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1 A&E > Toxicology > Flashcards

Toxicology Flashcards

1
Q

How can BBQ’s kill?

A

Small tin foil BBQ inside tent creates CO

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2
Q

What is a serious complication of sympathomimetics?

A

malignant hyperthermia

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3
Q

List two methods of cooling down a patient with malignant hyperthermia?

A

IV cold fluids
Fans
Ice packing

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4
Q

List one drug that is appropriate to administer activated charcoal

A

drugs that are toxic in small amounts e.g.
TCA
Digoxin
Theophylline
Phenobarbitones

Not useful for MILK- methanol, inorganic phosphate, lithium, potassium

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5
Q

Name one drug that is multi-dose charcoal is used for

A

salicylates, digoxin, carbamazepine

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6
Q

Should you ever induce emesis to treat drug overdose?

A

No! can cause aspiration resulting in pneumonitis that is difficult to treat

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7
Q

List two methods for enhancing elimination of drug overdoses

A
  1. alkalising the urine
  2. haemodialysis- MILK
  3. intralipid- e.g. anaesthetic overdose
  4. charcoal haemoperfusion
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8
Q

List three features of anticholinergic toxidrome

A

mydriasis
confusion
hot
flushing
dry skin and membranes
urinary retention
constipation

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9
Q

Name an example of anticholinergic drug

A

TCA e.g. amitriptyline

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10
Q

Why do TCA’s cause tachyarrhythmias?

A

block cardiac sodium potassium ATPase channels therefore reduce sodium upstroke, prevents propagation of electrical signals from myocytes

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11
Q

What is the treatment for anticholinergic overdose?

A

fluids
glucagon
sodium bicarbonate

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12
Q

WHat are the symptoms of cholinergic overdose?

A

SLUDGE
salivation
lacrimation
urination
diarrhoea
GI cramping
Emesis

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13
Q

What are the killer B’s in cholinergic toxidrome?

A

bradycardia
bronchorrhoea
bronchospasm

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14
Q

List two cholinergic drugs

A

Pesticides
Neostigmine
Alzheimer’s disease drugs- donepezil, rivastigmine

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15
Q

List two examples of sympathomimetics

A

Caffeine
Cocaine
MDMA
Theophylline- excess in asthmatics

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16
Q

List three features of sympathomimetic toxidrome

A

tachyopnoea
hypertension
tachyarrhythmias
mydriasis
psychosis
hyperthermia

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17
Q

What is a treatment for sympathomimetics?

A

benzodiazepines (don’t give beta blockers!!)

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18
Q

List three features of sympathomimetic serotinergic crisis

A

rigid jaw and airway compromise
acidosis
coma
cardiovascular collapse
malignant hyperthermia
hypertonicity with clonus= most important test!!!
refractory hypoglycaemia

19
Q

What is the management of serotineregic crisis

A

intubation
lots and lots and benzodiazepines
aggressive cooling

20
Q

Difference between anticholinergic and sympathomimetic toxidrome?

A

anticholinergic- dry and quiet
sympathomimetic- wet and gurgly?

21
Q

List three features of opioid overdose

A

airway compromise
hypoventilation/hypoxia
hypotension
bradycardia
reduced GCS
pinpoint pupils
hypothermia

22
Q

MOA of naloxone?

A

Naloxone hydrochloride is an opioid antagonist that antagonizes opioid effects by competing for the same receptor sites.

23
Q

What is the half life of naloxone?

A

Since the half life of naloxone is 60–90 minutes, it would seem logical to observe patients for signs of recurrent toxicity for at least 2 hours

24
Q

How long is naloxone effective for?

A

20-40 mins

25
Q

List an example of sedative drug

A

benzodiazepines, alcohol?

26
Q

List two features of sedative/hypnotic

A

hypotension
bradycardia
dizzy
ataxic
respiratory compromise

27
Q

What is the treatment for sedative/hypnotic toxidrome?

A

supportive treatment
watch for withdrawal
flumenazil only rarely used

28
Q

What is a serious complication of benzodiazepine?

A

withdrawal- seizure

29
Q

At what mg/kg of paracetamol would you definitely treat the overdose?

A

150mg/kg

30
Q

List two options for eliminating drugs in general

A

intralipid
haemodialysis
alkalinisation urine
endoscopy and lavage

31
Q

Name two blood tests for paracetamol overdose

A

LFTs
INR
paracetamol levels

32
Q

State two criteria for referral for liver transplant in paracetamol overdose

A

hypoglycaemia
encephalopathy
INR >3
Thrombocytopaenia

33
Q

What is the reversal agent for verpamil?

A

calcium chloride (as verapamil is a CCB)

34
Q

What is the management for verapamil overdose?

A

adrenaline
glucagon
insulin

35
Q

What dose of insulin do you give for verapamil overdose?

A

10x the dose for DKA

36
Q

What is the management for sympathomimetic toxidrome?

A

cool down and calm down
cold IV fluids
diazepam
ice packs in groin and axilla

37
Q

What are the top drug overdoses to know about?

A

paracetamol
opioids
benos
anti-cholinergics TCAs
Cardotoxics
Serotonergics
Cocaine + other sympathomimetics

38
Q

Which is the alcohol withdrawal score?

A

GMAWS= glasgow modified alcohol withdrawal scale

39
Q

What is the normal range for venous carboxyhaemoglobin in a non smoking adult?

A

1-3%

40
Q

What can the normal range for venous carboxyhaemoglobin be in a smoker??

A

up to 7% can be normal

41
Q

Describe a systematic approach to assess a patient with ? carbon monoxide poisoning

A

ABCDE + write out what each letter stands for

42
Q

Name two symptoms that can present with carbon monoxide poisoning

A

dizziness
lethargy
headache

43
Q

Why is it important to be aware of the presenting symptoms of CO poisoning

A

non-specific symptoms can lead to underdiagnosis wherein the toxicity can kill you

44
Q

Describe the physiological principle that makes pulse oximetry inaccurate in patients with CO poisoning

A

can’t differentiate between oxygen and CO saturation to Hb due to similar binding affinity

1 A&E (22 decks)

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