume to match pre-intubation PCO2 Establish an elevated minute volume

Answer 24

Salicylic acid | H ion replaced in urine for Potassium

Answer 25

``` Due to manifestations of ischemia Ataxia Dizziness Confusion Incoordination Tachycardia Tachypnea Dyspnea ```

Answer 26

1- > 60mg/kg | 2- >50ug/ml of Acetaminophen ,4 hours after infusion stopped.

Answer 27

1- Regular ingestion of INH 2- Malnourished 3- Chronic EtOH abuse 4 Severe dehydration

Answer 28

``` 1- Levels > 1000 ug/ml at 4 hours post ingestion 2- Hepatorenal syndrome 3- Metabolic acidosis < 7.30 4- Lactate levels >3.5 mmol/L 5 Encephalopathy ```

Answer 29

pH <7.3 /Lactate >3.5 after resuscitation PTT >100 / INR >5 Grade 3/4 hepatic encephalopathy Cr >3.3

Answer 30

``` 1- Inhibition of mitochondrial cytochrome oxidase Inhibiting intracellular respiration 2- Free radical formation 3 - Antioxidant impairment 4- Lipid peroxidation ```

Answer 31

``` Acute neurologic stage (30 mins -12 hours post ingestion) 1- Inebriation 2- Euphoria 3- Seizures 4- Coma 5- Hypotonia 6- Ataxia 7- Nystagmus 8- Myoclonic jerks ``` ``` Cardiopulmonary stage (12 -24 hours) 1- Tachycardia (metab acidosis) 2-Tachypnea 3- Hypoxia 4- ARDS 5- Circulatory collapse ``` ``` Renal Stage (24 to 72 hours) 1- Flank pain 2- Hematuria 3- ARF ( Anuric,oliguric ,non-oliguric Reversible renal failure with tx ``` ``` Delayed neurologic stage (5 - 20 days) Bulbar palsy with CN VII and VIII dysfunction 1- Vertigo 2- Facial droop 3- opthalmoplegia 4- Nystagmus 5-Facial sensory loss 6- Hearing loss Autonomic nerve dysfunction 1- Postural hypotension 2-Gastroparesis ```