Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IV lipid emulsion is useful for what 7 agents?

A
  • Cocaine
  • Propranolol
  • Bupropion
  • Amitriptyline
  • Diltiazem, Verapamil
  • Lamotrigine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The following are possible causes of which toxidrome?

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

Anticholinergic toxidrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat a patient with anticholinergic toxidrome?

A
  1. ABCs
  2. Supportive care
  3. Rapid cooling
  4. Benzos for agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When does serotonin syndrome occur?

A

Usually occurs in patients taking 2 SSRIs

(ex: Lithium + MAOI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat serotonin syndrome?

A

Treatment is supportive:

  • Remove offending agent
  • Reduce temperature
  • Judicious use of benzodiazepines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The following are symptoms of which toxidrome?

  • Pin point pupils
  • depressed respirations
A

Opiate toxidrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

THe following is tx for which toxidrome

  • ABCs
  • Naloxone
A

Opiate toxidrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

KNOW THIS!

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which Toxidrome?

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

A

Sympathomimetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

A

Opioid

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

A

P450

25
Q

Acetaminophen toxicity:

Should check 4 hour level after single acute ingestion and plot on ______ nomogram

A

Rumack-Matthew

26
Q

Toxic effects of Acetaminophen:

  • _____ _______ in 40%
  • Renal failure : occurs in 20% of those with liver failure
  • _______: MCly seen in children
A
  • Centrolobular necrosis in 40%
  • Renal failure: occurs in 20% of those with liver failure
  • Vomiting : MCly seen in children
27
Q

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
A

Acetaminophen Toxicity

8 hours

28
Q

What is the antidote for acetaminophen toxicity? This has no benifit if > ____ hours postingestion

A

N-acetylcysteine (IV preferred over PO)

>8 hours

29
Q

What is a toxic dose of acetaminophen?

A

140mg/kg

30
Q

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
A

Salicylate Toxicity

31
Q

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
A

Salicylate Toxicity

32
Q

The Done Nomogram is useful for single acute ingestion of _______ but is not used for liquid preparations, chronic use or enteric coated substances

A

salicylate

33
Q

What are the 4 treatment options for Salicylate toxicity?

A
  • 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
Q

T/F: The anticonvulsant phenytoin can cause a false pos. for amphetamines on a drug screen

A

True

35
Q

T/F: You cannot give Phenytoin with Dextrose containing IV fluid because it will precipitate

A

True

36
Q

The following are signs and symptoms of which toxicity?

  • Slurred speech
  • Ataxia
  • Nystagmus (horizontal)
  • Visual changes
  • Decreased LOC
  • Hallucinations
  • ↑ DTRs
  • N/V
  • Seizure (rare)
A

Anticonvulsant toxicity–>Phenytoin

37
Q

What is the treatment for anticonvulsant toxicity (Phenytoin)?

A
  • Supportive
  • MDAC (multidose activated charcoal)
38
Q

T/F: Carbamazepine (anticonvulsant) toxicity possesses antimuscarinic affects such as:

  • Sedation
  • Agitation
  • Tachycardia
  • Dilated pupils
  • Ileus
  • Urinary retention
  • Dry skin
A

True

39
Q

In addition to antimuscarinic effects, Carbamazepine (anticonvulsant) toxicity can cause hypotension, bradycardia and what 3 EKG findings?

A

QRS widening

Long PR

Long QT

40
Q

What is the tx for Carbamazepine (anticonvulsant) toxicity?

A
  • Supportive
  • MDAC (multi dose activated charcoal)
41
Q

The MCC of coma from overdose is from what?

A

Barbiturates (anticonvulsant) toxicity

42
Q

The following are signs and symptoms of what toxicity?

  • CNS depression
  • Hypothermia
  • Urinary retention
  • Hypoglycemia
  • Decreased motor activity
  • Aspiration pneumonia (~40% of severe ingestions)
A

Barbiturate (anticonvulsant) toxicity

43
Q

What is the treatment for Barbiturate (anticonvulsant) toxicity? (5)

A
  • Supportive
  • Glucose
  • Narcan (won’t see response b/c not opioid)
  • Charcoal
  • Urinary alkalinization for long-acting preparations
44
Q

What is important to check if you suspect someone has a valproate (anticonvulsant) toxicity) and what would you give them if it is positive?

A

Check ammonia

if increased and pt also has decreased LOC–> give carnitine

45
Q

What are the 3 most common findings of valproate (anticonvulsant) toxicity?

A
  1. Drowsiness
  2. Confusion
  3. Mental status change
46
Q

Most toxicity of which medication is related to the following drug-drug rxns:

  • Haloperidol (major)
  • ACE-I
  • Caffeine
  • Carbamazepine
  • Clozapine
  • Fluoxetine
  • NSAIDs
  • Phenytoin
  • TCAs
A

Lithium Toxicity

47
Q

The following are the clinical effects of which toxicity?

  • Hand tremor
  • fatigue
  • decreased concentration
  • polyuria
  • anorexia with N/V/D
  • rash
  • seizure
A

Lithium toxicity

48
Q

How do you treat Lithium toxicity? Which treatment is ineffective?

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions