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Clinical Medicine Lecture - Professor Kramer > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Phenobarbital OD: Tx ?

A

Urinary alkalinization (like ASA)

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2
Q

Tricyclic antidepressant OD: Tx. : Hypotension ?

A

norepinephrine

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3
Q

BB tx if hypotensive ?

A

Norepi.

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4
Q

Theophylline OD: H and P ?

A

Nausea

Tremor

Hypotension

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5
Q

SSRI OD tx consider ?

A

Cyproheptadine– antiserotonin

Chlorpromazine– antagonist of 5-HT2A receptors

Benzodiazepines– relaxation

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6
Q

INR should be 2-3 ( if it is 5 and they are not bleeding ?

A

then stop the dose or lower the dose

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7
Q

Anticholinergic OD: Wide Complex Tachy tx. ?

A

Sodium bicarbonate

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8
Q

CCB OD first line ?

A

Calcium glutinate

chloride

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9
Q

Antipsychotic OD: typical patient tx. ?

A

IV fluids

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10
Q

MAOI OD H and P: Initial ?

A

headache, agitation, irritability, nausea, palpitations, and tremor. sinus tachycardia, hyperreflexia, hyperactivity, fasciculations, mydriasis, hyperventilation, nystagmus, and generalized flushing

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11
Q

Dig. EKG ?

A

Bradyarrhythmia

Scooped ST segment (Salvadore Dali mustache)

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12
Q

Clonidine OD: tx. ?

A

Naloxone

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13
Q

MAOI OD H and P: Moderate ?

A

opisthotonus, muscle rigidity, diaphoresis, chest pain, hypertension, diarrhea, hallucinations, combativeness, confusion, marked hyperthermia, and trismus

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14
Q

Opiate overdose class drugs ?

A 
Hydrocodone
Oxycodone
Morphine
Fentanyl
Hydromorphone
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15
Q

Dig. OD ?

A

Bradycardia

Hypotension

yellow-green halos around objects

Hallucination

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16
Q

Potassium for Dig. OD ?

A

elevated

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17
Q

Theophylline aka ?

A

Methylxanthine

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18
Q

Lithium OD hx. and PE ?q

A

muscle fasciculations (viper snake)

Ataxia

muscle weakness

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19
Q

BB tx consider ?

A

Insulin

glucose infusions

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20
Q

BB first line tx. ?

A

glucagon

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21
Q

Digoxin OD if hyperkalemia ?

A

Calcium chloride/ gluconate

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22
Q

MAOI OD class drugs ?

A

Phenelzine

Selegiline

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23
Q

MAOI OD H and P: Severe ?

A

coma, seizures, bradycardia, hypotension, hypoxia, and worsening hyperthermia

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24
Q

Tricyclic antidepressant OD: H and P : initial ?

A

drowsiness, confusion, slurred speech, ataxia, dry mucous membranes and axillae, sinus tachycardia, urinary retention, myoclonus, and hyperreflexia

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25
Q

Digoxin OD typical tx. ?

A

digoxin-specific Fab

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26
Q

Antipsychotic OD class drugs ?

A 
Haloperidol
Chlorpromazine
Thioridazine
Clozapine
Olanzapine
Risperidone
Aripiprazole
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27
Q

Amphetamine overdose class drugs ?

A

Adderall

Ritalin

Cocaine

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28
Q

if they are bleeding out ?

A

give them FFP,

GI bleed on coumadin

especially if they are in shock

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29
Q

SSRI OD H and P ?

A

Hyperreflexia/ myoclonus

Hyperthermia

clonus

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30
Q

Anticholinergic OD typical patient tx. ?

A

Activated charcoal

Admit if significant presentation

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31
Q

Theophylline OD: Labs ?

A

Theophylline level

Hypokalemia

Metabolic acidosis

Hyperglycemia

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32
Q

Amphetamine overdose tx. ?

A

Mostly monitoring

Consider benzodiazepines (Lorazepam, Valium) - depress everything down

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33
Q

Tricyclic antidepressant OD: H and P : Serious toxicity is almost always seen within 6 hours ?

A

coma, cardiac conduction delays, supraventricular tachycardia, hypotension, respiratory depression, premature ventricular beats, ventricular tachycardia, and seizures.

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34
Q

Tricyclic antidepressant OD: Tx. : cardiac conduction delay ?

A

sodium bicarbonate

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35
Q

Phenobarbital OD: H and P ?

A

Respiratory depression

Hypotension

Hypothermia

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36
Q

Phenobarbital OD: Labs ?

A

phenobarbital levels

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37
Q

Valproate OD: Labs ?

A

Valproic acid levels

Ammonia elevated

Liver enzyme elevation

Hypoglycemia
Hypocalcemia
Hypernatremia
Hypophosphatemia

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38
Q

Anticholinergic OD: Severe delirium tx. ?

A

Physostigmine -

acetlychoinesterase inhibitor

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39
Q

Antipsychotic OD: Consider treatments ?

A

Dantrolene

Amantadine

Electroconvulsive therapy

40
Q

SSRI OD tx ?

A

Primarily supportive

IV fluids

41
Q

Antipsychotic OD: EKG findings ?

A

QT prolongation

42
Q

Long acting class drug benzo ?

A

Clonazepam

Diazepam

43
Q

Muscarinic toxidrome ?

A

Organophosphates

44
Q

MAOI OD Tx. ?

A

ICU admission and careful monitoring

45
Q

Phenytoin OD: Tx. ?

A

IV fluids

Charcoal

Observe/admit

46
Q

Tricyclic antidepressant OD: Tx. : seizure ?

A

benzo, phenobarbital

47
Q

Valproate OD: Tx. consider?

