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Critically Ill Exam 3 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

what is the phone number for the poison control center?

A

1-800-222-1222

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2
Q

what are 3 general treatments to toxicology?

A
  1. fluids
  2. labs
  3. lipids
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3
Q

what are 3 general pharmacologic treatments used for toxicology?

A
  1. gastric lavage/ ipecac
  2. activated charcoal
  3. hemodialysis
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4
Q

when is activated charcoal the most effective?

A

in the first 1-2 hours of ingestion

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5
Q

what are 6 common causes of anticholinergic symptoms?

A
  1. antihistamines
  2. TCAs
  3. SSRIs
  4. H2RAs
  5. antipsychotics
  6. muscle relaxants
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6
Q

what are 9 symptoms of an anticholinergic toxidrome?

A
  1. blind a s a bat
  2. dry mouth/urinary retention
  3. tachycardia
  4. flushed skin
  5. hyperthermia
  6. dilated pupils
  7. confusion
  8. grabbing invisible objects
  9. shaking
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7
Q

what are 2 common causes of cholinergic symptoms?

A
  1. organophosphates
  2. pyridostigmine
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8
Q

what are symptoms that are associated with a cholinergic toxidrome?

A

SLUDGE OR DUMBBELS (everythings coming out)

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9
Q

what are some symptoms of an opiod overdose? 3

A
  1. respiratory depression
  2. miosis
  3. rhabdomyolysis
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10
Q

what are 2 common causes of a sympathomimetic toxidrome?

A
  1. amphetamines
  2. cocaine
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11
Q

what are 6 sympathomimetic symptoms?

A
  1. agitation
  2. mydriasis
  3. tachycardia
  4. hypertension
  5. hyperthermia
  6. diaphoresis
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12
Q

what medication is the most common cause for a liver transplant?

A

acetaminophen

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13
Q

what is the toxic metabolite seen with acetaminophen?

A

NAPQI

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14
Q

what enzyme coverts acetaminophens toxic metabolite?

A

glutathione

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15
Q

how do you diagnose an acetaminophen toxicity?

A

using the Rumack Matthew Nomogram

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16
Q

when using the RMN, when should you give antidotal treatment?

A

if the level is on or above the line

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17
Q

when can you use the RM nomogram?

A

if it was a single dose ingestion between 4-24 hours

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18
Q

when using the RMN, when would you not give antidotal tx?

A

if level is below the line

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19
Q

what is the reversal agent for acetaminophen toxicity?

A

NAC

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20
Q

what is the oral dose for NAC?

A

140 mg/kg loading dose followed by 70 mg/kg every 4 hours for a total of 18 doses over 72 hours

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21
Q

what is the IV dose for NAC?

A

150 mg/kg over 1 hour followed by 50 mg/kg over 4 hours followed by 100 mg/kg over the next 16 hours

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22
Q

what is a main ADR of NAC?

A

anaphylactic reactions (IV only)

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23
Q

what are the triad of symptoms seen with an aspirin toxixcity?

A
  1. hyperventilation
  2. tinnitus
  3. GI irritation
24
Q

what are 3 treatments that can used for aspirin toxicity?

A
  1. activated charcoal
  2. sodium bicarbonate
  3. hemodialysis
25
Q

what is the MOA of sodium bicarbonate?

A

alkalization of the serum and urine leads to enhanced elimination via ion trapping

26
Q

what is the MOA of warfarin?

A

inhibits the synthesis of vitamin K dependent clotting factors

27
Q

what is the reversal agent for warfarin?

A

vitamin K (phytonadione) + factor product

28
Q

to avoid an anaphylactic reaction with phytonadione, what should you do?

A

infuse it over 30 minutes

29
Q

what factor product can be given?

A

prothrombin concentrate complex (Kcentra)

30
Q

what is an adr of kcentra?

A

thrombosis

31
Q

what is a reversal agent for the anti Xas?

A

andexxa

32
Q

what are 2 alternative agent sto andexxa?

A
  1. Kcentra
  2. FEIBA
  3. activated charcoal (maybe)
33
Q

what is a reversal agent for pradaxa?

A

Idarucizubmab (praxbind)

34
Q

what is a reversal agent for heparin and LMWH?

A

protamine

35
Q

what is a reversal agent for opioids?

A

naloxone (narcan)

36
Q

what type of CCBs has a greater effect on peripheral vasodilation?

A

DHP

37
Q

what are 6 treatment options for CCB toxicity?

A
  1. activated charcoal
  2. vasopressors
  3. calcium
  4. lipids
  5. High dose insulin euglycemia therapy (HIET)
  6. ECMO
38
Q

what 2 things must be administered with HIET?

A
  1. glucose
  2. potassium
39
Q

what are 6 treatment options for beta blocker toxicity?

A
  1. lipids
  2. glucagon
  3. charcoal
  4. vasopressors
  5. HIET
  6. ECMO
40
Q

what are 3 treatment options for sulfonyurea toxicity?

A
  1. activated charcoal (if recent ingestion)
  2. dextrose
  3. octreotide
41
Q

what osmolar gap is normal?

A

-14-10

42
Q

what is used for an alcohol/ethanol toxicity? 2

A

1.ethanol
2. fomepizole

43
Q

when is fomepizole the most effective?

A

when given early on

44
Q

when should fomepizole be initiated?

A
  1. methanol/ethanol > 20 mg/dL
    OR
  2. osmolal gap >10
    OR
  3. suspected toxic alcohol ingestion with metabolic acidosis
45
Q

what are 2 other treatment options for alcohol/ethanol toxicity?

A
  1. dialysis
  2. sodium bicarbonate
46
Q

what is a reversal agent to digoxin?

A

DigiFab, DigiBind

47
Q

when can digifab or digiband be used?

A

for life threatening arrhytmias

48
Q

what reversal agent is used for BZD toxicity?

A

flumazenil

49
Q

what agents can be used to treat a cyanide toxicity? 3

A
  1. hydroxocobalamin
  2. sodium thiosulfate
  3. sodium nitrate & amyl nitrate
50
Q

what is a main symptom seen with serotonin syndrome?

A

clonus

51
Q

what agent is used to reverse serotonin syndrome?

A

cyproheptadine

52
Q

what are 3 supportive care options for treating serotonin syndrome?

A
  1. BZDs
  2. fluids and cooling
  3. Non-depolarizing neuromuscular blockers (if severe)
53
Q

what is used for the treatment of TCA toxicity?

A

sodium bicarbonate

54
Q

what is used to treat bupropion IR toxicity?

A

decontamination-charcoal

55
Q

what is used to treat bupropion XL/SR toxicity?

A

whole bowel irrigation

Critically Ill Exam 3 (9 decks)

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