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N494 ICU Prep > Toxicology > Flashcards

Toxicology Flashcards

1
Q

List the toxidromes

A

Anticholinergic

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2
Q

s/s of anticholinergic

A 
MAD AS A HATTER 
HOT AS A HARE 
DRY AS A BONE 
BLIND AS A BAT
RED AS A BEET

Mental Status – altered
Eyes – midriasis
Skin – dry, flushed, hyperthermia, dry mucous membranes
GI/GU – decreased bowel sounds, urinary retension

Agent – antihistamines, atropine, scopolamine, tricyclic antidepressants
Treatment – physostigmine, sedation, cooling

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3
Q

Cholinergic

A

Skin – lacrimination, salivation
GI/GU – nausea, emesis, increased stooling and urination
Neuromuscular – muscle fasciculations, weakness
Lung – respiratory secretions
Heart – bradycardia

Agent – insecticides including carbamate, organophosphate, mushrooms
Treatment – atropine, pralidoxime, airway management and ventilatory support

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4
Q

Sympathomimetic

A

Mental Status – agitation
Heart – tachycardia, hypertension
Eyes – mydriasis
Skin – diaphoresis, hyperthermia

Agent – amphetamine, cocaine
Treatment – sedation, cooling, hydration

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5
Q

Hypoglycemic

A

Mental Status – altered
Heart – tachycardia, hypertension
Skin – diaphoresis
Mental Status – abnormal behavior, slurred speech, seizures

Agent – insulin, sulfonylureas
Treatment – glucose solutions intravenously or orally

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6
Q

Opioid

A

Mental Status – depressed
Lung – respiratory depression
Eyes – miosis
Skin – hypothermia

Agent – clonidine, heroin, morphine
Treatment – naloxone, respiratory support

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7
Q

Salicylates

A 
Mental Status – altered
Heart – tachycardia
Lung – hyperpnea, respiratory alkalosis
Skin – diaphoresis
GI/GU – nausea, emesis

Agent – aspirin, wintergreen oil
Treatment – hydration, urine alkalinization, hemodialysis

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8
Q

Serotonin

A

Mental Status – altered especially agitation, hallucination
Neuromuscular – increased tone, hyperreflexia
Skin – hyperthermia
Neuromuscular – whole body tremors

Agent – SSRI, SSRI with other medications such as MAOI and TCAs, drugs of abuse including ectasy, LSD
Treatment – cooling, sedation, possibly cyproheptadine

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9
Q

Acetaminophen toxicity

A 
Skin – diaphoresis
GI/GU – anorexia, nausea, emesis
Other Common Problems
Mental Status – altered, agitated
Heart – dysrhythmia
Skin – jaundice
GI/GU – hypoglycemia, hepatitis, pancreatitis, renal failure

Agent – acetaminophen
Treatment – N-acetyl choline

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10
Q

What are common medications poisonings?

A 
Acetaminophen
ASA
Digoxin
Theophylline
Phenobarb
Iron
Lithium
Methanol, Ethylene glycol
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11
Q

What is the antidote for Opiates?

A

Naloxone

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12
Q

What is the antidote for Benzodiazepines?

A

Flumazenil

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13
Q

What is the antidote for TCA, ASA?

A

Bicarbonate

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14
Q

What is the antidote for CCB?

A

Calcium

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15
Q

What is the antidote for Beta-blockers, CCB?

A

Glucagon

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16
Q

What is the antidote for Anticholinergics

A

Physostigmine

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17
Q

What is the antidote for Organophosphates, Carbamates?

