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PICU > Toxicology > Flashcards

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?

A

Oxygen

24
Q

antidote for pesticide

A

atropine

25
Q

antidote for nifedipine?

A

glucose and insulin

26
Q

antidote foramitriptyline?

A

Na bicarbonate

27
Q

antidote for methanol

A

fomepizole

28
Q

antidote for Glyburide

A

glucose or octreotide

29
Q

how do you manage a hydrocarbon ingestion

A

Stat CXR and repeat in 4-6 hours
oxygen
+/- bronchodilator
can DC if well 4-6 hrs

30
Q

what metabolic abnormality could you see with metformin

A

lactic acidosis

31
Q

what drugs can cause hypoglycemia?

A

Glyburide
beta blockers
ethanol
ASA

32
Q

what is the toxic dose of Tylenol

A

150 mg/kg

33
Q

what are complications of tylenol OD?

A

Anion gap metabolic acidosis
acute tubular necrosis
fulminant liver failure

34
Q

when does the hepatotoxicity of Tylenol OD start?

A

24-72 hours - stage II

35
Q

when do most deaths occur in Tylenol OD

A

stage III -72-96 hours

36
Q

what is the nomogram used for Tylenol OD

A

Rumack-Mathew

best outcome if started within 8hours

37
Q

what might make you think your patient took an ASA OD?

A

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
Q

how do you manage an ASA ingestion?

A
  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
Q

what makes you think your patient ingested IRON

A
  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
Q

how do you manage IRON OD

A

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
Q

what is the only alcohol that does not cause metabolic acidosis

A

isopropyl alcohol

ketosis without acidosis

42
Q

if patient ingested windshield fluid, what are they most at risk of developing?

A

Methanol

retinal injury and blindness

43
Q

what electrolyte abnormalities might you see post ethylene glycol ingestion?

A

metabolic acidosis

hypocalcemia causing prolonged QTc and calcium oxalate crystals

44
Q

clinical presentation of Ethylene Glycol ingestion

A

inebriation but odorless
cardiac decompensation andprolonged QTc
Renal failure
cerebral hearniation

45
Q

how do you manage ethylene glycol ingestion

A

Na bicarb to correct acidosis
Fomepizole
may need dialysis
cofactor therapy -folic acid and leucovorinm

46
Q

How do you manage a TCA OD

A
  1. charcoal
  2. may needintubation
  3. Na bicarb if QRS >100
  4. Norepinephrine for low BP
    physostigmine is contraindicated
47
Q

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

A

Carboxyhemoglobin level > 25%
start 100% O2
if > 25% - need hyperbaric treatment

48
Q

a patient states that they tried bath salts. WHat might we find?

A 
hallucinations
suicidality
Seizures
GI symptoms
inc HR

PICU (2 decks)

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