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Wrap Up Block > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Antidote for arsenic?

A

dimercaprol, succimer, d-penicillamine

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2
Q

Antidote for lead?

A

succimer, EDTA, dimercaprol, d-penicillamine

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3
Q

Antidote for mercury?

A

dimercaprol, succimer, d-penicillamine

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4
Q

Antidote for black widow spider bite?

A

Lactrodectus antivenin

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5
Q

Antidote for calcium channel blockers?

A

calcium, glucagon, insulin + glucose

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6
Q

Antidote for cyanide?

A

nitrite + thiosulfate, hydroxycobalamin

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7
Q

Antidote for hydroxyfluoric acid?

A

calcium gluconate

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8
Q

Antidote for methemoglobinemia?

A

methylene blue, ascorbic acid

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9
Q

Antidote for opioids?

A

nalmefene, naloxone

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10
Q

Antidote for rattlesnake bite?

A

CroFab

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11
Q

Antidote for sulfonylureas?

A

ocreotide

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12
Q

Antidote for valproic acid?

A

carnitine

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13
Q

Antidote for TCAs?

A

sodium bicarbonate

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14
Q

Pt has taken an enteric coated, extended release drug. It’s only been 30 min. What to do?

A

whole bowel irrigation w/ 1-2L isotonic PEG electrolyte soln

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15
Q

Hemodialysis is an option for poisoning with…

A

methanol, ethylene glycol, lithium, salicylates, sotalol

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16
Q

Hemoperfusion is an option for poisoning with…

A

carbamazepine, phenytoin, phenobarbital, theophylline

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17
Q

Drugs that need quantitative serial levels?

A

PADlock the TV and the PC

Phenytoin
Aspirin/salicylates
Digoxin
Theophylline
Valproic acid
Phenobarbital
Carbamazepine
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18
Q

Drugs that need a single quantitative level at a set point?

A 
MACE HIM
Methanol
Acetominophen
Carbon monoxide
Ethanol, ethylene glycol
Heavy metals (24 hr urine)
Iron
Methemoglobin
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19
Q

What antidote is c/i in sympathomimetic toxicity?

A

beta blocker w/o alpha blocking activity

this is b/c unopposed alpha blockade is bad

give a combo blocker like carvedilol

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20
Q

Most toxic beta blocker?

A

propranolol

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21
Q

Membrane-depressant effects (widened QRS) of beta blockers may respond to…

A

sodium bicarbonate (as for TCA toxicity)

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22
Q

How well does calcium administration aid in treatment of calcium channel blocker toxicity?

A

it is most useful for negative inotropic effects, less effective for AV nodal blockade and bradycardia

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23
Q

IV lipid emulsion may aid in treating…

A

Calcium channel blocker toxicity and propranolol toxicity (lipophilic)

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24
Q

How does INH cause metabolic acidosis?

A

inhibits hepatic conversion of lactate -> pyruvate

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25
Q

What is a Rumack-Matthew nomogram?

A

computer program: give it a blood level of acetominophen and how long after overdose you are and it tells you the likelihood of hepatic toxicity

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26
Q

Administer N-acetylcysteine in Tylenol overdose if levels are…

A

> 150 mcg/mL @ 4 hours

27
Q

When to discontinue N-acetylcysteine administration in acetominophen overdose?

A

DO NOT d/c once started. must give q4h x17

28
Q

What concentration of ASA after acute poisoning indicates possibility of severe overdose?

A

100 mg / dL

29
Q

Acute Rx of salicylate poisoning?

A

glucose-containing fluids to reduce risk of cerebral hypoglycemia

sodium bicarb to treat acidosis and acidify urine

add in some potassium to maintain lytes

hemodialysis for severe acidosis or severe neurological sx

30
Q

Tx for inhalation of chlorine gas?

A

humidified O2, bronchodilators

31
Q

Tx for inhalation of ammonia gas?

A

humidified O2, bronchodilators

32
Q

Tx for inhalation of sulfur dioxide gas?

A

humidified O2, bronchodilators

33
Q

How does cyanide cause damage?

A

blocks binding of O2 to cytochrome c

inhibts complex IV in ETC

34
Q

How does hydrogen sulfide cause damage?

A

similar to cyanide: blocks binding of O2 to cytochrome c

but there is no specific antidote

smells like rotten eggs

35
Q

What gas causes damage in a manner similar to cyanide but has no specific antidote?

A

hydrogen sulfide (smells like rotten eggs)

36
Q

How does nitrogen oxide gas cause damage?

A

causes methemoglobinemia…

tx w/ methylene blue, ascorbic acid

37
Q

How does the cyanide kit work?

