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Toxicology Flashcards

1
Q

what are radio-opaque drugs

A 
COINS
choral hydrate
Opiods packets
Iron and other heavy metals
Neuroleptics if earlyalc
Sustained release tablets - bezoar formed
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2
Q

what ingestion will cause tachycardia

A

anticholinergics
ethanol
sympathomimetics

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3
Q

what ingestion will cause bradycardia

A

opiods
bet blockers
Ca channel block

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4
Q

what ingestion will cause QRS widening?

A

TCA

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5
Q

what ingestion will cause prolonged QT

A

neuroleptics

TCA

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6
Q

organophosphates, carbamates (neostigmine..) and alzheimer drugs are part of what group

A

cholinergics

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7
Q

what is DUMBELLS?

A 
cholinergic toxidromes symptoms:
Diaphoresis
Urination
Miosis
Bronchorrhea/bradicardia
Emesis
Lacrimation
Lethargy
Salivation
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8
Q

how do you manage a cholinergic poisoning

A

eg. organophosphates
1. 100% O2
2. early intub
3. Remove clothing and irrigate skin
4. Atropine + Pralidoxine

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9
Q

what is a common anticholinergic that teens will try to abuse

A

Jimson weed

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10
Q

what are common anticholinergics

A

TCA are weakly antichol
antihistamine
atropine or cyclopentolate eye drops
neuroleptics

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11
Q

how do you manage a anticholinergic poisoning?

A

Lorazepam for agitation
bring down T
consider activated charcoal if < 1 hr
Physostigmine if central and periph toxicity EXCEPT if TCA

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12
Q

what are sympathomimetic drugs?

A

cocaine
amphetamine
PCP
MDMA

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13
Q

what are sympathomimetic features

A 
diaphoresis
HTN
Sez
agitation - drug dep
inc HR
inc temp
Psychosis
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14
Q

how can Dx MDMA use?

A

ecstacy

can do urine test

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15
Q

opiod toxidrome

A 
miosis
brady
low BP
hypopnea
coma
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16
Q

when does Charcoal PHAIL

A 
PHAILS
Potassium
Hydrocarbons
Alcohols
Iron
Lithium
Solvents
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17
Q

What are the drugs where one can be enough to kill

A 
cardiovascular drugs (eg, β-blockers and calcium-channel antagonists)
antidepressants
antipsychotics
anticonvulsants
antiarrhythmic agents
salicylates
oral hypoglycemics
opioids
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18
Q

what does an organophosphate injestion look like

A 
organophosphate inhibit cholinesterase enz and cause Colinergic syndrome
DUMBBELS
Diarrhea
Urination
Miosis
Bronchorrhea
Bradycardia
Emesis
Lacrimation
Salivation
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19
Q

how do you manage a organophosphate OD?

A

remove clothing and wash skin
Atropine-competitive inhibitor of Ach at muscarinic level
Pralidoxine to help remove the organo -in first 18 hrs

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20
Q

What makes you think your patient tooks ecstacy?

A 
HTN- can be and emergency
Hyperthermia
Hyponatremia from drinking too much H2O
Serotonin syndrome
Cardiac ischemia
Hepatotoxicity
21
Q

how do you manage ecstacy ingestion

A

Activated charcoal if it has been < 1 hours
Lorazepam for HTN and agitation
fluid restrict for hyponatremia
cool mist and fans

22
Q

Antidote for Iron

A

deferoximine

23
Q

Antidote for carbon monoxide?

24
Q

antidote for pesticide

25
antidote for nifedipine?
glucose and insulin
26
antidote foramitriptyline?
Na bicarbonate
27
antidote for methanol
fomepizole
28
antidote for Glyburide
glucose or octreotide
29
how do you manage a hydrocarbon ingestion
Stat CXR and repeat in 4-6 hours oxygen +/- bronchodilator can DC if well 4-6 hrs
30
what metabolic abnormality could you see with metformin
lactic acidosis
31
what drugs can cause hypoglycemia?
Glyburide beta blockers ethanol ASA
32
what is the toxic dose of Tylenol
150 mg/kg
33
what are complications of tylenol OD?
Anion gap metabolic acidosis acute tubular necrosis fulminant liver failure
34
when does the hepatotoxicity of Tylenol OD start?
24-72 hours - stage II
35
when do most deaths occur in Tylenol OD
stage III -72-96 hours
36
what is the nomogram used for Tylenol OD
Rumack-Mathew | best outcome if started within 8hours
37
what might make you think your patient took an ASA OD?
HIGH temps CNS:confusion, hallucination, Sz, cerebral edema RESP: tachypnea, pulmonary edema - resp alkalosis can see AG metabolic acidosis if develop pulmonary or cerebral edema LYTES: Low glucose,Low potassium PARADOXICAL aciduria N/V/GI bleed Tinnitus and hearing loss Hyperglycemia regressing to hypoglycemia Diaphoresis ? renal failure
38
how do you manage an ASA ingestion?
1. ABC 2. Charcoal up to 6 HRS!!! bc of bezoar formation 3. Alkalinize urine -aim for 7-7.5 wth bicarbonate 4. K IV May need dialysis or ECMO if CNS inolvement
39
what makes you think your patient ingested IRON
1. N/V/D 2. poor perfusion and metabolic acidosis 3. GI bleed 4. Coagulopathy - 12-24 5. resp failure - 12-24 6. ARDS - 2-3 7. Liver failure - d2-3 8. GI stricture - Wk 3-4
40
how do you manage IRON OD
Whole bowel irrigation if tablest seen o AXR or if < 6 hrs - textbook only fluid resc deferoxamine early bc once in cell, chelation is useless
41
what is the only alcohol that does not cause metabolic acidosis
isopropyl alcohol | ketosis without acidosis
42
if patient ingested windshield fluid, what are they most at risk of developing?
Methanol | retinal injury and blindness
43
what electrolyte abnormalities might you see post ethylene glycol ingestion?
metabolic acidosis | hypocalcemia causing prolonged QTc and calcium oxalate crystals
44
clinical presentation of Ethylene Glycol ingestion
inebriation but odorless cardiac decompensation andprolonged QTc Renal failure cerebral hearniation
45
how do you manage ethylene glycol ingestion
Na bicarb to correct acidosis Fomepizole may need dialysis cofactor therapy -folic acid and leucovorinm
46
How do you manage a TCA OD
1. charcoal 2. may needintubation 3. Na bicarb if QRS >100 4. Norepinephrine for low BP physostigmine is contraindicated
47
a pt is brought in with dizziness, nausea and HA.The est of the family has similar symptoms. Normal pulse oxymetry and normal PO2. What BW will help Dx and how do you manage
Carboxyhemoglobin level > 25% start 100% O2 if > 25% - need hyperbaric treatment
48
a patient states that they tried bath salts. WHat might we find?
``` hallucinations suicidality Seizures GI symptoms inc HR ```

PICU (2 decks)

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