Toxicology

Question 1

Benzos can be reveresed with?

Answer 1

Flumazenil (doesn’t work for barbiturates)

Question 2

In a patient with hypotension which sedative would you use?

Answer 2

Etomidate b/c it won’t decrease BP any further

Question 3

non-depolarizing paralytics used in intubation?

Answer 3

Vecuronium, Rocuronium

Question 4

Dis-advantage of depolarizing paralytics in intubation?

Answer 4

Harder to reverse. They are ach-like and overwhelm the NMJ. Ex. Succinyl

Question 5

Reversal of non-depolarizing paralytic agents?

Answer 5

Neostigme - ach-esterase inhibitor. Advantage over phystigme is that it doesn’t cross the BBB.

Question 6

Opioid toxidrome

Answer 6

decreased RR, pinpoint pupils, decreased bowel sounds

Question 7

Opioid antidote

Answer 7

Naloxone

Question 8

Benzo toxidrome

Answer 8

depressed mental status but normal vital signs

Question 9

Difference between benzo and barbiturates

Answer 9

Barbiturates have lots of respiratory depression

Question 10

Dangers of Flumazenil

Answer 10

can precipitate acute withdrawl (in people who are tolerant to benzos) which can result in seizures. Often not given to adults for this reason.

Question 11

Antidote to acetaminophen tox and its MOA

Answer 11

N-acetylcysteine - presursor of glutithione and replenishes it as a substrate. Best if used within 8 hours

Question 12

Tricyclic Antidepressant Toxidrome

Answer 12

Hypotension;
Gaba antagonist (seizures);
Sodium channel blocker -- widen QRS complex, this kills!

Question 13

TCA Antidote

Answer 13

Sodium Bicarbonate

Question 14

Anticholinergic Toxidrome

Answer 14

Mydriasis, dry skin, INCREASED TEMP, altered mental status. Ex. Robitussin, benadryl, TCA’s

Question 15

Anticholinergic antidote

Answer 15

Phyostigmine - CI after TCA exposure can cause asystole…make sure no EKG changes before give it

Question 16

Cholinergic toxidrome

Answer 16

miosis, salvation, lacrimation, urination, defecation, bronchospasm (drowning in own secretions)
ex. nerve gas, organophosphates (ach-esterase inhibitor)

Question 17

Cholinergic antidote

Answer 17

Atropine and Pralidoxime

Question 18

Difference between Atropine and Pralidoxime

Answer 18

Atropine cannot work at the NMJ b/c it just works at the muscarinic receptors (secretions)
Use Pralidosime - actually pulls organophosphate off ach-esterase so that it regenerates the ability to use that enzyme –> therefore works at both nicotinic and muscarinic

Question 19

Methanol or ethylene glycol antidote

Answer 19

Fomepizole –> competitive inhibitor of ADH

Question 20

If ingestion of ethylene glycol was awhile ago and acid metabolites have already been formed use:

Answer 20

hemodialysis to remove acids from blood. Fomepizole only useful in stopping conversion to acids but once formed it is not useful

Question 21

CCB toxidrome (verapamil)

Answer 21

peripheral vasodilation –> decreased vascular resistance;
Decreased sinus rate –> bradycardia;
Slows AV conduction –> decreased contractility;
Bottom line: Bradycardia and Hypotension

Question 22

Specific CCB antidote

Answer 22

high dose insulin euglycemia (replenishes ATP in myocyte)

vasopressors

Question 23

Beta blocker OD

Answer 23

bradycardia and hypotension w/ possible av blocks

Question 24

Clonidine OD (treatment for ADHD)

Answer 24

bradycardia, pin point pupils and CNS depression

Question 25

Clonidine OD treatment

Answer 25

naloxone

Question 26

Digoxin Toxicity

Answer 26

N/V, Hyperkalemia!, hypotension, bradycardia, dysrhythmias

Question 27

Digoxin toxicity antidote

Answer 27

Digibind - Digoxin specific FAB fragments

Question 28

Antidote to cocaine

Answer 28

diazapam