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Toxicology Flashcards

1
Q

What are your options regarding the specific management of intoxicants

A

1) Decrease the absorption of the intoxicant
2) Increase the elimination of the intoxicant
3) Use a specific antagonist/ antidote

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2
Q

Provided that some of the toxicant stays in the GI tract to be absorbed, what could the physician administer?

A

Activated Charcoal…absorbs the toxin and is then excreted in the feces

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3
Q

What is essential when administering charcoal for toxicity?

A

Airway protection

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4
Q

The greatest benefit of charcoal is within how long of ingestion

A

1 hr…..and don’t give it unless the pt has protected airways

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5
Q

Syrup of Ipecac most likely useless after how long?

A

30 minutes

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6
Q

Hemodialysis can be effective if the toxin has what:

A
  • Water solubility
  • Low volume of distribution
  • Low Molecular Wt Molecular Wt under 500 Da
  • Low Plasma Protein Binding

Useful for methanol, ethylene glycol, salicyclates, lithium, sotalol

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7
Q

Hemoperfusion can be used in place of hemodialysis when?

A

When there is a high degree of plasma protein binding.

Phenobarbital, carbamezapine, theophyline

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8
Q

What are some of the sympathomimetics

A
  • Cocaine, amphetamine, Methamphetamine, caffeine, theophyline …..so mostly stimulants
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9
Q

Treatment of sympathomimetic overdose

A
  • Phentolamine, nitrates, or calcium channel blockers for HTN
  • Benzos for agitation
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10
Q

Top three causes of toxicity causing arrhythmias

A

1) Amphetamines
2) TCAs
4) Digitalis

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11
Q

Most potent Beta Blocker

A

Propanolol

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12
Q

Beta Blocker toxicity treatment

A

Glucagon

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13
Q

Alternative to glucagon as treatment for Beta Blocker Toxicity?

A

High-dose insulin along with glucose suplementation

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14
Q

Calcium Channel Blocker Toxicity

A
  • Charcoal if it hasn’t been very long
  • Treat the hypotension and bradycardia with Calcium chloride or calcium gluconate.
  • Give epinephrine and gluconate
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15
Q

Realize that Beta Blockers and Calcium Channel Blockers also lead to hyperglycemia, hypoinsulinemia, and acidosis by blocking specific channels in the pancreas.

A

The administration of Insulin may reverse this.

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16
Q

Isoniazid produces acute brain toxicity how?

A

Reduces the amount of brain P5P….Results in low levels of CNS GABA which leads to seizures

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17
Q

Treatment of Isoniazid induced seizures

A

Pyridoxine and a beno if necessary

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18
Q

Acetaminophen and Aspirin (salicilate) poisoning

A

Phase 1- 30 min -4 hrs: anorexia, pallor, N/V, diaphoresis

Phase II (24-48 hrs)- Symptoms less severe, potential right upper quad pain. liver enzymes become abnormal

Phase III (3-5 days)- hepatic necrosis, jaundince, coag defects, death due to renal failure

Phase IV- 4 days to 2 weeks- death or resolution

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19
Q

Antidote for acetaminophen od

A

N-Acetylecysteine (replenishes the glutathione)

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20
Q

Antidote for Salicylates

A

NaHCO3 (alkalinize urine)

Also give glucose containing fluids to reduce the risk of cerebral hypoglycemia.

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21
Q

What do Salicylates do that cause harm?

A
  • Uncouple cellular oxidative phosphorylation which leads to acidosis and excess heat
  • Stimulate respiratory center in brainstem which leads to tachypnea
  • You see metablic acidosis and respiratory alkalosis
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22
Q

High Anion Gap Acidosis produced by what drugs

A

MUDPILES CAT

Methanol or Metformin
Uremia
DKA
P
Iron, INH, Ibuprofen
Lactic Acidosis
Ethylene Glycol
Salicylates
Cyanide
Alcohol or acids
Toluene or Theophyline
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23
Q