A

Atropine

18
Q

What is the antidote for Organophosphates

A

Protopam

19
Q

What is the antidote for Methanol, ethylene glycol

A

Ethanol

20
Q

What is the antidote for Acetaminophen

A

N-acetylcysteine

21
Q

Describe acetominophen poisoning

A

7.5 and 15 grams in most adults
Clinical Presentation: (U of Alberta, Critical Care Medicine ppt)
Stage 1: Pre-injury period– 0-24h
Asymptomatic or minor N+V
Stage 2: Acute liver injury– 24-48h
RUQ pain, ↑AST/ALT, PTT, INR, bili +/- ↑Cr
Stage 3: Maximal liver injury – 48-96h
marked hepatic dysfn®fulminant hepatic failure, encephalopathy, coagulopathy, hypoglycemia, acidosis, renal failure
Stage 4: Recovery period - 4-14 days
Resolution of hepatic dysfunction and recovery

22
Q

S/S of acetominophen poisoning

A 
Lethargy -> encephalopathy -> death
GI upset
Diaphoresis
Right upper quadrant pain
Labs
- Abnormal liver function tests
- Prolonged prothrombin time
- Increase bilirubin
Hepatomegaly -> liver failure
23
Q

Treatment of acetominophen overdose

A

Administer syrup of ipecac and follow emesis with activated charcoal
Prep for possible hemodialysis
This clears acetaminophen out but doesn’t stop the liver damage
Administer N-acetylcystein (NAC, Mucomyst) by IV
NAC replenishes essential liver enzymes - give q4h for 18 doses
Is most effective when started within 8 hours of ingestion
NAC is a glutathione precursor/substitute
Charcoal absorbs NAC, do not give together

24
Q

S/S of ASA (salicyclates) by stage

A 
Early
- Tinnitus
Significant
- Nausea, vomiting
- Hyperventilation/tachypnea ->respiratory alkalosis
- Fever
- Altered LOC
- Hyperactivity -> lethargy
- metabolic acidosis, ketosis
Serious
- Seizures
- Rhabdomyolysis
- Pulmonary edema
- Cerebral edema
- Acute renal failure
- Respiratory failure
- Coma
- Death
25
Q

S/S of ASA in general

A

Restlessness, tinnitus, deafness, blurring of vision
Hyperpnea, hyperpyrexia, sweating
Epigastric pain, vomiting, dehydration
Respiratory and metabolic acidosis
Disorientation, coma, cardiovascular collapse

26
Q

CO poisoning toxicology

A

Normally, oxygen is carried through the bloodstream by hemoglobin (Hgb) in red blood cells. But since Hgb has a 200–250 times greater affinity (i.e., force to combine) for CO than for oxygen, introduction of CO into the bloodstream via the respiratory tract interferes with the oxygen-carrying capacity of blood. CO binds to Hgb, forming carboxyhemoglobin (COHb) and reducing the number of binding sites available for oxygen. As a result, there is a shift to the left in the oxyhemoglobin curve and tissue hypoxia occurs. In addition to its interference with tissue perfusion, CO has direct poisoning effects on the cellular level. Inhibition of the mitochondrial cytochrome oxidase system causes depression of cellular respiration. Direct binding of CO to cardiac myoglobin causes depression of cardiac function and muscle activity. CO also compromises the integrity of blood vessels, causing leakage of fluid into extravascular spaces.

27
Q

Complications of CO poisoning

A 
systemic acidosis, 
myocardial infarction (MI), 
rhabdomyolysis (i.e., acute renal failure resulting from renal tubule accumulation of byproducts from toxic destruction of skeletal muscle), 
pulmonary edema, and 
cerebral edema, which can cause 
retinal hemorrhage and papilledema.
28
Q

S/S of CO poisoning

A

Early
- headache, dizziness, weakness, confusion, chest pain, nausea, and vomiting.
Severe
- hyperventilation, hypoxia, hypotension, and hyperreflexia develop

29
Q

COHb levels

A

A normal COHb level in a healthy individual is < 3%; smokers may have COHb levels up to 10%
COHb level > 25% is dangerous, and COHb level > 50% can be fatal

30
Q

S/S of cocaine overdose

A

Cocaine is a CNS stimulant that can:

  • increase heart rate and blood pressure and
  • cause hyperpyrexia,
  • seizures, and
  • ventricular dysrhythmias.
  • intense euphoria,
  • then anxiety, sadness, insomnia and sexual indifference;
  • cocaine hallucinations with delusions;
31
Q

