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Toxicology Flashcards

1
Q

What toxidrome consists of the following symptoms?

diarrhea, urination, miosis, bradycardia, bronchosecretions, emesis, lacrimation, salivation, sweating

A

cholinergic

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2
Q

What are the signs of the cholinergic toxidrome?

A

diarrhea, urination, miosis, bradycardia, bronchosecretions, emesis, lacrimation, salivation, sweating

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3
Q

What are some causes of the cholinergic toxidrome?

A

organophosphates, carbamates, mushrooms

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4
Q

What is the antidote for the cholinergic toxidrome?

A

atropine

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5
Q

What is the major concern/ complication of the cholinergic toxidrome

A

respiratory failure from excessive bronchosecretion

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6
Q

What toxidrome consists of the following symptoms?

hyperthermia, dry skin, mydriasis, tachycardia, delerium, hallucination, urinary retention, seizure

A

Anticholinergic

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7
Q

What are the symptoms of the anticholinergic toxidrome?

A

hyperthermia, dry skin, mydriasis, tachycardia, delerium, hallucination, urinary retention, seizure

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8
Q

What are some causes of the anticholinergic toxidrome?

A

antihistamines, antidepressants, antipsychotic, antiparkinsonians
atropine

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9
Q

What is the antidote for the anticholinergic toxidrome?

A

physostigmine

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10
Q

What is the most serious complication of anticholinergic toxicity?

A

seizure

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11
Q

What toxidrome consists of the following symptoms?

hyperthermia, diaphoresis, mydriasis, tachycardia, hypertension, seizure

A

sympathomimetic

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12
Q

List symptoms of the sympathomimetic toxidrome

A

hyperthermia, diaphoresis, mydriasis, tachycardia, hypertension, seizure

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13
Q

What are some causes of the sympathomimetic toxidrome?

A

cocaine

amphetamines

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14
Q

What is the antidote for the sympathomimetic toxidrome?

A

none

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15
Q

What toxidrome consists of the following symptoms?

miosis, hypoventilation, coma, bradycardia, hypotension

A

opioid

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16
Q

What are symptoms of the opioid toxidrome?

A

miosis, hypoventilation, coma, bradycardia, hypotension

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17
Q

What are some causes of the opioid toxidrome?

A

heroin, methadone, oxycodone, hydrocodone

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18
Q

What is the antidote for opioid toxicity?

A

naloxone

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19
Q

Poisoning with what substances can NOT be treated with activated charcoal?

A

PHAILS

pesticides, hydrocarbons, acid/alkali, iron, lithium, solvents

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20
Q

Multiple dose activated charcoal can be used in some toxicities because it interrupts ______

A

enterohepatic circulation

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21
Q

What drugs can be removed by multiple dose activated charcoal?

A

AABBCD

antimalarials, aminophylline, barbiturates, beta blockers, carbamazepine, dapsone

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22
Q

What poisonings are treated with urinary alkalinization?

A

aspirine, phenobarbitol

give sodium bicarb until urine pH=8

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23
Q

What poisonings are treated with urinary acidification?

A

NONE

used to be indicated for PCP and amphetamines, but issue of complication of rhabdomyolysis

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24
Q

What drugs can be removed by hemodialysis?

A

in short: salicylate and toxic alcohols, lithium

I STUMBLE= isopropyl alcohol, salicylate, theophylline, uremia, methanol, barbiturates, lithium, ethylene glycol