Serotonin syndrome antidote

A

Cyproheptadine

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24
Q

Charcoal doesn’t work for hydrocarbons

25
Describe the vital sign findings of a pt experiencing toxicity from adrenergic drug
RR- up HR- up...beta 1 BP- up Temp- up
26
Physical exam findings for a pt experiencing overdose on adrenergic drug
- Alert/agitated Pupils: dilated mucus: wet Increased bowel sounds increased urine, increased everything basically.
27
Vital sign findings for an anti-cholinergic overdose
RR- No change HR- up BP- no change T-Up
28
Mental status findings for anti-cholinergic overdose
depressed, confused, hallucinating
29
Vital sign findings for opiod overdose
Low rr, hr, bp, and fever
30
pupils in opioid overdose?
constricted...the only time you'll see constricted pupils is in opioid overdose and cholinergic agonist overdose
31
Vital sign findings in serotonergic overdose
Inc in everything...think serotonin syndrome
32
How do you treat the bradycardia and hypotension associated with beta blocker toxicity
IVglucagon
33
Propanolol overdose
IV lipid emulsion can help
34
Calcium channel blocker toxicity treatment
treat hypotension and bradycardia with IV clcium chloride or calcium gluconate Epinephrine can also raise HR
35
Insulin and detrose used during Beta Blocker toxicity and Calcium channel blocker toxicity why>
Because they somehow improve heart function...not real clear how. We know that insulin promotes the uptake of glucose into skeletal and cardiac muscles and adipose tissue, it also shifts potassium intracellularly.
36
Isoniazid is used to treat what
TB
37
How is isoniazid toxic?
produces acute toxic effects by reducing brain pyridoxal 5-phosphate, the active form of vitamin B6. All of this results in low GABA and thus seizures, ALSO, inhibits the conversion of lactate to pyruvate in the liver thus exacerbating the lactic acidosis resulting from seizures.
38
What is the antidote for Isoniazid toxicity
Pyridoxine
39
Salicylate poisoning?
Causes tinnitus, vertigo, change in mental status, confusion - Directly stimulates the respiratory center which may lead to respiratory alkalosis early, respiratory acidosis late. - Adult overdose shows respiratory alkalosis and metabolic acidosis HYPERTHERMIA- damages the innermitochondrial membrane and oxidative energy is released as heat
40
How do you diagnose salicyclate poisoning
High anion gap + positive salicylate test
41
Treatment of salicylate poisoning
IV sodium bicarbonate which alkalinizes the urine and enhances renal salicylate excretion by trapping the salicylate anion in the urine
42
Cyproheptadine is what
An Antihistamine that also has alti-serotonin activity
43
Where does cyproheptadine work?
GI smooth muscle and other locations
44
WHat is in a cyanide kit and how does it work
Amyl Nitrate + Sodium Nitrite + Sodium thiosulfate You take the amyl nitrite as an inhalant and then IV sodium nitrite which converts a portion of your hemoglobin to methemoglobin, Cyanide is strongly drawn to the methemoglobin than to cytochrome oxidase in cells. Once the cyanide binds the methemoglobin, it becomes cyanomethemoglobin. The sodium thiosulfate and cyanomethemoglobin become thiocyanate, releasing the hemoglobin for renal elimination
45
What are the two types of insecticides we need to know
- Organophosphates- malathion | - Carbamates- carbofuran
46
How do the organophosphates and carbamates cause toxicity?
``` Inhibit acetylcholinesterase and thus acetylcholine levels go way up and you get cholinergic effects....sludgebbb Salivation Lacrimation Urination Defecation GI probs Emesis Bronchorrea Bronchospasm Bradycardia ```
47
Treatment of insecticide poisoning
Protopam (cholinesterase restarter) + Atropine (anti-cholinergic)
48
How do botanical insecticides work?
Work on voltage gated ion channels
49
How does acid cause harm
- On the skin it causes coagulative necrosis - Stomach is the most commonly involved organ ans the esophagus and pharynx are relatively resistant. Causes Gastric/intestinal perforation, upper GI hemorrhage, metabolic acidosis, hemolysis, acute renal failure and death
50
Caustic alkalis
Tissue injury by liquefactive necrosis DOES affect the epithelium of the oropharyx, hypopharynx, and esophagus. Tissue edema occurs immediately and may progress to airway obstruction
51
High protoporphyrin =
lead toxicity
52
The presence of lead, even at low levels, impacts what in children?
Neural development
53
Lead toxicity is reversed by?
Chelators such as: Succimer- mild cases Dimercaprol- for severe symptoms Calcium EDTA-
54
Remember that lead levels will fall and then rise again as lead is mobilized from tissue, thus the use of chelators is not a one and done thing, must be used as a series
ok
55
Lead Toxicity
GI: Colic and constipation Nerves: Peripheral neuropathy due to demyelination Blood: Anemia, microcytic Kidneys: Impairment of prox tubule function CNS: Interferes with PKC and neurotransmitters
56
Arsenic poisoning treated with
Dimercaprol in adults Succimer in kids
57
Mercury posoning treatment
Dimercaprol and Succimer.....do not reduce neurotoxicity
58
The pattern of symptoms in iron supplement toxicity in kids
Nausea and hemorrhagic diarrhea with abdominal pain At 6-12 hrs the GI symptms resolve and there is apparent recovery 24 hours: metabolic acidosis Long term is GI tract scarring with obstruction

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