Toxicology Flashcards
Pink color urine is associated with what antidote?
Defroximine
During overdoses of acetaminophen what compound does our body run out of?
Glutathione
What is the goal pH of urine in an aspirin toxicity?
Alkalinization of urine to a pH of 7.5 to 8
What is the main treatment of a calcium channel blocker toxicity?
Treat symptoms
When do symptoms of beta blocker ingestion present?
Within 2 hours
When should you obtain a serum acetaminophen level?
4 hours post ingestion or immediately if more time has elapsed
What is the management of iron toxicity?
Defloroxamine iv
What toxic ingestion is associated with rhabdomyolysis?
Bath salts or spice
What are signs of anticholinergic toxicity?
Hot, dry, red
Agitation, urinary retention, dry mouth, hypotension, tachycardia, hypertension, fever
What is the most common dose for activated charcoal?
10 to 25 grams PO
What condition does an ecstasy overdose mimic?
Malignant hyperthermia
What taxiderm is characterized by dry skin, increased heart rate, dilated pupils, fever, urinary retention, decrease bell sounds, CNS excitation?
Anticholinergic
How do you treat the hypotension associated with calcium channel blocker toxicity?
Volume and or vasoactive agents
What findings are specific to toxic ingestion of ethylene glycol?
Renal failure, cerebral edema, not associated with visual complaints
What cardiac arrhythmia is associated with calcium channel blockers?
Second degree AV block
What toxin is found in industrial solvents, gasoline blends, paint strippers, windshield wiper fluid, and hobby adhesives?
Methyl alcohol or methanol
What is the management of an ecstasy overdose?
Aggressive cooling and dantroline as well as supportive care
How does a bath salt ingestion present?
Hypertension, tachycardia, euphoria, alertness, hyperactivity followed by coronary vases spasm gastritis or hyperthermia
What additive inactivated charcoal do we need to be aware of?
Sorbitol and its effect on electrolytes
Her males or females more likely to have toxic ingestions during adolescence?
Females
What are the two main symptoms of a beta blocker toxicity?
Bradycardia and hypotension
What happens when NAPQI levels become too high?
Hepatocellular necrosis, irreversible liver failure
What is the best test to order to evaluate for rhabdomyolysis?
Serum creatinine kinase
How many hours after acetaminophen ingestion does peak toxicity occur?
Greater than 72 hours
What toxidrome is characterized by beady eyes, sunglasses, decrease blood pressure, and respiratory depression?
Narcotic
What taxiderm is characterized by increased salivation, tearing, urination, defecation, emesis, muscle weakness and fasciculations?
Cholinergic
What symptoms are specific to ethanol toxicity?
Respiratory depression, profound hypoglycemia, lethargy, sedation, vomiting
When do you need to give sodium bicarb in a beta blocker ingestion?
If formulation ingested possesses MSA as it will cause ventricular arrhythmias
What is the presentation of severe iron toxicity
Hypertension, drowsiness, metabolic acidosis
What is the most commonly abused amphetamine by adolescence and college students?
MDMA or ecstasy
What is the treatment of a bath salt ingestion?
Dantrolene for hyperthermia, monitor for coronary spasms and give morphine or nitroglycerin if present
What ingestion will cause changes to a chest radiograph?
Iron ingestion
What oral symptoms are associated with an ecstasy overdose?
Bruxism ( grinding teeth), sweating, dry mouth
Why do you give sodium bicarb in TCA overdoses?
Blocks sodium channels causing changes to an EKG
What are the end products of hepatic metabolism of methanol and ethylene glycol that produce significant toxicity?
Alcohol dehydrogenase and aldehyde dehydrogenase
Where are alcohols metabolized?
Liver
What are the three initial signs of calcium channel blocker toxicity?
Hypertension, bradycardia or Brady arrhythmias, SA/AV node conduction abnormalities
What is the antidote for Tylenol ingestion?
An acetyl cysteine or mucumyst
How should you act if he ingested agent is unknown?
Refer to your taxidromes
What serum iron levels indicate mild, moderate, and severe toxicity?
Mild less than 300, moderate 300 to 500, severe greater than 500
What toxin drone is characterized by diarrhea, dilated pupils, goosebumps, tachycardia, yawning, stomach cramps, hallucinations?
Withdrawal
What symptoms are present after 24 hours after a Tylenol ingestion?
Nausea, malaise, increased liver function test
What findings are specific to methanol toxicity?
Severe metabolic acidosis and symptoms similar to ethanol
Where is Tylenol metabolized?
The liver
What are late signs of calcium channel blocker toxicity?
Arrhythmias, hypoglycemia, shock, seizures, death
On the acetaminophen what line suggests the need for treatment?
The solid line
What medications are calcium channel blockers?
Amlodipine, isradipine, nicardipine
What taxiderm is characterized by scenic excitation such as confusion, in coordination, agitation, delirium seizures as well as increased blood pressure and heart rate?
Sympathomimetic
What lab findings on an ABG are associated with salycilate toxicity?
Respiratory alkalosis and anion gap metabolic acidosis
How do you treat the bradycardia associated with calcium channel blockers
Atropine, dopamine
How does a salycilate toxicity present?
Hyperthermia, tachycardia, vertigo, hyperactivity, hyperventilation, seizures
What symptoms are present greater than 72 hours after acetaminophen ingestion?
Kragulopathy, and cephalopathy, liver failure
What toxin is associated with the ingestion of antifreeze, herbicides, paints?
Ethylene glycol
How do symptoms present with an iron toxisity?
Starts with gastro like symptoms followed by hematemesis and hematochezia.
What complicates treatment of a calcium channel blocker ingestion?
Several different formulations and concentrations are available such as immediate or sustained release tablets
What age group accounts for half of all poisonings?
Less than 3 years of age
When is hemodialysis required in aspirin toxicity?
Levels approaching 100 or severe clinical manifestations
What affects do bath salts mimic?
Cocaine and amphetamines
What treatment is specific to methanol and ethylene glycol toxicity?
Ethanol, dialysis
What drug class are TCAs in?
Anticholinergic
Where did the majority of toxic ingestion events occur?
In the child’s home
Where are calcium channel blockers metabolized?
Liver
