Toxicology Flashcards
Phenobarbital OD: Tx ?
Urinary alkalinization (like ASA)
Tricyclic antidepressant OD: Tx. : Hypotension ?
norepinephrine
BB tx if hypotensive ?
Norepi.
Theophylline OD: H and P ?
Nausea
Tremor
Hypotension
SSRI OD tx consider ?
Cyproheptadine– antiserotonin
Chlorpromazine– antagonist of 5-HT2A receptors
Benzodiazepines– relaxation
INR should be 2-3 ( if it is 5 and they are not bleeding ?
then stop the dose or lower the dose
Anticholinergic OD: Wide Complex Tachy tx. ?
Sodium bicarbonate
CCB OD first line ?
Calcium glutinate
chloride
Antipsychotic OD: typical patient tx. ?
IV fluids
MAOI OD H and P: Initial ?
headache, agitation, irritability, nausea, palpitations, and tremor. sinus tachycardia, hyperreflexia, hyperactivity, fasciculations, mydriasis, hyperventilation, nystagmus, and generalized flushing
Dig. EKG ?
Bradyarrhythmia
Scooped ST segment (Salvadore Dali mustache)
Clonidine OD: tx. ?
Naloxone
MAOI OD H and P: Moderate ?
opisthotonus, muscle rigidity, diaphoresis, chest pain, hypertension, diarrhea, hallucinations, combativeness, confusion, marked hyperthermia, and trismus
Opiate overdose class drugs ?
Hydrocodone Oxycodone Morphine Fentanyl Hydromorphone
Dig. OD ?
Bradycardia
Hypotension
yellow-green halos around objects
Hallucination
Potassium for Dig. OD ?
elevated
Theophylline aka ?
Methylxanthine
Lithium OD hx. and PE ?q
muscle fasciculations (viper snake)
Ataxia
muscle weakness
BB tx consider ?
Insulin
glucose infusions
BB first line tx. ?
glucagon
Digoxin OD if hyperkalemia ?
Calcium chloride/ gluconate
MAOI OD class drugs ?
Phenelzine
Selegiline
MAOI OD H and P: Severe ?
coma, seizures, bradycardia, hypotension, hypoxia, and worsening hyperthermia
Tricyclic antidepressant OD: H and P : initial ?
drowsiness, confusion, slurred speech, ataxia, dry mucous membranes and axillae, sinus tachycardia, urinary retention, myoclonus, and hyperreflexia
Digoxin OD typical tx. ?
digoxin-specific Fab
Antipsychotic OD class drugs ?
Haloperidol Chlorpromazine Thioridazine Clozapine Olanzapine Risperidone Aripiprazole
Amphetamine overdose class drugs ?
Adderall
Ritalin
Cocaine
if they are bleeding out ?
give them FFP,
GI bleed on coumadin
especially if they are in shock
SSRI OD H and P ?
Hyperreflexia/ myoclonus
Hyperthermia
clonus
Anticholinergic OD typical patient tx. ?
Activated charcoal
Admit if significant presentation
Theophylline OD: Labs ?
Theophylline level
Hypokalemia
Metabolic acidosis
Hyperglycemia
Amphetamine overdose tx. ?
Mostly monitoring
Consider benzodiazepines (Lorazepam, Valium) - depress everything down
Tricyclic antidepressant OD: H and P : Serious toxicity is almost always seen within 6 hours ?
coma, cardiac conduction delays, supraventricular tachycardia, hypotension, respiratory depression, premature ventricular beats, ventricular tachycardia, and seizures.
Tricyclic antidepressant OD: Tx. : cardiac conduction delay ?
sodium bicarbonate
Phenobarbital OD: H and P ?
Respiratory depression
Hypotension
Hypothermia
Phenobarbital OD: Labs ?
phenobarbital levels
Valproate OD: Labs ?
Valproic acid levels
Ammonia elevated
Liver enzyme elevation
Hypoglycemia
Hypocalcemia
Hypernatremia
Hypophosphatemia
Anticholinergic OD: Severe delirium tx. ?
Physostigmine -
acetlychoinesterase inhibitor
Antipsychotic OD: Consider treatments ?
Dantrolene
Amantadine
Electroconvulsive therapy
SSRI OD tx ?
Primarily supportive
IV fluids
Antipsychotic OD: EKG findings ?
QT prolongation
Long acting class drug benzo ?
Clonazepam
Diazepam
Muscarinic toxidrome ?
Organophosphates
MAOI OD Tx. ?
ICU admission and careful monitoring
Phenytoin OD: Tx. ?
IV fluids
Charcoal
Observe/admit
Tricyclic antidepressant OD: Tx. : seizure ?
benzo, phenobarbital
Valproate OD: Tx. consider?
Naloxone
I-caritine
Hemodialysis
Stage 3 (day 3-4) hx. and PE ?
Nausea/vomiting reoccur
Jaundice
Altered mental status
Anuria
Opioid-like manifestations: coma, miosis, decreased respirations ?
Clonidine
Antipsychotic OD Hx and PE ?
