Toxicology

Question 1

How can BBQ’s kill?

Answer 1

Small tin foil BBQ inside tent creates CO

Question 2

What is a serious complication of sympathomimetics?

Answer 2

malignant hyperthermia

Question 3

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

Answer 3

IV cold fluids
Fans
Ice packing

Question 4

List one drug that is appropriate to administer activated charcoal

Answer 4

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

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

Question 5

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

Answer 5

salicylates, digoxin, carbamazepine

Question 6

Should you ever induce emesis to treat drug overdose?

Answer 6

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

Question 7

List two methods for enhancing elimination of drug overdoses

Answer 7

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

Question 8

List three features of anticholinergic toxidrome

Answer 8

mydriasis
confusion
hot
flushing
dry skin and membranes
urinary retention
constipation

Question 9

Name an example of anticholinergic drug

Answer 9

TCA e.g. amitriptyline

Question 10

Why do TCA’s cause tachyarrhythmias?

Answer 10

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

Question 11

What is the treatment for anticholinergic overdose?

Answer 11

fluids
glucagon
sodium bicarbonate

Question 12

WHat are the symptoms of cholinergic overdose?

Answer 12

SLUDGE
salivation
lacrimation
urination
diarrhoea
GI cramping
Emesis

Question 13

What are the killer B’s in cholinergic toxidrome?

Answer 13

bradycardia
bronchorrhoea
bronchospasm

Question 14

List two cholinergic drugs

Answer 14

Pesticides
Neostigmine
Alzheimer’s disease drugs- donepezil, rivastigmine

Question 15

List two examples of sympathomimetics

Answer 15

Caffeine
Cocaine
MDMA
Theophylline- excess in asthmatics

Question 16

List three features of sympathomimetic toxidrome

Answer 16

tachyopnoea
hypertension
tachyarrhythmias
mydriasis
psychosis
hyperthermia

Question 17

What is a treatment for sympathomimetics?

Answer 17

benzodiazepines (don’t give beta blockers!!)

Question 18

List three features of sympathomimetic serotinergic crisis

Answer 18

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

Question 19

What is the management of serotineregic crisis

Answer 19

intubation
lots and lots and benzodiazepines
aggressive cooling

Question 20

Difference between anticholinergic and sympathomimetic toxidrome?

Answer 20

anticholinergic- dry and quiet
sympathomimetic- wet and gurgly?

Question 21

List three features of opioid overdose

Answer 21

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

Question 22

MOA of naloxone?

Answer 22

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

Question 23

What is the half life of naloxone?

Answer 23

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

Question 24

How long is naloxone effective for?

Answer 24

20-40 mins

Question 25

List an example of sedative drug

Answer 25

benzodiazepines, alcohol?

Question 26

List two features of sedative/hypnotic

Answer 26

hypotension bradycardia dizzy ataxic respiratory compromise

Question 27

What is the treatment for sedative/hypnotic toxidrome?

Answer 27

supportive treatment watch for withdrawal flumenazil only rarely used

Question 28

What is a serious complication of benzodiazepine?

Answer 28

withdrawal- seizure

Question 29

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

Answer 29

150mg/kg

Question 30

List two options for eliminating drugs in general

Answer 30

intralipid haemodialysis alkalinisation urine endoscopy and lavage

Question 31

Name two blood tests for paracetamol overdose

Answer 31

LFTs INR paracetamol levels

Question 32

State two criteria for referral for liver transplant in paracetamol overdose

Answer 32

hypoglycaemia encephalopathy INR >3 Thrombocytopaenia

Question 33

What is the reversal agent for verpamil?

Answer 33

calcium chloride (as verapamil is a CCB)

Question 34

What is the management for verapamil overdose?

Answer 34

adrenaline glucagon insulin

Question 35

What dose of insulin do you give for verapamil overdose?

Answer 35

10x the dose for DKA

Question 36

What is the management for sympathomimetic toxidrome?

Answer 36

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

Question 37

What are the top drug overdoses to know about?

Answer 37

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

Question 38

Which is the alcohol withdrawal score?

Answer 38

GMAWS= glasgow modified alcohol withdrawal scale

Question 39

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

Answer 39

1-3%

Question 40

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

Answer 40

up to 7% can be normal

Question 41

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

Answer 41

ABCDE + write out what each letter stands for

Question 42

Name two symptoms that can present with carbon monoxide poisoning

Answer 42

dizziness lethargy headache

Question 43

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

Answer 43

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

Question 44

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

Answer 44

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