Toxicology

Question 1

What are the features of anticholinergic toxidrome?

Answer 1

CVS:- tachycardia, arrhythmias,- hypotension/dehydration
Neuro:- Mydriasis- confusion- seizures
Other:- dry mouth- flushed skin- constipation/absent bowel sounds- urinary retention

Question 2

Which drugs can be dialysed?

Answer 2

B - barbiturates
L - Lithium
A - aminophylline
S - salicylates
T - Theophylline
M - Metformin/methano
E - ethylene glycol

Question 3

What are the features of those molecules that cannot be dialysed?

Answer 3

• Heavily protein bound
• Large molecular weight >60kDa
• High volume of distribution

Question 4

What are the features of cholinergic toxidrome?

Answer 4

E.g. organophosphates/nerve agents
S - salivation
L - lacrimation
U - urination
D - diarrhoea
G - Gastrointestinal upset
E - Emesis
Other features:CVS: Bradycardia, hypotension
Neuro: confusion, miosis

Question 5

What toxidromes are you aware of? What are their antidotes?

Answer 5

1. Cholinergic - SLUDGE - Pralidoxime
2. Anticholinergic - Amitriptyline - Physostigmine
3. Sedative - benzos - Flumazenil
4. Narcotic - opiate - naloxone
5. Seratonergic - SSRI, tramadol, confusion, autonomic features, NM excitability - cyproheptadine
6. Sympathomimetic - raised RR, HR, temp - beta blockers

Question 6

In which drugs are activated charcoal indicated?

Answer 6

Salicylates
Digoxin
Carbamazepine
Barbiturates
Theophylline/TCA
Quinine

Question 7

What is the pathophysiology of cyanide poisoning?

Answer 7

Inhibits mitochondrial cytochrome oxidase, inhibiting cellular oxygen utilisation.Causing tissue hypoxia.Hydroxycobalamin is antidote