toxicology

Question 1

ethylene glycol urinary fnding

Answer 1

Ca oxalate crystals

Question 2

freshly mown grass scent

Answer 2

organophosphates

Question 3

almond scent

Answer 3

phosgene, arsenic, phosphorus

Question 4

symmetrical descending muscle weakness + drooling + dysphagia (toxicity)

Answer 4

botulism

Question 5

arthritis pain + tinnitus med concern

Answer 5

aspirin

Question 6

when should first level of acetaminophen be drawn after ingestion of unknown amount?

Answer 6

4 hours

Question 7

toxicity: sympathomimetic agents

Answer 7

cocaine, amphetamines, meth, street drugs

Question 8

toxicity: cholinergic agents

Answer 8

organophosphate (pesticide, insecticide)

Question 9

toxicity: anticholinergic agents

Answer 9

jimson weed, atropine

Question 10

tell-tale sign of opioid toxicity

Answer 10

pinpoint pupils

Question 11

toxidrome mgmt: key points

Answer 11

ABCsAMS + glucosehyperactivityhtnseizures (benzos)decon

Question 12

causes of miosis

Answer 12

OpioidsCentral alpha 2 agonistsOrganophosphatesPhencyclidineSedative hypnoticsPhenothiazinesNicotinePilocarpine Opthalmic dropsOlanzapine (Zyprexa)Pontine Hemorrhage

Question 13

activated charcoal: how much + when to use

Answer 13

1g/kg PO within 2 - 4 hours ingestion

Question 14

when not to use activated charcoal

Answer 14

P esticidesH ydrocarbonsA lcohol, acids, alkaliI ron preparationsL ithiumS olvents

Question 15

naloxone (Narcan) doses + half life

Answer 15

10 mgopioids: start ~0.4 and titrate up to wake respiratory drive (may not want to fully awaken d/t agitation)half-life usually ~60-90 min

Question 16

when to use naloxone (Narcan)

Answer 16

R eserpineO pioidsC lonidineL omotilA CE & ARBV alproic acidA ldometZanaflex

Question 17

benzo: reversal agent

Answer 17

flumazenil + airway mgmt- rare d/t poss withdrawal seizures (ok if not chronic benzo user)

Question 18

heparin: reversal agent

Answer 18

protamine - basic vs heparin acidic- also anticoag, don’t give too much

Question 19

warfarin: reversal agent

Answer 19

vitamin K +/- FFP or PCC- takes 4 to 6 hrs- FFP replenishes other products, PCC as effective

Question 20

chelating agents, lead or zinc: reversal agent

Answer 20

EDTA or BAL

Question 21

chelating agents, gold, arsenic, or mercury: reversal agent

Answer 21

BAL or D-penicillamine

Question 22

med contraindicated in mgmt of meth assoc htn crisis

Answer 22

metoprolol - beta 1 selective blocker = unopposed alpha

Question 23

causes of gap acidosis

Answer 23

M ethanolU remiaD KAP ropylene GlycolI NH or IngestionL actic AcidosisE thylene GlycolS alicylates

Question 24

sulfonylurea: reversal agent

Answer 24

octreotide (Sandostatin)

Question 25

crotalidae snake + toxin

Answer 25

pit viber (rattlesnakes, copperheads, cottonmouths, water moccasin)hemotoxin

Question 26

elapidae snake + toxin

Answer 26

coral snake: neurotoxin