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FM4 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

List the symptoms of a cholinergic toxidrome.

A

DUMBBELSS (leaky syndrome/ SLUDGE)

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

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2
Q

List the symptoms of an anticholinergic toxidrome.

A

hyperthermia, dry skin, mydriasis (dilated), delirium, hallucinations, tachycardia, urinary retention (large bladder), seizure

hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat

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3
Q

Antidote for cholinergic toxidrome?

A

atropine +2-PAM

likely causes include organophosphates, mushrooms, sarin gas

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4
Q

What is the antidote for anticholinergic syndrome?

A

physostigmine

caused by the anti’s and atropine (anti

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5
Q

List the symptoms of a sympathomimetic toxidrome.

A

hyperthermia, diaphoresis, mydriasis (dilated), tachycardia, hypertension, seizure, agitation, may have active bowel sounds

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6
Q

List the symptoms of a opioid toxidrome.

A

mitosis (constricted), hypoventaliation (decreased rate and effort), coma, bradycardia, hypotension

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7
Q

What is the antidote for anticholinergic syndrome?

A

physostigmine

caused by the anti’s and atropine (anti-histamine, antipsychotics, anti depressants and anti parkinsonions

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8
Q

What is the antidote for sympathomimetic toxidrome?

A

no antidote, treat symptomatically re: seizure, HTN, hyperthermia

typical poisons: cocaine, amphetamines/methamphetamines

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9
Q

What is the antidote for opioid toxidrome?

A

naloxone (narcan- blocks all receptors)

typical poisons: heroin, methadone, oxy/hydrocodone

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10
Q

List the things that activated charcoal cannot be used to treat.

A 
PHAILS to remove:
pesticides
hydrocarbons
acid/alkali
iron
lithium
solvents
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11
Q

Multiple dose activated charcoal is useful in treating what toxins?

A 
ABCD
antimalarials and aminophylline
barbiturates and Beta-blockers
carbamazepine
dapsone
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12
Q

Urinary alkalinization is useful in treating which toxins?

A

aspirin and phenobarbital overdose

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13
Q

Hemodialysis is used in which overdoses?

A 
ISTUMBLE 'over the dialysis machine'
isopropyl alcohol
salicylate
thiophyline
uremia
methanol
barbiturates
lithium
ethylene glycol
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14
Q

Hemodialysis is used in which overdoses?

A 
ISTUMBLE 'over the dialysis machine'
isopropyl alcohol
salicylate
thiophyline
uremia
methanol
barbiturates
lithium
ethylene glycol
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15
Q

Give examples of a few controversial interventions and when they are used.

A

syrup of ipecac- never indicated
cathartics- mostly never
gastric lavage- sometimes, not if unconscious
whole bowel irrigation for foreign bodies or drug packers
urinary acidification: PCP, amphetamine but not done due to rhabdomyolysis

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16
Q

Give examples of a few controversial interventions and when they are used.

A

syrup of ipecac- never indicated
cathartics- mostly never
gastric lavage- sometimes, not if unconscious
whole bowel irrigation for foreign bodies or drug packers
urinary acidification: PCP, amphetamine but not done due to rhabdomyolysis

17
Q

What are antidotes used in toxic alcohols, acetaminophen and lead?

A

toxic alcohols: fomeprizole, ethanol
acetaminophen (NAC)
lead: succimer (PO), BAL (IM) and CaNa2EDTA (IV)

18
Q

What are antidotes used in toxic alcohols, acetaminophen and lead?

A

toxic alcohols: fomeprizole, ethanol
acetaminophen (NAC)
lead: succimer (PO), BAL (IM) and CaNa2EDTA (IV)

19
Q

List which toxins give an osmolar gap and which toxins give anion gap.

A

Osmolar: MEDIE- methanol, ethylene glycool, diuretic, isopropyl alcohol, ethanol

MUDPILES: methanol, uremia, diabetic ketoacidosis, propylene glycol, iron poisoning or isoniazid, lactic acidosis, ethylene glycol, salicylates

20
Q

List which toxins give an osmolar gap and which toxins give anion gap.

A

Osmolar: MEDIE- methanol, ethylene glycool, diuretic, isopropyl alcohol, ethanol

MUDPILES: methanol, uremia, diabetic ketoacidosis, propylene glycol, iron poisoning or isoniazid, lactic acidosis, ethylene glycol, salicylates

21
Q

How do you calculate and osmolar gap?

A

2 Na + Glucose/18 + BUN/2.8

normal range is

22
Q

How is metabolism of alcohols related to osmolar gap and anion gap?

A

alcohols cause intoxication and osmolar gap
methanol and ethylene glycol cause AGMA

(metabolism is via alcohol dehydrogenase)

23
Q

What are the effects of methanol and ethylene glycol?

A

methanol: blindness/basal

ethylene glycol: renal failure/oxylate crystals

24
Q

What are the symptoms of aspirin toxicity? How do you treat?

A

primary respiratory alkalosis (hyperventilation) and metabolic acidosis (formation of lactic and ketoacidosis)

**tinnitus, sweating, N/V

tx: with urinary alkalization to increase excretion

25
Q

What are the symptoms of aspirin toxicity? How do you treat?

A

primary respiratory alkalosis (hyperventilation) and metabolic acidosis (formation of lactic and ketoacidosis)

**tinnitus, sweating, N/V

tx: with urinary alkalization to increase excretion

26
Q

What is the level of toxicity in dosing acetaminophen for adults or children?

A

toxic >7.5 g for adults in 4 hours

>150 mg/kg for kids in 4 hours

27
Q

When can you use the Rumack Matthews nomagram to predict acetaminophen toxicity?

A

when ingestion was at a known time and a known single dose

28
Q

What are the endpoints for treatment with NAC?

A

resolution of sxs, undetectable acetaminophen AND normalization of liver markers

29
Q

What are the blood levels require treatment and what type of treatment?

A

.

30
Q

What are the blood levels require treatment and what type of treatment?

A

treatment mandated if level is

31
Q

What are the blood levels require treatment and what type of treatment?

A

treatment mandated if level is succimer OR CaNa2 EDTA

70-100 mug/dL cause severe toxicity; >69–>BAL + CaNa2EDTA

32
Q

What are the clinical findings of someone with lead toxicity?

A

CNS- cognitive delay, frank encephalopathy and coma
GI- lead colic, severe and obscure abdmonial pain
NM- wrist drop
Renal PCT dysfunction, necrosis, saturnine gout
Blood-microcytic hypo chromic anemia (basophilic stippling
bone: radio dense metaphysical lines
dental- caries, gingival lead lines

FM4 (6 decks)

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