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MJ- Disciplines Exam 4 > Toxicology 2 > Flashcards

Toxicology 2 Flashcards

1
Q

When is gastric lavage effective? (timing)

A

If w/in 60 min of ingestion

(reserved for life threatening substances)

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2
Q

How does activated charcoal work? When should you avoid this?

A
  • Directly absorbs substance and interrupts enterohepatic recirculation
  • Avoid in perforation, obstruction, vomiting, or if endoscopy planned
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3
Q

What 8 things are NOT absorbed by charcoal? (“CHARCOAL”)

A
  • Caustics, Corrosives
  • Heavy metals, Hydrocarbons
  • Alcohols, Alkali/Acids
  • Rapidly absorbed substances
  • Cyanide
  • Other insoluble drugs
  • Allopathic substances
  • Lithium, Laxatives
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4
Q

What 5 things is GI decontamination (whole bowel irrigation- Golytely) good for?

A

(“Pack LIES”)

  1. Iron
  2. Lithium
  3. Sustained release substances
  4. Enteric coated pills
  5. “Packers”

*use is now controversial*

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5
Q

When is IV lipid emulsion indicated? (2 situations)

A

For overdoses of lipophilic agents w/:

1. Cardiac arrest (stop 10 min after get pulse back)

or

  1. Significant hemodynamimc instabbility failing conventional therapy
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6
Q

IV lipid emulsion is useful for what 7 agents?

A
  • Cocaine
  • Propranolol
  • Bupropion
  • Amitriptyline
  • Diltiazem, Verapamil
  • Lamotrigine
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7
Q

What is the toxidrome for anticholinergics?

(Will be on exam)

A
  • Hot as Hell
  • Blind as a Bat
  • Dry as a Bone
  • Red as a Beet
  • Mad as a Hatter- agitated
  • Fixed dilated pupils
  • hyperthermic
  • DRY ARMPITS
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8
Q

The following are possible causes of which toxidrome?

  • Jimson weed
  • Antihistamines (Diphenhydramine)
  • Antidepressants
  • Scopolamine
  • Cyclobenzaprine
  • Carbamazepine
A

Anticholinergic toxidrome

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9
Q

How do you treat a patient with anticholinergic toxidrome?

A
  1. ABCs
  2. Supportive care
  3. Rapid cooling
  4. Benzos for agitation
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10
Q

What is the cholinergic (Muscarinic) toxidrome?

(“every system is leaking”)

A

“SLUDGE”

  • Salivation
  • Lacrimation
  • Urination
  • Diarrhea
  • GI cramps
  • Emesis

Also have sweating and Miosis

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11
Q

What is the cholinergic (Nicotinic) toxidrome?

(“Monday-Sunday”)

A
  • Monday – Miosis
  • Tuesday – Tachycardia
  • Wednesday – Weakness
  • Thursday – Tremors
  • Friday – Fasciculations
  • Saturday – Seizures
  • Sunday – Somnolent
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12
Q

What are the clinical features of the sympthomimetic toxidrome? How is it different from the anticholinergic toxidrome?

(sympathomimetic= Amphetamines, cocaine, pseudophedrine, caffeine, PCP)

A
  • ↑BP and HR
  • Delusions
  • _*Hyperthermia_
  • Seizure
  • _*Diaphoresis_
  • Piloerection
  • _*Mydriasis_
  • Hyperreflexia
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13
Q

When does serotonin syndrome occur?

A

Usually occurs in patients taking 2 SSRIs

(ex: Lithium + MAOI)

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14
Q

A person with _____ syndrome might have the following clinical effects:

  • Confusion - agitation - seizure - coma
  • Fever, tachycardia, diarrhea, mydriasis
  • Ataxia, hyperreflexia, clonus
A

Serotonin syndrome

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15
Q

How do you treat serotonin syndrome?

A

Treatment is supportive:

  • Remove offending agent
  • Reduce temperature
  • Judicious use of benzodiazepines
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16
Q

The following are symptoms of which toxidrome?

  • Pin point pupils
  • depressed respirations
A

Opiate toxidrome

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17
Q

THe following is tx for which toxidrome

  • ABCs
  • Naloxone
A

Opiate toxidrome

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18
Q

Summary of comparison of the following toxidromes: Anticholinergic, cholinergic, opioid, sympathomimetic and sedative-hypnotic

KNOW THIS!

A
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19
Q

Which Toxidrome?

22 y/o M presents w/ agitation, HTN, tachycardia, mydriasis and diaphoresis

A

Sympathomimetic

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20
Q

Which toxidrome? What other toxidrome might this be confused with and why?

17 y/o presents with tachycardia, hyperthermia, mydriasis, dry skin and hallucinations?

A

Anticholinergic

This might be confused with sympathomimetic- the only difference is the skin. In sympathomimetic, the patient would be diaphoretic

21
Q

Which toxidrome?

40 year old with altered mental status, bradypnea, hypoxia

22
Q

Which toxidrome?

22 year old with vomiting, diarrhea, and urinary incontinence

A

Cholinergic

(leaking from every system)

23
Q

What is the MC potentially toxic pharmaceutical drug overdose?

