Toxicology

Question 1

Elements of the cholinergic toxidrome

Answer 1

Over-stimulation of PS nervous system (DUMBBELLSS)
Patient is bradycardic and leaky

Diarrhea
Urination
Miosis
Bradycardia
Bronchial Secretions*
Emesis
Lacrimation
Salivation
Sweating

Question 2

Agents of the anti-cholinergic toxidrome

Answer 2

ANTIs
Anti-depressants (TCA
Anti-histamine
Anti-psychotics
Anti-parkinsonian
Atropine

Question 3

Elements of the anti-cholinergic toxidrome

Answer 3

Associated with PS downregulation

Hyperthermia
Dry skin (not that sweating is purely sympathetic)
Delirium
Mydriasis
Seizures*
Tachycardia
URINARY RETENTION (

Question 4

How to differentiate anti-cholinergic toxidrome from sympathomimetic

Answer 4

Anticholinergic: Dry skin, delirium
Sympathomimetic: sweating, hyperactive

Question 5

Reversal agent for anticholinergic toxidrome

Answer 5

physostigmine (NOT NEOSTIGMINE)

Question 6

Agents of the sympathomimetic toxidrome

Answer 6

Methamphetamine
Amphetamine
Cocaine

Question 7

Elements of the sympathomimetic toxidrome

Answer 7

Sweating
Mydriasis
Seizure
Hyperthermia
tachycardia

Question 8

Antidote to the sympathomimetic toxidrome

Answer 8

NONE - seizure and hyperthermia must be addressed

Question 9

Poisonings that cause diaphoresis

Answer 9

SOAP
Sympathomimetics
Organophosphates (cholinergic toxidrome)
Aspirin
PCP

Question 10

Poisonings that cause horizontal nystagmus

Answer 10

Alcohol
Barbiturates
phenytoin/carbamazepine/anti-epileptics

Question 11

Poisonings that cause vertical nystagmus

Answer 11

PCP

Question 12

elements that charcoal is ineffective at removing

Answer 12

PHAILS

Phenytoin
Hydrocarbons
Acid/alkalai
Iron
Lithium
Solvents

Question 13

Elements that charcoal can remove

Answer 13

AABBCD

Anti-malarials
Aminophylline (theophylline)
Barbitruates
B-blockers
Carbmazapine
Dapsone

Question 14

Drugs removed by urine alkalinization

Answer 14

Aspirin

Phenobarbital

Question 15

Drugs removed by hemodialysis

Answer 15

I STUMBLE

Isopropyl
Salicylate
Theophylline
Uremia
Methanol
Barbitruates
Lithium
Ethylene glycol

Question 16

Antidotes for toxic alcohol ingestion

Answer 16

Ethanol

Fomepizole

Question 17

Calculation of Anion Gap

Answer 17

Sodium - (Chloride + Bicarbonate)

Normal range is 8-12

Question 18

Calculation of OSMOLAR gap

Answer 18

Serum osmolality - (2Na +glucose/18 + BUN/2.8 +ethanol/4.6)

Should be

Question 19

Agents that can cause an anion gap

Answer 19

MUDPILES

Methanol
Uremia
Diabetic KA
Propolyene glycol
INH/Iron
Lactic acid
Ethylene glycol
Salicylates

Question 20

agents that can cause an osmolar gap

Answer 20

ME DIE

Methanol
Ethylene glycol
Diuretics
Isopropyl alcohol
Ethanol

Really just the alcohols PLUS diuretics

Question 21

Target urin pH in aspirin or phenobarbital overdoses

Answer 21

8

Question 22

Toxic doses of acetaminophen in adults and children

Answer 22

Adults: >7.5 g in 4 hours
Children: >150mg/kg in 4 hours

Question 23

Situations in which the Romack nomogram is not applicable

Answer 23

Chronic ingestion
Unknown timing
Delayed absorption
Late presenting patients

Question 24

Side effects associated with NAC

Answer 24

Flushing, pruritus, or rash (stop infusion, give benadryl, resume infusion)
Hypersensitivity (give oral)
Vomiting (give IV)

Question 25

End points for NAC treatment

Answer 25

20 hours ono IV NAC
72 hours of oral NAC
Lack of symptoms and detectable acetaminophen

Question 26

Appropriate treatments for each level of lead poisoning

Answer 26

Encephalopahty: BAL (dimercaperol) + EDTA
>69: BAL + EDTA
45-69: Succimer or BAL (never give EDTA alone)
20-45: Chelation controversial

Question 27

Lead level at which patients become symptomatic

Answer 27

50-70mcg/dL

Question 28

Symptoms associated with chronic lead poisoning

Answer 28

WRIST DROP
Insomnia, convulsion, drop in intelligence, dizziness, headache
Appendicitis mimic, vomiting, bowel spasms
Renal necrosis with elevated urine glucose, phosphate and amino acids
MICROcytic, hypochromic anemia