A

contains sodium nitrite, sodium thiosulfate, amyl nitrite

the inhaled amyl nitrite + IV sodium nitrite cause formation of methemoglobin. cyanide likes methemoglobin more than cytochrome c, so it binds here. thiosulfate + cyanomethemoglobin = thiocyanate, regular hemoglobin. the thiocyanate is eliminated renally

38
Q

Charcoal/gastric lavage for hydrocarbon toxicity?

A

nope… not usually.

charcoal isn’t used; gastric lavage may be indicated for some rare situations w/ a few select hydrocarbons that have severe toxicity

39
Q

Tx for hydrocarbon toxicity?

A

no specific antidote

intubation for resp failure
Mg, K for arrhythmias
lidocaine or beta blockers for vfib

KEEP CALM since they’re sensitive to catecholamine release

40
Q

Rx for organophosphate poisoning?

A

atropine + pralixodime [ProtoPam]

41
Q

Rx for carbofuran poisoning?

A

it’s a carbamate that causes cholinergic tox

give atropine + pralixodime [ProtoPam]

42
Q

What botanical insecticide can cause seizures and neurotoxicity?

A

pyrethrum (via inhalation or ingestion)
(and nicotine)
acts at voltage-sensitive Na, Ca, and Cl channels

can also cause contact dermatitis

tx: symptomatic support and control of seizures

43
Q

What are the toxic botanical insecticides?

A

nicotine
pyrethrum
rotenone (GI irritation, rhinitis, pharyngitis, dermatitis)

all of these are treated w/ symptomatic support

44
Q

Toxic herbicides? How to treat?

A

2,4-D and Paraquat

GI symptoms + bizarre or aggessive behavior (2,4-D)
MOF, lung scarring, CNS effects (Paraquat)

treat w/ fluids, sodium bicarbonate (2,4-D) and maintenance of lytes

45
Q

Lab values in 2,4-D poisoning?

A

(herbicide)

metabolic acidosis, elevated creatine phosphokinase, possibly myoglobinuria

46
Q

Difference in effects of caustic acids vs. alkalis?

A

acids -> coagulative necrosis. stomach is most common involved site. esophagus and oropharynx relatively resisitant

alkalis -> liquefactive necrosis. oropharynx, hypopharynx, esophagus most likely involved

47
Q

Caustic acids cause (coagulative / liquefactive) necrosis.

A

coagulative

stomach most common involved site

48
Q

Caustic alkalis cause (coagulative / liquefactive) necrosis.

A

liquefactive

esophagus, pharynx most common involved site

49
Q

Treatment for acute caustic acid or alkali ingestion?

A

intubation

NO EMETICS: it’ll burn on the way up

gastric lavage

dilute alkalis if w/in 30 min (don’t dilute acids: too hot)

don’t try and neutralize: too hot

50
Q

Lead inhibits which enzymes of heme synthesis?

A

delta-ALA dehydratase

and

ferrochelatase

51
Q

What levels of lead impact brain development in a child?

A

10 mcg/mL

52
Q

Which lead chelator may actually increase CNS lead levels?

A

EDTA

therefore only use with dimercaprol, which is typically used for lead encephalopathy

53
Q

You’re treating someone with lead poisoning. You give them a chelating agent and after a short dip, their serum lead levels rise again. What did you do wrong?

A

serum levels may rise after chelation due to tissue redistribution. repeat the chelation

54
Q

Heavy metal poisoning that can be measured in hair?

A

arsenic

55
Q

Chronic exposure to this heavy metal causes dermatologic issues like palmar and solar keratoses.

A

arsenic

56
Q

What drug is formulated in peanut oil?

A

dimercaprol

(IM injection q4h)

problem: hypersensitivity, G6PD deficiency, nephrotoxicity, sterile abscess at injection site, etc. etc.

57
Q

Mercury toxicity causes what?

A

interstitial pneumonitis, intention tremor, inflammation of gums w/ excessive salivation

desquamative rash in small children

dose-related nephrotic syndrome

58
Q

Which antivenin is made in horses and therefore may result in hypersensitivity reaction when administered?

A

lactrodectus antivenin

59
Q

What happens if you take syrup of ipecac chronically?

A

cardiotoxicity

60
Q

Why is glucagon a good antidote for beta blocker toxicity?

A

acts on cardiac muscle cells to increase intracellular cAMP

but does so independent of beta receptors

61
Q

How does insulin help in beta blocker toxicity?

A

switches cardiac metabolism to glucose which improves heart muscle function….

also, since beta blockers and calcium channel blockers reduce insulin secretion (beta2 pancreatic receptors and L-type calcium channels), toxicity results in hyperglycemia, hypoinsulinemia, and acidosis. insulin helps correct this

62
Q

Use metaclopramide for N/V associated w/ _______________ overdose.

A

acetominophen

63
Q

This drug is an antihistamine with antiserotonin effects.

A

cyproheptadine

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