Toxicology Flashcards
what is the phone number for the poison control center?
1-800-222-1222
what are 3 general treatments to toxicology?
- fluids
- labs
- lipids
what are 3 general pharmacologic treatments used for toxicology?
- gastric lavage/ ipecac
- activated charcoal
- hemodialysis
when is activated charcoal the most effective?
in the first 1-2 hours of ingestion
what are 6 common causes of anticholinergic symptoms?
- antihistamines
- TCAs
- SSRIs
- H2RAs
- antipsychotics
- muscle relaxants
what are 9 symptoms of an anticholinergic toxidrome?
- blind a s a bat
- dry mouth/urinary retention
- tachycardia
- flushed skin
- hyperthermia
- dilated pupils
- confusion
- grabbing invisible objects
- shaking
what are 2 common causes of cholinergic symptoms?
- organophosphates
- pyridostigmine
what are symptoms that are associated with a cholinergic toxidrome?
SLUDGE OR DUMBBELS (everythings coming out)
what are some symptoms of an opiod overdose? 3
- respiratory depression
- miosis
- rhabdomyolysis
what are 2 common causes of a sympathomimetic toxidrome?
- amphetamines
- cocaine
what are 6 sympathomimetic symptoms?
- agitation
- mydriasis
- tachycardia
- hypertension
- hyperthermia
- diaphoresis
what medication is the most common cause for a liver transplant?
acetaminophen
what is the toxic metabolite seen with acetaminophen?
NAPQI
what enzyme coverts acetaminophens toxic metabolite?
glutathione
how do you diagnose an acetaminophen toxicity?
using the Rumack Matthew Nomogram
when using the RMN, when should you give antidotal treatment?
if the level is on or above the line
when can you use the RM nomogram?
if it was a single dose ingestion between 4-24 hours
when using the RMN, when would you not give antidotal tx?
if level is below the line
what is the reversal agent for acetaminophen toxicity?
NAC
what is the oral dose for NAC?
140 mg/kg loading dose followed by 70 mg/kg every 4 hours for a total of 18 doses over 72 hours
what is the IV dose for NAC?
150 mg/kg over 1 hour followed by 50 mg/kg over 4 hours followed by 100 mg/kg over the next 16 hours
what is a main ADR of NAC?
anaphylactic reactions (IV only)
what are the triad of symptoms seen with an aspirin toxixcity?
- hyperventilation
- tinnitus
- GI irritation
what are 3 treatments that can used for aspirin toxicity?
- activated charcoal
- sodium bicarbonate
- hemodialysis
what is the MOA of sodium bicarbonate?
alkalization of the serum and urine leads to enhanced elimination via ion trapping
what is the MOA of warfarin?
inhibits the synthesis of vitamin K dependent clotting factors
what is the reversal agent for warfarin?
vitamin K (phytonadione) + factor product
to avoid an anaphylactic reaction with phytonadione, what should you do?
infuse it over 30 minutes
what factor product can be given?
prothrombin concentrate complex (Kcentra)
what is an adr of kcentra?
thrombosis
what is a reversal agent for the anti Xas?
andexxa
what are 2 alternative agent sto andexxa?
- Kcentra
- FEIBA
- activated charcoal (maybe)
what is a reversal agent for pradaxa?
Idarucizubmab (praxbind)
what is a reversal agent for heparin and LMWH?
protamine
what is a reversal agent for opioids?
naloxone (narcan)
what type of CCBs has a greater effect on peripheral vasodilation?
DHP
what are 6 treatment options for CCB toxicity?
- activated charcoal
- vasopressors
- calcium
- lipids
- High dose insulin euglycemia therapy (HIET)
- ECMO
what 2 things must be administered with HIET?
- glucose
- potassium
what are 6 treatment options for beta blocker toxicity?
- lipids
- glucagon
- charcoal
- vasopressors
- HIET
- ECMO
what are 3 treatment options for sulfonyurea toxicity?
- activated charcoal (if recent ingestion)
- dextrose
- octreotide
what osmolar gap is normal?
-14-10
what is used for an alcohol/ethanol toxicity? 2
1.ethanol
2. fomepizole
when is fomepizole the most effective?
when given early on
when should fomepizole be initiated?
- methanol/ethanol > 20 mg/dL
OR - osmolal gap >10
OR - suspected toxic alcohol ingestion with metabolic acidosis
what are 2 other treatment options for alcohol/ethanol toxicity?
- dialysis
- sodium bicarbonate
what is a reversal agent to digoxin?
DigiFab, DigiBind
when can digifab or digiband be used?
for life threatening arrhytmias
what reversal agent is used for BZD toxicity?
flumazenil
what agents can be used to treat a cyanide toxicity? 3
- hydroxocobalamin
- sodium thiosulfate
- sodium nitrate & amyl nitrate
what is a main symptom seen with serotonin syndrome?
clonus
what agent is used to reverse serotonin syndrome?
cyproheptadine
what are 3 supportive care options for treating serotonin syndrome?
- BZDs
- fluids and cooling
- Non-depolarizing neuromuscular blockers (if severe)
what is used for the treatment of TCA toxicity?
sodium bicarbonate
what is used to treat bupropion IR toxicity?
decontamination-charcoal
what is used to treat bupropion XL/SR toxicity?
whole bowel irrigation
