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Pharm > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Describe the ABCDs of the acute management and stabilization of the poisoned patient.

A

Airway
Breathing
Circulation
Dextrose/decontamination

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2
Q

List drugs/substances that induce hypotension due to vomiting and diarrhea.

A 
Iron
Arsenic
Food poisoning
Organophosphates and carbamates
Mushroom poisoning
Thallium
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3
Q

List drugs/substances that induce hypotension due to sweating and venodilation.

A

Organophosphates and carbamates
Barbiturates
Other sedative-hypnotics

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4
Q

List drugs/substances that induce hypotension due to depressed cardiac contractility.

A

TCAs
Beta-blockers
Calcium antagonists
Sympathetic agents (clonidine, sedative-hypnotics, etc.)

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5
Q

List drugs/substances that induce hypotension due to reduced peripheral vascular resistance.

A 
Beta2-adrenergic stimulations
Phenothiazines
TCAs
Hydralazine
Nitrates
Trazadone
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6
Q

List the common causes of drug-induced seizures.

A 
TCAs/antidepressants
Cocaine/amphetamines
Theophylline
Diphenhydramine
Isoniazid
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7
Q

What are some causes of sympathomimetic autonomic syndrome?

A

Cocaine
Amphetamines
Pseudoephedrine
Yohimbine

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8
Q

What are some empirical interventions for sympathomimetic autonomic syndromes? ie…
(How would you treat the HTN?)
(How would you treat the tachycardia?)

A

Sedation
Treat HTN w/phentolamine or other vasodilator
Treat tachycardia w/beta-blocker

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9
Q

What are some causes of sympatholytic autonomic syndromes?

A 
Clonidine
Oxymetazoline
Tetrahydrozoline
Bromonidine
Tizanidine
Barbiturates
Opioids
Benzodiazepines
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10
Q

What are some empirical interventions for sympatholytic autonomic syndromes…

  1. For opioid OD?
  2. For benzo OD?
A

Naloxone for opioid OD

Flumazenil for benzo OD

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11
Q

What are some causes of cholinergic autonomic syndrome?

A

Organophosphate and carbamate insectacides

Chemical warfare nerve agents

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12
Q

What are some empirical interventions for cholinergic autonomic syndrome?

A

Give atropine and pralidoxime; obtain measurements of serum and RBC cholinesterase activity

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13
Q

What are some causes of anticholinergic autonomic syndrome?

A 
Atropine and related drugs
Antihistamines
Carbamezapine
Phenothiazines
TCAs
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14
Q

What are some empirical interventions for anticholinergic autonomic syndrome…

  1. If TCAs are involved (what test should you order?)
  2. If TCAs are not involved (what drug?)
A
  1. Get EKG if TCA poisoning

2. Consider physostigmine only if TCAs are not involved

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15
Q

List the sx of sympathomimetic autonomic syndrome.

A 
Agitation
Dilated pupils
Elevated BP and HR
Sweaty skin
Hyperthermia
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16
Q

List the sx of sympatholytic autonomic syndrome.

A

Lethargy/coma
Small pupils
Normal/low BP and HR
Low temp

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17
Q

List the sx of cholinergic autonomic syndrome.

A

Pinpoint pupils
Variable HR
Sweaty skin
Abdominal cramps and diarrhea

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18
Q

List the sx of anticholinergic autonomic syndrome.

A 
Agitation
Delirium
Dilated pupils
Tachycardia
Decreased peristalsis
Dry, flushed skin
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19
Q

List methods of acute gastrointestinal decontamination.

A

Emesis
Gastric lavage
Activated charcoal
Whole bowel irrigation

20
Q

In what situations would emesis be a useful method of GI decontamination?

A

Possible benefit in rare circumstances after a potentially lethal ingestion when medical care is > 60 min away but only under guidance of a poison-control center.

21
Q

In what situations would gastric lavage be a useful method of GI decontamination?

A

Useful in obtunded or comatose patients, in recent ingestions (< 1 hr), or in ingestion of anticholinergic agents or salicylates (delayed gut emptying)

22
Q

In what situations would activated charcoal be a useful method of GI decontamination?

*When is it NOT affective? (5)

A

Often useful because adsorbs most drugs and poisons; may be equally effective when given alone as when given after emesis or lavage.

(Not effective for ingestion of Fe, Li, K+, Na+, or alcohols.)

23
Q

In what situations would whole bowel irrigation (colyte/golytely) be a useful method of GI decontamination?

A

Useful in ingestion of Fe, Li, sustained-release or enteric-coated pills, and drug packets or other foreign bodies.

24
Q

How do you treat OD/poisoning with acetaminophen?

A

Charcoal

*Acetylcysteine

25
Q

How do you treat OD/poisoning with anticholinergic agents?

A

Charcoal
*Physostigmine
Supportive
Mg2+ for v-tac

26
Q

How do you treat OD/poisoning with antihistamines?

A

Charcoal
Supportive
Mg2+ for v-tac

27
Q

How do you treat OD/poisoning with anticoagulants?

A

Charcoal
*Vitamin K
FFP or whole blood

28
Q

How do you treat OD/poisoning with beta-blockers?

A

Gastric lavage
Charcoal
*Glucagon

29
Q

How do you treat OD/poisoning with CO?

A

O2

30
Q

How do you treat OD/poisoning with cocaine, amphetamines, or other stimulants?

A

Benzos
Phentolamine
Nitroprusside
Beta or alpha/beta blocker

31
Q

How do you treat OD/poisoning with Cu?

A

*Penicillamine (1st choice) or dimercaprol for chelation

32
Q

How do you treat OD/poisoning with cyanide?

A

Charcoal
*B12
Nitrites
Thiosulfates

33
Q

How do you treat OD/poisoning with digitalis glycosides?

A

Charcoal
Atropine
*Digibind (antibody)

34
Q

How do you treat OD/poisoning with ethanol?

A

Supportive

35
Q

How do you treat OD/poisoning with methanol or ethylene glycol?

A

Gastric aspiration
*Fomepizole or EtOH
Hemodialysis

36
Q

How do you treat OD/poisoning with gold?

A

*Dimercaprol for chelation

37
Q

How do you treat OD/poisoning with Fe?

A

Gastric decontamination
IV fluids
*Deferoxamine for chelation

38
Q

How do you treat OD/poisoning with Pb?

A

Removal of Pb source from stomach

EDTA for chelation

39
Q

How do you treat OD/poisoning with Li?

A

Gut decontamination

IV fluids

40
Q

How do you treat OD/poisoning with methemoglobinemia-inducing agents?

A

Methylene blue

41
Q

How do you treat OD/poisoning with opioids?

A

Ventilation
O2
*Naloxone

42
Q

How do you treat OD/poisoning with organophosphate agents?

A

Charcoal
Gastric lavage
*Atropin, then 2-PAM (pralidoxime)

43
Q

How do you treat OD/poisoning with salicylates?

A

Charcoal
Gastric lavage
NaHCO3 to alkalinize urine
Hemodialysis

44
Q

How do you treat OD/poisoning with sedative/hypnotics?

A

Airway
Pressors
*Flumazenil

45
Q

How do you treat OD/poisoning with TCAs?

A 
Charcoal
Gastric lavage
Benzos/barbs for seizures
IV fluids
NaHCO3
46
Q

For what drug class OD/poisoning would you add Mg2+ to the regimen to treat v-tac? (2)

A

Anticholinergic agents

Antihistamines

47
Q

How do you treat OD/poisoning with CCBs?

A

Gastric lavage
Charcoal
Fluids, pressors, Ca+, Epi or Glucagon for hypotension

Pharm (32 decks)

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