Toxicology

Question 1

What are the signs/symptoms of opioid overdose?

Answer 1

Altered mental status
Decreased RR
Pinpoint pupils
Decreased bowel sounds

Question 2

What is the antidote for opioid toxicity?

Answer 2

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

Question 3

What is seen with naloxone associated opioid withdrawal?

Answer 3

Flu-like symptoms
Piloerection
Yawning, irritability
NORMAL MENTAL STATUS
Last 15-30 minutes

Question 4

What are the signs and symptoms of benzodiazepine toxicity?

Answer 4

Depressed mental status
Normal vital signs

DOES NOT cause respiratory depression

Question 5

What is the antidote for benzo toxicity?

Answer 5

Flumazenil – competitive non-selective benzo receptor antagonist

Question 6

What are the dangers of Flumazenil?

Answer 6

Can precipitate acute withdrawal

Seizures

Question 7

What are the 4 stages of acetaminophen toxicity?

Answer 7

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

Question 8

What is the antidote for acetaminophen poisoning?

Answer 8

N-acetylcysteine (NAC)

• -Best if given within 8 hrs of overdose
• -works to restore glutathione

Question 9

Treatment for acute acetaminophen poisoning is based upon ________.

Answer 9

Rumack Matthew nomogram

Question 10

What are the signs of late acetaminophen poisoning hepatotoxicity?

Answer 10

Prothrombin time > 200s
Serum creatinine > 3.3
Hepatic encephalopathy
Blood pH 30 (factor V made in the liver)

Question 11

What are the signs/symptoms of tricyclic antidepressant overdose?

Answer 11

Hypotension
Seizures
Widened QRS

Question 12

What is the antidote for tricyclic antidepressant overdose?

Answer 12

Sodium bicarbonate –change to non-ionized form so it doesn’t bind as well

–Narrowing of QRS

Question 13

What are the signs/symptoms of anticholinergic toxicity?

Answer 13

Mydriasis
Dry, flushed skin
Decreased bowel sounds
Urinary retention
Increased Temperature
Altered mental status--confusion, hallucinations, seizures

Question 14

What are some anticholinergics?

Answer 14

Atropine
Diphenhydramine
Scopolamine
Meclizine

Question 15

What is the antidote for anticholinergic toxicity?

Answer 15

Physostigmine

Question 16

Physostigmine is contraindicated after ______ exposure?

Answer 16

TCA–cases of asystole after administration

Question 17

What are the indications for physostigmine administration?

Answer 17

Pure anticholinergic poisoning–good Hx
CNS manifestations
PNS manifestations
No ECG findings–suggesting TCA exposure (widened QRS)

Question 18

What are the signs/symptoms of cholinergic toxicity?

Answer 18

Opposite of anticholinergic
Miosis
Salivation
Lacrimation
Urination
Defecation
CNS excitation
Bronchorrhea/spasm
Fasciculations

Question 19

What are some cholinergic agents that can cause toxicity?

Answer 19

Nerve gases
Organophosphates
Carbamates
Physostigmine
Neostigmine
Bethanechol

Question 20

What is the antidote for cholinergic toxicity?

Answer 20

Atropine or Pralidoxime (decreases atropine requirement)

Question 21

What is the antidote for methanol/ethylene glycol toxicity?

Answer 21

ETOH or Fomepizole–block alcohol dehydrogenase

Question 22

What is the DDX for a pt who have bp med toxicity and have bradycardia and hypotension?

Answer 22

B-blocker
Calcium channel blocker
Alpha-2 agonist
Digoxin

Question 23

What can be given in high doses to counteract calcium channel blocker toxicity?

Answer 23

Insulin –increases ATP within the cell