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Medicine > Toxicology > Flashcards

Toxicology Flashcards

1
Q

what must be considered when dealing with toxic pt?

A 
dose (manifestations may be related to how much they took)
route
intentional/unintentional
time elapsed (how long has it been since you took this?)
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2
Q

snorting

A

insluphation

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3
Q

toxidromes

A

toxic substance

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4
Q

AMS

A

altered mental status (frightened, agitated, delerium)

-overdose should always be in the differential when a pt presents with this

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5
Q

differential of AMS

A 
AEIOUTIPS
alcohol/acidosis
electrolytes/epilepsy
infection (sepsis, elderly)
opiates/overdose
uremia (kidney failure)
trauma/toxicity/tumor
insulin (hypoglycemic/hyperglycemic)
psych
stroke
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6
Q

steps to manage patient

A

ABC -airway (protect it proactively)
D-decontamination (remove garments)
E-easily correctable issues (hypoglycemia, hypoxia, hypotension, hypo/hyperthermia)

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7
Q

what is the most common OTC overdose?

A

acetaminophen

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8
Q

what organ does acetaminophen affect?

A

liver

encephalopothy

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9
Q

what is the max dose in people of acetaminophen?

A

4gms (adults)

90mg/kg (children)

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10
Q

toxicity is assoc with what dose of acetaminophen

A

150mg/kg

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11
Q

what is the first stage of acetaminophen overdose?

A

stage 1: asymptomatic, anorexia, nausea/vomiting, LFTs (liver enzymes) rise in the first 24 hours

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12
Q

what is the 2nd stage of acetaminophen overdose?

A 
18-24 hrs post ingestion
RUQ pain
continued rise in LFTs and aPTT
oliguria (urine output drops)
tachycardia
hypotension
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13
Q

what is the 3rd stage of acetaminophen overdose?

A

72-96 hrs post ingestion
continued abdominal pain
hepatic necrosis and encephalopathy (due to rising ammonia levels because liver can’t break down nitrogenous wastes of protein synthesis)
jaundice
GI bleeding
LFTs peak, ammonia and bilirubin continue to rise

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14
Q

what is the 4th stage of acetaminophen overdose?

A

4dys -2weeks
resolution of hepatic abnormalities of liver failure
LFTs come down

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15
Q

what lab studies will you order with acetaminophen overdose?

A

CBC
CMP
arterial blood gasses (ABG)
acetaminophen level (recheck every 4 hrs)
U/A
RUQ ultrasound (grossly enlarged gallbladder?)
CT of the head (with evidence of encephalopathy)
EKG (for baseline)

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16
Q

what are examples of salicylates?

A

aspirin
pepto-bismol
oil of wintergreen

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17
Q

what drug is taking the place of aspirin as a common overdose drug?

A

anti-depressants

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18
Q

what is the early presentation of aspirin OD?

A

early (1-2 hrs post ingestion)

  • tinnitus
  • vertigo
  • Nausea/Vomiting/Diarrhea
  • hyperpyrexia
  • coma
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19
Q

what is the later presentation of aspirin OD?

A 
hypernea
blood gas abnormalities
-respiratory alkalosis (CO2 is leaving the body)
-metabolic acidosis
-cerebral edema (AMS)
(cleared in the liver and kidney)
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20
Q

what labs do you order for aspirin OD?

A 
salicylate levels
CBC
CMP
LFT
ABG (blood gasses)
UA
(protein will go up, spill blood in the urine)
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21
Q

what are the normal/abnormal levels of salicylate?

A

110 mg/dL severe toxicity

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22
Q

what are exampels of opioids

A 
codeine
morphine
hydrocodone
oxycodone
heroine
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23
Q

what is the presentation of opioid OD?

A 
respiratory depression
pinpoint pupils (lost light reaction-no dilation)
24
Q

when are the peak effects of opioid with IVs?

A

10 min with IV route

25
Q

when are the peak effects of opioid with insufflation?

