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FM4 > Toxicology > Flashcards

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
Q

List some specific interventions that are never or rarely used to treat toxicology

A

syrup of ipecac
cathartics
gastric lavage- risk of perforation, aspiration
whole bowel irrigation- only for lead based paint chips, solid object visible on radiographs

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26
Q

What is the antidote for poisoning with cholinergics?

A

atropine + pralidoxime

27
Q

What is the antidote for poisoning with anticholinergics?

A

physostigmine

28
Q

What is the antidote for poisoning with opioids?

A

naloxone

29
Q

What is the antidote for poisoning with toxic alcohols?

A

fomepizole, ethanol

30
Q

What is the antidote for poisoning with acetaminophen?

A

n-acetylcysteine

31
Q

What is the antidote for poisoning with lead?

A

succimer, BAL, CaNa2-EDTA

32
Q

What is the antidote for methemoglobinemia?

A

methylene blue

33
Q

What is the antidote for cyanide poisoning?

A

sodium thiosulfate, hydroxocolbamin

34
Q

What is the antidote for CCB channel blocker toxicity?

A

insulin

35
Q

What is the antidote for sulfonylurea induced hypoglycemia?

A

octreotide

36
Q

How is osmolar gap calculated?

A

2(Na+) + Glucose/18 + BUN/2.8 (+ ETOH/4.6)

Normal is

37
Q

What are causes of increased osmolar gap?

A

ME DIE

methanol, ethylene glycol, diuretic, isopropyl alcohol, ethanol

38
Q

How is anion gap calculated?

A

Na+ - (Cl- + HCO3-)

39
Q

What are causes of elevated anion gap?

A 
Methanol intoxication
Uremia
Diabetic or alcoholic ketoacidosis
Paraldehyde
Isoniazid or Iron overdose
Lactic acid
Ethylene glycol intoxication
Salicylate intoxication
40
Q

What are the agents that cause elevate anion gap AND elevated osmolar gap?

A

methanol or ethylene glycol

41
Q

Describe the pattern over time of osmolarity and acidemia in methanol/ ethylene glycol toxicity

A

Parent alcohol causes EARLY osmolar gap, acid metabolites cause LATE anion gap

42
Q

Why is fomepixole helpful in treating toxic alcohol poisoning?

A

inhibits alcohol dehydrogenase, less metabolism of the parent alcohol

43
Q

Why does intoxication with isopropyl alcohol NOT cause an elevated anion gap?

A

Isopropyl alcohol metabolized to ketone not an aldehyde, so no anion gap. There will be an osmolar gap

44
Q

What complication is associated with each of the following?

  • isopropyl
  • methanol
  • ethylene glycol
A

Isopropyl→Hemorrhagic Gastritis
Methanol →Blindness/Basal ganglia
Ethylene Glycol →Renal failure/oxylate crystals

45
Q

What are the metabolites of methanol

A

methanol–> formaldehyd–> formic acid

46
Q

What are the metabolites of ethylene glycol

A

EG–> glycol aldehyd–> glycolic acid

47
Q

List clinical signs of aspirin toxicity

A

tinnitus, sweathing, N/V

*** Primary respiratory alkalosis and metabolic acidosis

48
Q

Describe the etiology of the respiratory alkalosis seen in aspirin toxicity

A

early hyperventilation

49
Q

Describe the etiology of the metabolic acidosis seen in aspirin toxicity

A

uncoupling of oxidative phosphorylation–> anaerobic metabolism lactic and ketoacidosis (not due to the fact that ASA is a weak acid)

50
Q

How is aspirin toxicity treated?

A

alkalinize urine with IV NaHCO3

51
Q

When is hemodialysis indicated for aspirin toxicity?

A

severe or refractory, CNS symptoms

52
Q

Acetaminophen is metabolized to non-toxic metabolites and to _____, which is usually conjugated with glutathione and excreted

A

NAPQI

53
Q

In acetaminophen overdose, _____ is depleted leading to an increase in NAPQI and liver injury

A

glutathione

54
Q

How is NAC helpful in treating acetaminophen overdose?

A

precursor of glutathione/aids first phase conjugation

55
Q

List the doses of acetaminophen that are considered toxic for adults and kids

A

Toxic: >7.5 grams for adult or >150 mg/kg for kids

56
Q

Describe the stages of acetaminophen toxicity

A 
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
Q

When is the Rumack Mattews nomogram useful?

A

known time of a known ingestion of acetaminophen

58
Q

What are end points of NAC treatment?

A

resolution of symptoms
undetectable acetaminophen
normalization of liver markers

59
Q

Why are kids more susceptible to lead poisoning?

A

greater absorption, greater BBB permeability

60
Q

Therapeutic treatment of lead toxicity is mandated at levels > _____

A

45

61
Q

What are manifestations of lead toxicity?

A

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
Q

Describe current treatment guidelines for lead poisoning

A
  • Toxicity OR Level >69= BAL + CaNa2EDTA
  • Asymptomatic at 45-69= succimer OR CaNa2EDTA
  • Blood Lead Level 20-44= Chelation controversial
    = Blood Lead Level
63
Q

What is the goal end point of lead chelation therapy?

A

BLL

FM4 (6 decks)

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