A

Naloxone
I-caritine
Hemodialysis

48
Q 
Stage 3 (day 3-4)
 hx. and PE ?
A

Nausea/vomiting reoccur

Jaundice

Altered mental status

Anuria

49
Q

Opioid-like manifestations: coma, miosis, decreased respirations ?

50
Q

Antipsychotic OD Hx and PE ?

A

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
51
Q

Anticholinergic OD class drugs ?

A

Antihistamines (diphenhydramine)

SSRI (fluoxetine)

Tricyclic antidepressants (amitriptyline)

Atropine

Skeletal muscle relaxants (cyclobenzaprine)

52
Q

MAOI OD: Toxic symptoms delayed ____ hours

53
Q

Antipsychotic OD: if QT >500ms tx. ?

A

Magnesium sulfate

54
Q

Clonidine OD: H and P ?

A

Bradycardia

Hypotension

Miosis
Decreased respirations

55
Q

CCB OD typical ?

A

activated charcoal

IV fluids

56
Q

Profound metabolic acidosis and elevated lactate level ?

57
Q

CCB OD second line ?

58
Q 
Stage 3 (day 3-4) - failure 
findings ?
A

Hepatic failure

Metabolic acidosis

Coagulopathy

Renal failure

Pancreatitis

59
Q

if it is high and they are bleeding a little bit ?

60
Q 
Stage 1 (first 24 hours)
 hx. and PE ?
61
Q

Which has liver damage, lithium of valproate OD ?

A

Valproate OD

62
Q 
Stage 4 (after day 5)
hx. and PE ?
A

Clinical improvement OR

Multi-organ failure

63
Q

Digoxin MOA ?

A

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

64
Q

Anticholinergic OD: Hyperthermia, agitation tx. ?

65
Q

Opiaite OD h and P ?

A

Bradycardia

Bradypnea

Pinpoint pupils

Hypothermia
Bowel sounds decrease
Dry skin

everything decrease really like benzos

66
Q

Tricyclic antidepressant OD: Labs ?

A

EKG–

sinus tachycardia, right axis deviation, and prolongation of the PR, QRS, and QT intervals

67
Q

Which has marked hyperglycemia, BB OD or CCB OD ?

68
Q

3rd most common prescription poisoning death ?

69
Q

Carbamazepine OD: Tx. ?

A

IV fluids
Charcoal
Hemodialysis

70
Q

Calcium channel blocker overdose class drugs ?

A

Amlodipine

Verapamil

Diltiazem

71
Q

Carbamazepine OD: H and P ?

A

Anticholinergic toxidrome
Coma
respiratory failure
Seizure

72
Q 
Stage 2 (day 2-3)
 hx. and PE ?
A

Nausea/vomiting improvement

Abdominal pain

Hepatic tenderness

73
Q

Intermediate acting class drug benzo ?

A

Lorazepam

Temazepam

74
Q

Short acting class drug benzo ?

A

Alprazolam

Midazolam

75
Q

Benzo Hx. and PE ?

A 
Bradycardia
Bradypnea
Somnolence
Dizziness
slurred speech
Confusion
Ataxia
incoordination

**everything is slowing down

PUPILS ARE UNCHANGED!**

76
Q

Elevated level on digoxin immunoassay, and hyperkalemia ?

77
Q

CCB OD consider ?

A

Glucagon

Insulin/glucose therapy

78
Q

Valproate OD: H and P ?

A

Respiratory Depression

Hypotension

altered mental status

79
Q

Antipsychotic overdose aka ?

A

Neuroleptic malignant syndrome

80
Q

Amphetamine (Sympathomimetic) overdose hx and PE ?

A 
Agitation
Mydriasis - dilated 
Diaphoresis
Tachycardia
Tachypnea
Hypertension
possibly hyperthermia

**everything is increased here **

81
Q

BB tx if brady ?

A

Atropine

Cardiac pacing

82
Q

Lithium OD Tx. ?

A

IV NL saline

sodium polystyrene

Severe = hemodialysis

83
Q

Digoxin OD considerations ?

A

Atropine

Cardiac pacing

84
Q 
Stage 4 (after day 5)
findings ?
A

Improvement OR

Worsening

85
Q

Wide-complex bradycardia ?

A

Class IC antiarrhythmic drugs (propafenone)

86
Q 
Stage 2 (day 2-3)
 findings ?
A

Liver enzyme elevations

Bilirubin elevated

PT/INR elevated

87
Q 
Stage 1 (first 24 hours)
 findings ?
A

Potassium low - cause Vomiting out acid

88
Q

SSRI overdose ?

A

Serotonin syndrome

89
Q

Antipsychotic OD: if intubation tx. ?

A

Nondepolarizing paralytic (rocuronium)

DO NOT USE succinylcholine

90
Q

Anticholinergic overdose pneumonic ?

A

Dry as a bone

Red as a beet

Hot as a hare

Blind as a bat

Mad as a hatter

Stuffed as a pipe

91
Q

ASA OD ABG ?

A

metabolic acidosis first

then

respiratory alkalosis

92
Q

Which has kidney and thyroid damage, Lithium or valproate OD ?

93
Q

Theophylline OD: Tx. ?

A

IV fluids

Charcoal

Consider observation

94
Q

Phenytoin OD: H and P ?

A

Vertical, bidirectional, or alternating nystagmus

Sedation

Ataxia

Later

  • Ophthalmoplegia
  • Apnea

this one slows things down and they get crazy eye movements

95
Q

Antipsychotic OD: If ventricular arrhythmia tx. ?

A

Sodium bicarbonate

96
Q

Tricyclic antidepressant OD: medications contraindicated ?

A 
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

Clinical Medicine Lecture - Professor Kramer (28 decks)

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