A

10-15 min

26
Q

when are the peak effects of opioid with IM administration? (intermuscular)

A

30-45 min

27
Q

when are the peak effects of opioid with oral ingestion?

A

90 min

28
Q

when are the peak effects of opioid with dermal application?

A

2-4 hours

29
Q

what labs should you order with opioid OD?

A 
CBC
CMP
ABG
toxicity screen-often times qualitative (opioids, canabis, salycilates, acetaminophen)
abdominal film (body packers)
30
Q

what is the peak effect of cocaine via inhalation?

A

1-5 min

31
Q

what is the peak effect of cocaine via IV?

A

3-5 min

32
Q

what is the peak effect of cocaine via nasal?

A

15 min

33
Q

what is the peak effect of cocaine via oral?

A

60 min

34
Q

what is mild presentation of cocaine OD?

A

euphoria
agitation
tachycardia
hypertension

35
Q

what is moderate presentation of cocaine OD?

A 
stroke
renal ischemia
seizures
ventricular dysrhythmias
apnea
cyanosis
hyperthermia
coma
death
36
Q

what are the physiologic affects of cocaine

A

vasoconstrictor
cardiotoxic
long term use = constrictive cardiomyopathy

37
Q

what labs would you order with cocaine OD?

A 
CBC
CMP
UA
EKG (baseline)
tox screen
38
Q

what are examples of benzodiazepines

A 
valium
xanax
ativan
klonopin
librium (older, not used as much)
tranxene (older, not used as much)
-extremely addictive, designed for short, acute,use
39
Q

presentation of benzo OD?

A 
coma with normal vital signs
nystagmus (horizontal typically)
hallucinations
slurred speech
ataxia (stumble, clumsy gait)
AMS
agitation
Respiratory depression
40
Q

what labs would you order with benzo OD?

A

CBC
ABG
tox screen (if suspect multiple ingestion)
no set test to identify benzos in blood or urine

41
Q

what are examples of antidepressants?

A

tricyclics

  • elavil
  • pamelor
  • tofranil
  • vivactyl
42
Q

presentation antidepressant OD?

A 
CNS sedation
confusion
delirium
hallucinations
cardiac arrhythmias (widened QT interval-ventricular dysrythmias )
43
Q

what labs would you order for antidepressant OD?

A 
EKG
tox screen (nothing else involved)
TCA levels (qualitative only)
salicylate levels
acetaminophen levels
44
Q

ethanol

A

ETOH

45
Q

BAC of 0.01-0.1 presents with

A

euphoria
mild coordination deficits
attention and cognition

46
Q

BAC of 0.1-0.2 presents with

A

coordination deficits and psychomotor skills, decreased attention, slurred speech, ataxia, impaired judgment and mood variability

47
Q

BAC of 0.2-0.3 presents with

A

lack of coordination, incoherent thoughts, confusion and nausea and vomiting

48
Q

BAC of >0.3 presents with

A

stupor and loss of consciousness
coma
respiratory depression and death

49
Q

what is a common complication of vomiting while drunk?

A

aspiration

50
Q

things to consider with ETOH

A

BAC may not correlate with S & S

watch out for respiratory depression

51
Q

labs for ETOH

A

ETOH level
ABGs
tox screen (if something else is going on)

52
Q

why is carbon monoxide dangerous?

A

it has a greater affinity for hemoglobin compared to oxygen (300 times greater)

53
Q

presentation of acute CO poisoning

A 
headache (most common)
malaise
nausea
dizziness
can be misdiagnosed as ETOH intoxication
chest pain (AMI)
54
Q

presentation of long term CO poisoning

A 
cognitive deficits
personality changes
movement disorders (ataxia that doesn't resolve)and
 focal neurological deficits
55
Q

what social group has higher levels of CO?

A

smokers

56
Q

labs for CO poisoning?

A

Pulse ox is NOT reliable, cannot distinguish between O2 and carboxyhemaglobin
ABGs (smokers may have 10-15% baseline)

Medicine (146 decks)

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