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Acute care. > Toxicology. > Flashcards

Toxicology. Flashcards

1
Q

How quickly does diamorphine start to take effect/last?

A

1 minute onset and 2 hour duration.

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2
Q

What do we need to remember about the timings of naloxone vs diamorph?

A

naloxone lasts an hour and heroin 2 hours, so need to make sure we keep them in as they can die after an hour of being fine in overdose.

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3
Q

What can toxidromes help us with?

A

can help us identify the poison if we know the stereotyped syndromes.

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4
Q

What is the syndrome associated with TCA OD?

A 
anticholinergic:
flushing
arrhythmias (long QRS)
dry
dilated pupils
tachycardia
hypotension
acidotic
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5
Q

What is the problem with acidosis and the heart?

A

acid is negatively inotropic.

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6
Q

What should we give for acidosis in TCA overdose?

A

sodium bicarbonate and airway support.

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7
Q

What are the indications for sodium bicarbonate in TCA OD?

A

hypo tension unresponsive to fluid resus

long QRS

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8
Q

What are the different types of alcohol?

A

ethanol
methanol
ethylene glycol

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9
Q

What happens in alcohol toxicity?

A

different alcohol are fine but are metabolised into harmful metabolites in the liver by alcohol dehydrogenase.

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10
Q

How do we treat methanol or ethylene glycol poisoning?

A

give them alcohol as this has preferential binding with alcohol dehydrogenase meaning the others aren’t broken down into their toxic metabolites.

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11
Q

What are the symptoms of serotonin syndrome?

A 
has sympathetic effects so:
hypertension
tachycardia
hyperthermia
agitation
(can result in rhabdo)
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12
Q

What is the treatment of serotonin syndrome?

A

supportive and

dantrolene for malignant hyperthermia (although might work well for other drug hyperthermia better e.g. sux/volatiles).

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13
Q

What is organophosphate syndrome?

A 
(weedkillers)
cholinergic:
hypotension,
bradycardia
small pupils,
lacrimation and salivation
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14
Q

How do we treat organophosphate poisoning?

A

atropine (or praladoxine).

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15
Q

What are the different sympathomimetic drugs?

A

cocaine, speed etc.

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16
Q

What does cocaine do to the body?

A 
sympathetic:
hypertension,
tachycardia,
increased RR,
big pupils

cardiotoxic.
Might have funny neuro thinks like parasthesia from vasoconstriction.

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17
Q

Why is cocaine cardiotoxic?

A

sympathetic effect so causes vasoconstriction that may result in coronary vasospasm and MI. Aslo have increased O2 demand from tachy.

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18
Q

Why should we never use a beta blocker in cocaine?

A

Beta and alpha receptors are being triggered, if we block beta, its all alpha and this can result in a hypotensive crisis.

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19
Q

How do we treat cocaine toxicity?

A

benzodiazepines e.g. diazepam and GTN for chest.

20
Q

What can we use to treat ADME in drug OD?

A

A: activated charcoal causes adsorption, stopping drug absorption
D: intralipid (fat mops up from blood)
M: antidotes
E: fluids, dialysis or haemofiltration and urinary alkinylisation

21
Q

How quickly must we give activated charcoal and why?

A

Within 1 hour as drugs will still be in the stomach.

or when can see still vomiting pills, or in drugs that cause gastropareses can give later.

22
Q

What is intralipid traditionally used as an antidote for?

A

lidocaine toxicity

23
Q

How quickly do people with paracetamol OD die?

A

in 5-7 days of fulminant hepatic failure.

Never die straight away, see nothing for 24-48 hours, then vomit/abdo pain, then yellow, then dead.

24
Q

What part of paracetamol is toxic?

A

the inactive metabolites.

The active ones give the anlagesic effects.

25
Q

What happens to paracetamol inactive metabolites normally?

A

they are conjugated for excretion with glutathione in the liver.

26
Q

What happens to inactive paracetamol metabolites in OD?

A

they overwhelm the amount of glutathione and so are toxic.

27
Q

How do we treat paracetamol OD?

A

charcoal if within an hour.
Do paracetamol levels at 4 hours
if within 12-24 hours can give parvolex if blood levels are high enough on nomogram.

28
Q

What is the real name for parvolex?

A

Acetylcysteine

29
Q

What are the side effects of parvolex?

How can we counteract this?

A

10% get an uritcarial hypersenstivity type reaction.

So can prescribe prophylactic antihistamies with it.

30
Q

When do paracetamol levels in the blood peak?

A

4 hours after ingestion.

31
Q

Reverses the effects of benzodiazepine overdose?

A

Flumazenil

32
Q

What does Lignocaine do?

A

blocks the activity of sodium channels

33
Q

What does morphine work on?

A

Morphine is mu receptor agonist.

34
Q

Does morphine have active metabolites?

A

yes, One of its metabolites is active and indeed more potent than morphine.

35
Q

What is paraquat?

A

An organophosphate in weedkiller.

36
Q

What is the antidote for beta blocker over dose?

A

glucagon 5-10ml (for pre-filled).

37
Q

What is the normal dose of glucagon for hypo?

A

1mg IM.

38
Q

What are the side effects of giving glucagon for B blocker overdose?

A

they vomit, so need to watch airway.

39
Q

If someone has OD’d on co-codamol, what should we give as an antidote?

A

naloxone

parvolex

40
Q

What kind of picture should we expect to see with Co-codamol OD?

A

opioid type features.

41
Q

When prescribing aspirin what do we need to be aware of?

A

Check weight in skinny people (need to be over 50kg for full dose).

42
Q

What is a classic symptom of aspirin overdose?

A

ringing in ears.

43
Q

What blood tests do we see in aspirin overdose?

A

mixed metabolic and respiratory acidosis.

44
Q

How do we treat aspirin overdose?

A

Take bloods at 4 hours for levels (combined test with paracetamol).
if over nomogram levels then alkylyse urine (sodium bicarb) and fluids.

45
Q

Where do we find drug level nomograms?

A

toxbase.

46
Q

In real life, who is the only people we should give flumazenil to for benzo OD? (not the exam answer)

A

ones that we have OD’d by mistake.

Flumazenil, lowers seizure threshold, so if you don’t know a patients background. Reversing the benzo’s may cause seizure. If this happens because you have blocked benzo’s, you have a lack of options of how to treat them.

Acute care. (14 decks)

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