Fever >38°C (100.4°F)
Lead pipe muscle rigidity
Change in mental status
Tachycardia
Hypertension or hypotension Tachypnea or hypoxia Diaphoresis or sialorrhea Tremor Incontinence
Anticholinergic OD class drugs ?
Antihistamines (diphenhydramine)
SSRI (fluoxetine)
Tricyclic antidepressants (amitriptyline)
Atropine
Skeletal muscle relaxants (cyclobenzaprine)
MAOI OD: Toxic symptoms delayed ____ hours
6-12
Antipsychotic OD: if QT >500ms tx. ?
Magnesium sulfate
Clonidine OD: H and P ?
Bradycardia
Hypotension
Miosis
Decreased respirations
CCB OD typical ?
activated charcoal
IV fluids
Profound metabolic acidosis and elevated lactate level ?
Cyanide
CCB OD second line ?
Epi
Stage 3 (day 3-4) - failure findings ?
Hepatic failure
Metabolic acidosis
Coagulopathy
Renal failure
Pancreatitis
if it is high and they are bleeding a little bit ?
VK
Stage 1 (first 24 hours) hx. and PE ?
N and V
Which has liver damage, lithium of valproate OD ?
Valproate OD
Stage 4 (after day 5) hx. and PE ?
Clinical improvement OR
Multi-organ failure
Digoxin MOA ?
blocks the Na/K pump (repolarization, brings it back to the state) bring NA in and K out but this allows that not to work
Anticholinergic OD: Hyperthermia, agitation tx. ?
Lorazepam
Opiaite OD h and P ?
Bradycardia
Bradypnea
Pinpoint pupils
Hypothermia
Bowel sounds decrease
Dry skin
everything decrease really like benzos
Tricyclic antidepressant OD: Labs ?
EKG–
sinus tachycardia, right axis deviation, and prolongation of the PR, QRS, and QT intervals
Which has marked hyperglycemia, BB OD or CCB OD ?
CCB OD
3rd most common prescription poisoning death ?
BB
Carbamazepine OD: Tx. ?
IV fluids
Charcoal
Hemodialysis
Calcium channel blocker overdose class drugs ?
Amlodipine
Verapamil
Diltiazem
Carbamazepine OD: H and P ?
Anticholinergic toxidrome
Coma
respiratory failure
Seizure
Stage 2 (day 2-3) hx. and PE ?
Nausea/vomiting improvement
Abdominal pain
Hepatic tenderness
Intermediate acting class drug benzo ?
Lorazepam
Temazepam
Short acting class drug benzo ?
Alprazolam
Midazolam
Benzo Hx. and PE ?
Bradycardia Bradypnea Somnolence Dizziness slurred speech Confusion Ataxia incoordination
**everything is slowing down
PUPILS ARE UNCHANGED!**
Elevated level on digoxin immunoassay, and hyperkalemia ?
Dig.
CCB OD consider ?
Glucagon
Insulin/glucose therapy
Valproate OD: H and P ?
Respiratory Depression
Hypotension
altered mental status
Antipsychotic overdose aka ?
Neuroleptic malignant syndrome
Amphetamine (Sympathomimetic) overdose hx and PE ?
Agitation Mydriasis - dilated Diaphoresis Tachycardia Tachypnea Hypertension possibly hyperthermia
**everything is increased here **
BB tx if brady ?
Atropine
Cardiac pacing
Lithium OD Tx. ?
IV NL saline
sodium polystyrene
Severe = hemodialysis
Digoxin OD considerations ?
Atropine
Cardiac pacing
Stage 4 (after day 5) findings ?
Improvement OR
Worsening
Wide-complex bradycardia ?
Class IC antiarrhythmic drugs (propafenone)
Stage 2 (day 2-3) findings ?
Liver enzyme elevations
Bilirubin elevated
PT/INR elevated
Stage 1 (first 24 hours) findings ?
Potassium low - cause Vomiting out acid
SSRI overdose ?
Serotonin syndrome
Antipsychotic OD: if intubation tx. ?
Nondepolarizing paralytic (rocuronium)
DO NOT USE succinylcholine
Anticholinergic overdose pneumonic ?
Dry as a bone
Red as a beet
Hot as a hare
Blind as a bat
Mad as a hatter
Stuffed as a pipe
ASA OD ABG ?
metabolic acidosis first
then
respiratory alkalosis
Which has kidney and thyroid damage, Lithium or valproate OD ?
Lithium
Theophylline OD: Tx. ?
IV fluids
Charcoal
Consider observation
Phenytoin OD: H and P ?
Vertical, bidirectional, or alternating nystagmus
Sedation
Ataxia
Later
- Ophthalmoplegia
- Apnea
this one slows things down and they get crazy eye movements
Antipsychotic OD: If ventricular arrhythmia tx. ?
Sodium bicarbonate
Tricyclic antidepressant OD: medications contraindicated ?
all class Ia and Ic antiarrhythmic agents,
β-blockers,
calcium channel blockers
class III antiarrhythmic agents
do not give them things to slow them down more like BB and CCB