Toxicology Flashcards
What are the signs/symptoms of opioid overdose?
Altered mental status
Decreased RR
Pinpoint pupils
Decreased bowel sounds
What is the antidote for opioid toxicity?
Naloxone–competitive mu, delta, and kappa opioid receptor antagonist
Only needed to protect the airway
Also Nalmefene and Naltrexone–last longer and may produce a prolonged withdrawal state
What is seen with naloxone associated opioid withdrawal?
Flu-like symptoms Piloerection Yawning, irritability NORMAL MENTAL STATUS Last 15-30 minutes
What are the signs and symptoms of benzodiazepine toxicity?
Depressed mental status
Normal vital signs
DOES NOT cause respiratory depression
What is the antidote for benzo toxicity?
Flumazenil – competitive non-selective benzo receptor antagonist
What are the dangers of Flumazenil?
Can precipitate acute withdrawal
Seizures
What are the 4 stages of acetaminophen toxicity?
Stage 1 (.5-24 hrs)--asymptomatic Stage 2 (24-72 hrs)--LFT and renal function abnormalities Stage 3 (72-96 hrs)--Hepatic necrosis +/- renal failure Stage 4 (4days- 2wks)--Resolution of organ function
What is the antidote for acetaminophen poisoning?
N-acetylcysteine (NAC)
- -Best if given within 8 hrs of overdose
- -works to restore glutathione
Treatment for acute acetaminophen poisoning is based upon ________.
Rumack Matthew nomogram
What are the signs of late acetaminophen poisoning hepatotoxicity?
Prothrombin time > 200s
Serum creatinine > 3.3
Hepatic encephalopathy
Blood pH 30 (factor V made in the liver)
What are the signs/symptoms of tricyclic antidepressant overdose?
Hypotension
Seizures
Widened QRS
What is the antidote for tricyclic antidepressant overdose?
Sodium bicarbonate –change to non-ionized form so it doesn’t bind as well
–Narrowing of QRS
What are the signs/symptoms of anticholinergic toxicity?
Mydriasis Dry, flushed skin Decreased bowel sounds Urinary retention Increased Temperature Altered mental status--confusion, hallucinations, seizures
What are some anticholinergics?
Atropine
Diphenhydramine
Scopolamine
Meclizine
What is the antidote for anticholinergic toxicity?
Physostigmine
Physostigmine is contraindicated after ______ exposure?
TCA–cases of asystole after administration
What are the indications for physostigmine administration?
Pure anticholinergic poisoning–good Hx
CNS manifestations
PNS manifestations
No ECG findings–suggesting TCA exposure (widened QRS)
What are the signs/symptoms of cholinergic toxicity?
Opposite of anticholinergic Miosis Salivation Lacrimation Urination Defecation CNS excitation Bronchorrhea/spasm Fasciculations
What are some cholinergic agents that can cause toxicity?
Nerve gases Organophosphates Carbamates Physostigmine Neostigmine Bethanechol
What is the antidote for cholinergic toxicity?
Atropine or Pralidoxime (decreases atropine requirement)
What is the antidote for methanol/ethylene glycol toxicity?
ETOH or Fomepizole–block alcohol dehydrogenase
What is the DDX for a pt who have bp med toxicity and have bradycardia and hypotension?
B-blocker
Calcium channel blocker
Alpha-2 agonist
Digoxin
What can be given in high doses to counteract calcium channel blocker toxicity?
Insulin –increases ATP within the cell
