toxicology

Question 1

What is the treatment for a calcium channel blocker overdose?

Answer 1

manage ABCs
oxygen
fluid bolus of 500cc, up to 1Litre if hypotensive
treat bradycardia with atropine 0.6mg, max dose 0.04mg/kg
clinical
calcium chloride 1-2mg over 10 mins
consider push dose epi 10mcg or epi infusion for hypotension refractory to calcium.

Question 2

What is the treatment for beta blocker overdose?

Answer 2

manage ABCs
oxygen to sat of 94 or higher
take BGL
IV access and bolus 500cc if hypotensive. limit to max 2L
correct hypoglycemia
do 12 lead
correct bradycardia
-atropine 0.6mg, may need multiple doses,max of 0.04mg/kg
transcutaeous pacing may be required, though may be ineffective
manage seizures with midazolam
Clinical for epi infusion

Question 3

what is the definition of cholinergic substances ?

Answer 3

substances that agonizing acetylcholine
mimicking Ach behavior at one or more of the body’s acetylcholine receptors

Question 4

what are examples of substances that cause cholinergic toxicity

Answer 4

organophosphates
caramate
insecticides

Question 5

signs and symptoms if cholinergic toxicity

Answer 5

SLUDGE. BBB. DUMBELLS
Salivation. bradycardia. diarrhea
lacrimation. bronchorrhea urination
urination. bronchospasm. miosis
defecation. bradycardia
gastric emptying. emesis
lacrimation
lethargy
salivation

Question 6

what is the definition of an anticholinergic

Answer 6

inhibits acetylcholine

Question 7

examples of anticholinergic drugs

Answer 7

atropine
TCAs
antihistamines

Question 8

what is the mnemonic for anticholinergic side effects:
(Alice in wonderland)

Answer 8

blind as a bat (dilated pupils)
dry as a bone (dehydrated)
mad as a hatter (delusional, hallucinations)
hot as a hare (central and peripheral alpha blockade)
red as a beet (central and peripheral alpha blockade)

Question 9

what is the mechanism of salicylates

Answer 9

to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of COX enzyme

Question 10

signs and symptoms of salicylate OD

Answer 10

ALOC due to cerebral edema by acids
diaphoresis,
hyperthermia,
tachycardia
, hyperventilation due to direct stimulation of resp centre
nausea/vomiting
tinnitus (activation of NMDA receptors in cochlea)
fever
metabolic acidosis and respiratory alkalosis

Question 11

examples of sympathomimetics

Answer 11

cocaine
amphetamines
caffeine
bath salts

Question 12

signs and symptoms of sympathomimetic toxidrome

Answer 12

dilated pupils
diaphoresis
tachycardia
hyperthermia
hyper active bowel
seizures
anxiety

Question 13

Hyperkalemia - what’s it caused by and what are ecg findings

Answer 13

caused by ineffective elimination
renal failure
Addisons disease
rhabdomyolysis
blood transfusion
massive hemolysis

ecg: reduction of p-wave with peaked t waves
widened QRS with possible sinusoidal shape

Question 14

What is the toxic dosage of acetaminophen?

Answer 14

250mg/kg in 12 hours
(treatment guidelines)

Question 15

Antidote for acetaminophen toxicity

Answer 15

N-acetylcysteine

Question 16

What affinity does carbon monoxide have for hemoglobin compared to oxygen

Answer 16

250x more affinity for hemoglobin than oxygen

Question 17

You are called to a patient with known beta blocker toxicity. One of first things you do is check a blood sugar. It comes back low. Why would this be the case?

Answer 17

Beta adrenergic receptor antagonism inhibits both glycogenolysis and glyconeogenesis, causing hypoglycemia.

Question 18

what smell does hydrogen cyanide have?

Answer 18

bitter almond smell

Question 19

in hospital or CCP TX for cyanide poisoning:

Answer 19

hydroxycobalamin

Question 20

in a cholinergic toxicity, atropine is given at what dose?

Answer 20

1-2mg, q5-60 Mins, doubling the dose each time

Question 21

in a cholinergic toxicity, atropine works on ____ receptors/effects, but not ____ receptors/effects

Answer 21

muscarinic, but not nicotinic