Toxicology Flashcards
what is a toxidrome
constellation of physical findings that supports the clinical dgx of poisoning
Cholinergic toxidrome acronyms
Dumbbels, MTWRF, or SLUDGE Diarrhea Urination Miosis Bronchorrhea Bradycardia Emesis Lacrimation Salivation
Mydriasis Tachycardia Weakness HTN Fasiculation
Salivation Lacrimation Urination Defecation/Diarrhea GI complaint Emesis
What system cholinergics affect and some agents
increases PNS (overactivity of rest and digest) Ex. organophosphates, carbamates, some mushrooms, nerve agents
Anticholinergic toxidrome sx
Hot as a Hare (hyperthermia)
Blind as a Bat (blurred vision, mydriasis)
Dry as a bone (impaired sweating)
Red as a Beet ( flushing)
Mad as a Hatter ( agitation, psychosis, delirium, coma)
Bloated as a Bladded (urinary retention)
What system do anticholinergics affect and some agents
decreases PNS (underactivity of rest and digest)
anti-cholinergics (atropine, scopolamine)
anti-histamines (benadryl)
anti-psychotics (Haldol)
anti-emetics (compazine, phenergan)
antidepressants (TCAs, SSRIs)
plants (Jimson weed, deadly nightshade)
Opiate/Sedative Toxidrome sx
Everything DOWN miosis bradycardia HOTN decreased LOC, coma decrease RR/Effort hypotonia, hyporeflexia decrease bowel sounds
Opiate/Sedative affect and agents
decreases SNS (decrease in fight or flight)
Morphine, Heroin, Oxycodone, Codeine, Methadone
Barbituates
Benzos
Ethanol
Sympathomemtic Toxidrome sx
Hyperthermia HTN tachycardia mydriasis urinary retention psychosis sz *diaphoresis* *hyperactive bowel sounds*
Sympathomemtic Toxidrome sx
Hyperthermia HTN tachycardia mydriasis urinary retention psychosis sz *diaphoresis* *hyperactive bowel sounds*
Sympathomemetic affect and agents
increases SNS (overactivity of fight or flight) Cocaine amphetamine MDMA phencyclidine Ephedrine, Pseudoephedrine Theophylline Caffeine Withdrawal from alcohol or benzos
What is serotonin syndrome and how to dgx
it is a change in the SNS and PNS usually from stacking agents
Pt has to have 1-2 sx from each category:
Cognitive/Behavioral
Autonomic Nervous System
Neurmuscular
Drugs that cause Serotonin syndrome
drugs that inhibit serotonin breakdown (MAOIs, Linezolid)
drugs that prevent synaptic reuptake of serotonin (SSRIs, cocaine, dextromethorphan, TCAs, etc)
drugs that agonize serotonin receptors (LSD, buspirone)
drugs that increase serotonin release (lithium, amphetamines, MDMA)
Drugs that cause Serotonin syndrome
drugs that inhibit serotonin breakdown (MAOIs, Linezolid)
drugs that prevent synaptic reuptake of serotonin (SSRIs, cocaine, dextromethorphan, TCAs, etc)
drugs that agonize serotonin receptors (LSD, buspirone)
drugs that increase serotonin release (lithium, amphetamines, MDMA)
Cholinergic OD tx
Atropine 0.05-0.1 mg/kg in children
1-5mg in adults IV/IM
repeat every 5 min until secretions clear
competitive inhibition of ACh at active sites
Pralidoxime (2-PAM)
may repeat hourly
breaks covalent bond with active site on AChase
Anticholinergic AND sympathomimetic OD tx
DIazepam
5-10mg IV/IM for adults, repeat PRN
manage anxiety and sz
Also use cooling agents to prevent hyperthermia
Opiate/Sedative OD tx
Naloxone
2-4mg IV/IM/IN in adults
competitive inhibition of opiate
Flumazenil
usually reserved for pts we OD on benzos
Serotonin syndrome tx
diazepam
cooling
antipyretics
Cyproheptadine (antihistamine)
How to tx APAP toxicity
ABCs
supportive care
if in first hour, can do activated charcoal
if at least 4 hours out, can do N acetyl cysteine (NAC) which is a reactive sulfur source the NAPQI can bind to
Anticholinesterase Insecticides agents and antidotes
Agents:
Carbamate
Organophosphate-bond to active site of Ach-ase becomes irreversible over time
Antidotes:
Atropine
Pralidoxime
CCB OD effects and management
vasodilation, decreased cardiac contractility, and decreased conduction velocity, impair insulin release leading to hyperglycemia
IV calcium chloride infusion of insulin and dextrose consider GI decontamination (WBI) Glucagon bolus Intralipid
Iron toxicity sx and managment
N/V/D followed by 6-48 hours of absence of sx the progression of sx
Tx
ABCs, supportive care
*fluid resusitation
IV deferoxamine (highly selective iron chelator)
TCA toxicity sx and management
change in LOC, EKG in first hour
lethargy, coma, sz
depressed resp drive
if nothing occurs in first 6h probably unlikely to happen
Tx
ABCs, supportive care, ALS
BICARB