Cocaine overdose management

A

Ensure airway and ventilation
control seizures
monitor cardiovascular effects;
have lidocaine and defibrillator available.
treat for hyperthermia
if cocaine was ingested, use charcoal to treat

32
Q

S/S of opium overdose

A

Acute intoxication (overdose)

  • Pinpoint pupils (may be dilated with severe hypoxia);
  • Decreased blood pressure
  • Marked respiratory depression
  • Stuporà coma
  • Fresh needle marks along course of any superficial verin; skin abscesses
33
Q

Treatment of opiate overdose

A

1) support respiratory and cardioavascular functions
establish and IV line;
2) give narcotic antagonist (naloxone hydrochloride [Narcan]) as prescribed to reverse severe respiratory depression and coma
3) Hemodialysis may be indicated for severe drug intoxication.
4) maintain airway and provide respiratory support.
endotracheal intubation or tracheaostomy
5) hemodialysis

34
Q

S/S of barbiturate overdose

A

Acute intoxication (may mimic alcohol intoxication):

  • respiratory depression
  • flushed face
  • decreased pulse rate; decreased blood pressure
  • increasing nystagmus
  • depressed deep tendon reflexes
  • decreasing mental alertness
  • difficulty in speaking
  • poor motor coordination
  • coma, death
35
Q

Treatment of barbiturate overdose

A
  • maintain airway and provide respiratory support.
  • large-gauge needle or IV catheter to support blood pressure;
  • coma and dehydration result in hypotension and respond to infusion of IV fluids with elevation of blood pressure.
  • Sodium bicarbonate may be prescribed to alkalinize urine; it promotes excretion of barbiturates.
  • evacuate stomach contents or lavage as soon as possible to prevent absorption;
  • repeated doses of activated charcoal may be administered.
  • assist with hemodialysis for severely overdosed patient
    maintain neurologic and vital sign flow sheet
36
Q

S/S of Amphetamine-type Drug (Pep Pills, “Uppers,” “speed,” “crystal,” “meth”) overdose

A 
Nausea, 
vomiting, 
anorexia, 
palpitations, 
tachycardia, 
increased blood pressure, 
tachypnea, 
anxiety, 
nervousness, diaphoresis, mydriasis
Repetitive or stereotyped behaviour
Irritability, insomnia, agitation
Visual misperceptions, auditory hallucinations
Fearful anxiety/depression, cold, distant hostility, paranoia
Hyperactivity, rapid speech, euphoria
Seizures, coma, hyperthermia,
37
Q

Treatment of Amphetamine-type Drug

A

treat seizures with benzodiazepines

treat sympathetic stimulation with beta-blocker agents

38
Q

S/S of alcohol withdrawl

A

nausea and vomiting, dyspepsia, headache, anorexia, sweating, tachycardia, hypertension, anxiety, agitation, tremors, vivid dreams, insomnia, tactile, visual and
auditory disturbances, hallucinations and delirium tremens. SEIZURES

39
Q

Assessment of EtOH abuse

A

 frequency of use,

 usual quantity ingested,

 duration of a drinking session,

 date, time and amount of alcohol last used, and

 any other drug use.

40
Q

Assessment of withdrawl

A

> 20
10-20
7-10
1-6

41
Q

Delirium Tremens (the DT’s)

A

is the most severe form of alcohol withdrawal and is a medical emergency.

a) Confusion and disorientation.
b) Extreme agitation or restlessness.
c) Gross tremor.
d) Autonomic instability (fluctuation in blood pressure & pulse, disturbances of electrolytes, hypothermia).
e) Paranoid ideation, typically delusional intensity.
f) Distractibility and accentuated response to external stimuli.
g) Hallucinations affecting any of the senses but typically visual.
h) Major psychotic disorders can sometimes mimic this state.

N494 ICU Prep (9 decks)

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