Toxicology

Question 1

Acetaminophen

Answer 1

N-acetylcysteine

Question 2

Anticholinergics

Answer 2

Physostigmine

Question 3

Arsenic
Lead
Mercury

Answer 3

Dimercaprol, DMSA (Succimer), Penicillamine

Question 4

Opiods

Answer 4

Nalmefene

Naloxone

Question 5

TCA

Answer 5

Na Bicarbonate

Question 6

BNZ

Answer 6

Flumazenil

Question 7

B Blockers

Answer 7

Glucagon, Insulin, and Glucose

Question 8

CCBs

Answer 8

Calcium, Glucagon, Insulin, and Glucose

Question 9

Organophosphates and Carbamates

Answer 9

Atropine, Protopam

Question 10

Valproic acid

Answer 10

Carnitine

Question 11

Cyanide

Answer 11

Hydroxycobalamin

Question 12

Cyanide, Hydrogen Sulfate

Answer 12

Hydroxycobalamin, Na Thiosulfate, Na Nitrate

Question 13

Ethylene Glycol

Answer 13

Fomepizole, Pyridoxine, Thiamine

Question 14

Methanol

Answer 14

Ethanol, Fomepizole, Folate/Leucovorin

Question 15

Rattlesnake

Answer 15

CroFab Antivenin

Question 16

Wilson’s Dz

Answer 16

Penicillamine

Question 17

HF (hydrofluoric acid)

Answer 17

Calcium gluconate

Question 18

Fe

Answer 18

Deferoxamine (IV)–>ADE: Red Urine

Deferasirox (PO)–>ADE: Auditory/Visual changes

Question 19

Isoniazid, Hydrazine

Answer 19

Pyridoxine

Question 20

Serotonin Syndrome

Answer 20

Cyproheptadine

Question 21

Lead

Answer 21

DMSA (Succimer)

Question 22

Methemoglobin agents (Prilocaine, Benzocaine)

Answer 22

Methylene blue

Question 23

Sulfonureas

Answer 23

Octreotide

Question 24

Why are kids @ increased risk for intoxication?

Answer 24

They are kids, more likely to eat stuff.

Also, have increased water volume, decreased fat so they need a LOWER dose for intoxication

Question 25

what are mc substances used by adults?

Answer 25

Analgesics=Sedatives/Hypnotics>Antidepressants=CV Rx>Alcohol>Pesticides

Question 26

What is effect of charcoal?

Answer 26

Activated charcoal acts as a gastric decontaminant creating an increased surface area to absorb the toxin

***Must maintain airway protection and used within 1 hr of exposure

Question 27

What is effect of Ipecac?

Answer 27

Emetic. Works within 30 min, only works if toxin not yet absorbed

Question 28

What measures can be taken with intoxication with toxins that are ALREADY absorbed?

Answer 28

Hemodialysis: for water soluble toxins with decreased protein binding/molecular weight

Hemoperfusion: for toxins with increased protein binding; pass thru charcoal filter

Administer antagonist/antidote

Question 29

Describe the course of Acetaminophen intoxication

Answer 29

Phase 1 (30 min-4 hrs):  normal or anorexia, pallor, diaphoresis, N/V
Phase 2 (24-48 hrs):  RUQ pain and decreases renal function.  also, increased PT time
Phase 3 (3-5 days):  Centrilobular necrosis, coagulation defects, jaundice, hepatic encephalopathy, renal failure
Phase 4 (4 days-2 weeks):  resolution or death

Give N-acetylcysteine if drug concentration > 150ug/mL @ 4 hours
Do NOT stop NAC once started–>1 loading dose and 17 maintenance doses

Question 30

Describe the course of Aspirin intoxication

Answer 30

***Aspirin=ZERO ORDER KINETICS (like phenytoin and ethanol)

1st=Stimulates brainstem to increase RR–>decrease CO2–>Respiratory Alkalosis
2nd=Aspirin=Salicylate=MUDPILES=Metabolic acidosis

Acutely=Gastritis
Moderate intoxication=tinnitus, increased HR and RR
Severe intoxication=agitation, seizures, CV collapse, increase temperature

Tx if +anion gap and [salicylate]>100mg/dL

• activated charcoal
• glucose
• NaHCO3 and K+
• hemodialysis

Question 31

CO

Answer 31

100% oxygen

Question 32

Chlorine, ammonia, sulfur dioxide

Answer 32

humidified O2 and bronchodilators