A

Acetaminophen toxicity

24
Q

Acetaminophen toxicity:

Acute alcohol ingestion blocks_______ system and thus ↓s toxicity –-> chronic use ↑s risks because of glutathione depletion

25
Acetaminophen toxicity: Should check 4 hour level after single acute ingestion and plot on ______ nomogram
Rumack-Matthew
26
Toxic effects of Acetaminophen: * _____ \_\_\_\_\_\_\_ in 40% * Renal failure : occurs in 20% of those with liver failure * \_\_\_\_\_\_\_: MCly seen in children
* **_Centrolobular necrosis_** in 40% * Renal failure: occurs in 20% of those with liver failure * **_Vomiting_** : MCly seen in children
27
**The following are the phases of what toxicity? After how many hours can you no longer prevent the patient from dying because the damage has already been done?** * 0-24 hours = N/V, pallor, diaphoresis, malaise, asymptomatic * 24-48 hours = resolution of above and development of RUQ pain and ↑LFTs * 72-96 hours = LFTs peak, coagulopathy, encephalopathy * 4-14 days = recover or die
Acetaminophen Toxicity 8 hours
28
What is the antidote for acetaminophen toxicity? This has no benifit if \> ____ hours postingestion
N-acetylcysteine (IV preferred over PO) \>8 hours
29
What is a toxic dose of acetaminophen?
140mg/kg
30
**The following is a result of which toxicity?** * Resp. Alkalosis and ↓ed buffering capacity * GI bleeding * ↑temp. * Metabolic acidosis * Stimulates lipolysis--\> ↑ketones and acidosis * diaphoresis
Salicylate Toxicity
31
The following are signs and symptoms of what toxicity? * Vomiting/ abdominal pain * **_Met Ac w/ Resp Alk_** * **GI hemorrhage** * Heart failure * **Hypotension** * Prolonged bleeding time * Agitation * Lethargy
Salicylate Toxicity
32
The **Done Nomogram** is useful for single acute ingestion of _______ but is not used for liquid preparations, chronic use or enteric coated substances
salicylate
33
What are the 4 treatment options for Salicylate toxicity?
* **Gastric lavage** if within 1 hour of ingestion * Mutlidose activated **charcoal** (every 4 hours) * **Normal saline** at 2-3 x maintenance * **NaHCO3-** * **+/- Hemodialysis** (if renal failure, CNS toxicity, etc)
34
T/F: The anticonvulsant **phenytoin** can cause a **false pos. for amphetamines** on a drug screen
True
35
T/F: You cannot give Phenytoin with Dextrose containing IV fluid because it will precipitate
True
36
**The following are signs and symptoms of which toxicity?** * Slurred speech * Ataxia * **_Nystagmus (horizonta_**l) * Visual changes * Decreased LOC * Hallucinations * ↑ DTRs * N/V * Seizure (rare)
**Anticonvulsant toxicity--\>Phenytoin**
37
What is the treatment for **anticonvulsant toxicity (_Phenytoin_)**?
* Supportive * **_MDAC_** (multidose activated charcoal)
38
T/F: Carbamazepine (anticonvulsant) toxicity possesses antimuscarinic affects such as: * Sedation * Agitation * Tachycardia * Dilated pupils * Ileus * Urinary retention * Dry skin
True
39
In addition to antimuscarinic effects, Carbamazepine (anticonvulsant) toxicity can cause hypotension, bradycardia and what 3 EKG findings?
QRS widening Long PR Long QT
40
What is the tx for Carbamazepine (anticonvulsant) toxicity?
* Supportive * MDAC (multi dose activated charcoal)
41
The MCC of coma from overdose is from what?
**Barbiturates** (anticonvulsant) toxicity
42
The following are signs and symptoms of what toxicity? * **CNS depression** * **Hypothermi**a * Urinary retention * **Hypoglycemia** * Decreased motor activity * **Aspiration pneumonia** (~40% of severe ingestions)
Barbiturate (anticonvulsant) toxicity
43
What is the treatment for Barbiturate (anticonvulsant) toxicity? (5)
* Supportive * **Glucose** * Narcan (won't see response b/c not opioid) * **Charcoal** * Urinary alkalinization for long-acting preparations
44
What is important to check if you suspect someone has a valproate (anticonvulsant) toxicity) and what would you give them if it is positive?
Check **ammonia** if increased and pt also has decreased LOC--\> give carnitine
45
What are the 3 most common findings of valproate (anticonvulsant) toxicity?
1. Drowsiness 2. Confusion 3. Mental status change
46
Most toxicity of which medication is related to the following drug-drug rxns: * **_Haloperidol_ (major)** * **ACE-I** * **Caffeine** * Carbamazepine * Clozapine * Fluoxetine * NSAIDs * Phenytoin * TCAs
Lithium Toxicity
47
**The following are the clinical effects of which toxicity?** * Hand tremor * fatigue * decreased concentration * polyuria * anorexia with N/V/D * **rash** * **seizure**
Lithium toxicity
48
How do you treat Lithium toxicity? Which treatment is ineffective?
* **Benzos** for seizures * Aggressive **IV normal saline** * **Hemodialysis** for serum level \>3.5mEq/L and little change in level after 6 hours of hydration \*\*No role for GI decontamination (charcoal ineffective)\*\*

MJ- Disciplines Exam 4 (4 decks)

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