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25
List some specific interventions that are never or rarely used to treat toxicology
syrup of ipecac cathartics gastric lavage- risk of perforation, aspiration whole bowel irrigation- only for lead based paint chips, solid object visible on radiographs
26
What is the antidote for poisoning with cholinergics?
atropine + pralidoxime
27
What is the antidote for poisoning with anticholinergics?
physostigmine
28
What is the antidote for poisoning with opioids?
naloxone
29
What is the antidote for poisoning with toxic alcohols?
fomepizole, ethanol
30
What is the antidote for poisoning with acetaminophen?
n-acetylcysteine
31
What is the antidote for poisoning with lead?
succimer, BAL, CaNa2-EDTA
32
What is the antidote for methemoglobinemia?
methylene blue
33
What is the antidote for cyanide poisoning?
sodium thiosulfate, hydroxocolbamin
34
What is the antidote for CCB channel blocker toxicity?
insulin
35
What is the antidote for sulfonylurea induced hypoglycemia?
octreotide
36
How is osmolar gap calculated?
2(Na+) + Glucose/18 + BUN/2.8 (+ ETOH/4.6) Normal is
37
What are causes of increased osmolar gap?
ME DIE | methanol, ethylene glycol, diuretic, isopropyl alcohol, ethanol
38
How is anion gap calculated?
Na+ - (Cl- + HCO3-)
39
What are causes of elevated anion gap?
``` Methanol intoxication Uremia Diabetic or alcoholic ketoacidosis Paraldehyde Isoniazid or Iron overdose Lactic acid Ethylene glycol intoxication Salicylate intoxication ```
40
What are the agents that cause elevate anion gap AND elevated osmolar gap?
methanol or ethylene glycol
41
Describe the pattern over time of osmolarity and acidemia in methanol/ ethylene glycol toxicity
Parent alcohol causes EARLY osmolar gap, acid metabolites cause LATE anion gap
42
Why is fomepixole helpful in treating toxic alcohol poisoning?
inhibits alcohol dehydrogenase, less metabolism of the parent alcohol
43
Why does intoxication with isopropyl alcohol NOT cause an elevated anion gap?
Isopropyl alcohol metabolized to ketone not an aldehyde, so no anion gap. There will be an osmolar gap
44
What complication is associated with each of the following? - isopropyl - methanol - ethylene glycol
Isopropyl→Hemorrhagic Gastritis Methanol →Blindness/Basal ganglia Ethylene Glycol →Renal failure/oxylate crystals
45
What are the metabolites of methanol
methanol--> formaldehyd--> formic acid
46
What are the metabolites of ethylene glycol
EG--> glycol aldehyd--> glycolic acid
47
List clinical signs of aspirin toxicity
tinnitus, sweathing, N/V *** Primary respiratory alkalosis and metabolic acidosis
48
Describe the etiology of the respiratory alkalosis seen in aspirin toxicity
early hyperventilation
49
Describe the etiology of the metabolic acidosis seen in aspirin toxicity
uncoupling of oxidative phosphorylation--> anaerobic metabolism lactic and ketoacidosis (not due to the fact that ASA is a weak acid)
50
How is aspirin toxicity treated?
alkalinize urine with IV NaHCO3
51
When is hemodialysis indicated for aspirin toxicity?
severe or refractory, CNS symptoms
52
Acetaminophen is metabolized to non-toxic metabolites and to _____, which is usually conjugated with glutathione and excreted
NAPQI
53
In acetaminophen overdose, _____ is depleted leading to an increase in NAPQI and liver injury
glutathione
54
How is NAC helpful in treating acetaminophen overdose?
precursor of glutathione/aids first phase conjugation
55
List the doses of acetaminophen that are considered toxic for adults and kids
Toxic: >7.5 grams for adult or >150 mg/kg for kids
56
Describe the stages of acetaminophen toxicity
``` Stage 1 (0.5-24 hrs)-Asymptomatic, N/V Stage 2 (24-72 hrs)-RUQ pain/tender;Liver injury detectable Stage 3 (72-96 hrs)-Hepatic phase/ necrosis Stage 4 (4 days-3 weeks)-Recovery/no chronic disease ```
57
When is the Rumack Mattews nomogram useful?
known time of a known ingestion of acetaminophen
58
What are end points of NAC treatment?
resolution of symptoms undetectable acetaminophen normalization of liver markers
59
Why are kids more susceptible to lead poisoning?
greater absorption, greater BBB permeability
60
Therapeutic treatment of lead toxicity is mandated at levels > _____
45
61
What are manifestations of lead toxicity?
CNS- encephalopathy, cognitive delay, behavior problems GI- lead colic Neuro- wrist drop Renal- dysfunction, necrosis Heme- microcytic hypochromic anemia with basophilic stippling Bone- lead lines Dental- caries
62
Describe current treatment guidelines for lead poisoning
- Toxicity OR Level >69= BAL + CaNa2EDTA - Asymptomatic at 45-69= succimer OR CaNa2EDTA - Blood Lead Level 20-44= Chelation controversial = Blood Lead Level
63
What is the goal end point of lead chelation therapy?
BLL

FM4 (6 decks)

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