Toxicology Flashcards
Describe the ABCDs of the acute management and stabilization of the poisoned patient.
Airway
Breathing
Circulation
Dextrose/decontamination
List drugs/substances that induce hypotension due to vomiting and diarrhea.
Iron Arsenic Food poisoning Organophosphates and carbamates Mushroom poisoning Thallium
List drugs/substances that induce hypotension due to sweating and venodilation.
Organophosphates and carbamates
Barbiturates
Other sedative-hypnotics
List drugs/substances that induce hypotension due to depressed cardiac contractility.
TCAs
Beta-blockers
Calcium antagonists
Sympathetic agents (clonidine, sedative-hypnotics, etc.)
List drugs/substances that induce hypotension due to reduced peripheral vascular resistance.
Beta2-adrenergic stimulations Phenothiazines TCAs Hydralazine Nitrates Trazadone
List the common causes of drug-induced seizures.
TCAs/antidepressants Cocaine/amphetamines Theophylline Diphenhydramine Isoniazid
What are some causes of sympathomimetic autonomic syndrome?
Cocaine
Amphetamines
Pseudoephedrine
Yohimbine
What are some empirical interventions for sympathomimetic autonomic syndromes? ie…
(How would you treat the HTN?)
(How would you treat the tachycardia?)
Sedation
Treat HTN w/phentolamine or other vasodilator
Treat tachycardia w/beta-blocker
What are some causes of sympatholytic autonomic syndromes?
Clonidine Oxymetazoline Tetrahydrozoline Bromonidine Tizanidine Barbiturates Opioids Benzodiazepines
What are some empirical interventions for sympatholytic autonomic syndromes…
- For opioid OD?
- For benzo OD?
Naloxone for opioid OD
Flumazenil for benzo OD
What are some causes of cholinergic autonomic syndrome?
Organophosphate and carbamate insectacides
Chemical warfare nerve agents
What are some empirical interventions for cholinergic autonomic syndrome?
Give atropine and pralidoxime; obtain measurements of serum and RBC cholinesterase activity
What are some causes of anticholinergic autonomic syndrome?
Atropine and related drugs Antihistamines Carbamezapine Phenothiazines TCAs
What are some empirical interventions for anticholinergic autonomic syndrome…
- If TCAs are involved (what test should you order?)
- If TCAs are not involved (what drug?)
- Get EKG if TCA poisoning
2. Consider physostigmine only if TCAs are not involved
List the sx of sympathomimetic autonomic syndrome.
Agitation Dilated pupils Elevated BP and HR Sweaty skin Hyperthermia
List the sx of sympatholytic autonomic syndrome.
Lethargy/coma
Small pupils
Normal/low BP and HR
Low temp
List the sx of cholinergic autonomic syndrome.
Pinpoint pupils
Variable HR
Sweaty skin
Abdominal cramps and diarrhea
List the sx of anticholinergic autonomic syndrome.
Agitation Delirium Dilated pupils Tachycardia Decreased peristalsis Dry, flushed skin
List methods of acute gastrointestinal decontamination.
Emesis
Gastric lavage
Activated charcoal
Whole bowel irrigation
In what situations would emesis be a useful method of GI decontamination?
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.
In what situations would gastric lavage be a useful method of GI decontamination?
Useful in obtunded or comatose patients, in recent ingestions (< 1 hr), or in ingestion of anticholinergic agents or salicylates (delayed gut emptying)
In what situations would activated charcoal be a useful method of GI decontamination?
*When is it NOT affective? (5)
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.)
In what situations would whole bowel irrigation (colyte/golytely) be a useful method of GI decontamination?
Useful in ingestion of Fe, Li, sustained-release or enteric-coated pills, and drug packets or other foreign bodies.
How do you treat OD/poisoning with acetaminophen?
Charcoal
*Acetylcysteine
How do you treat OD/poisoning with anticholinergic agents?
Charcoal
*Physostigmine
Supportive
Mg2+ for v-tac
How do you treat OD/poisoning with antihistamines?
Charcoal
Supportive
Mg2+ for v-tac
How do you treat OD/poisoning with anticoagulants?
Charcoal
*Vitamin K
FFP or whole blood
How do you treat OD/poisoning with beta-blockers?
Gastric lavage
Charcoal
*Glucagon
How do you treat OD/poisoning with CO?
O2
How do you treat OD/poisoning with cocaine, amphetamines, or other stimulants?
Benzos
Phentolamine
Nitroprusside
Beta or alpha/beta blocker
How do you treat OD/poisoning with Cu?
*Penicillamine (1st choice) or dimercaprol for chelation
How do you treat OD/poisoning with cyanide?
Charcoal
*B12
Nitrites
Thiosulfates
How do you treat OD/poisoning with digitalis glycosides?
Charcoal
Atropine
*Digibind (antibody)
How do you treat OD/poisoning with ethanol?
Supportive
How do you treat OD/poisoning with methanol or ethylene glycol?
Gastric aspiration
*Fomepizole or EtOH
Hemodialysis
How do you treat OD/poisoning with gold?
*Dimercaprol for chelation
How do you treat OD/poisoning with Fe?
Gastric decontamination
IV fluids
*Deferoxamine for chelation
How do you treat OD/poisoning with Pb?
Removal of Pb source from stomach
EDTA for chelation
How do you treat OD/poisoning with Li?
Gut decontamination
IV fluids
How do you treat OD/poisoning with methemoglobinemia-inducing agents?
Methylene blue
How do you treat OD/poisoning with opioids?
Ventilation
O2
*Naloxone
How do you treat OD/poisoning with organophosphate agents?
Charcoal
Gastric lavage
*Atropin, then 2-PAM (pralidoxime)
How do you treat OD/poisoning with salicylates?
Charcoal
Gastric lavage
NaHCO3 to alkalinize urine
Hemodialysis
How do you treat OD/poisoning with sedative/hypnotics?
Airway
Pressors
*Flumazenil
How do you treat OD/poisoning with TCAs?
Charcoal Gastric lavage Benzos/barbs for seizures IV fluids NaHCO3
For what drug class OD/poisoning would you add Mg2+ to the regimen to treat v-tac? (2)
Anticholinergic agents
Antihistamines
How do you treat OD/poisoning with CCBs?
Gastric lavage
Charcoal
Fluids, pressors, Ca+, Epi or Glucagon for hypotension
