Toxicology

Question 1

What classes of medication can cause anticholinergic effects?
(Six bullets for this answer…)

Answer 1

Anti-histamines,
Anti-emetics,
Antispasmodics GI .. AND .. GU,
Anti-psychotics
Parkinsonism meds (some of them)
TCA’s and Flexeril/Baclofen (muscle relaxants)
(histamine-emetics, spasmodics-psychotics,parkinsons, TCA’s and relaxants)

Question 2

What classes of medications can cause WCT in overdose?

Name at least 7 classes

Answer 2

Anti-dysrhythmics, Beta-Blockers, CACB’s, Digoxin,
Anticholinergics (Benadryl, eg), Antipsychotics, TCA’s, MAO-I’s, SSRI’s (some of them), Antiemetics, Antiepileptics,
(Several classes of) Antibiotics (FQ class, Macrolide class, antimalarials), Quinine, Cocaine, MDMA, Amphetamines…

Question 3

What medications are typically amenable to activated charcoal, or even MDAC?

Answer 3

Most anti-epileptics, many anti-dysrhythmics, some anti-depressants (especially if anticholinergic properties).

Any substance that undergoes hepatic conjugation and bile excretion potentially could be enterohepaticallly recirculated; hence amenable to MDAC.

Question 4

What are the two phases of hepatic metabolism of medications/substances?

Answer 4

Phase 1 — typically hydrolysis or oxidation

Phase 2 — Then that product is conjugated to many diff substances, such as glutathione, or via sulfation, glucuronidation, acetylation.

Question 5

What does glucose do if a Calcium Channel Blocker overdose is substantial–and why does it happen?

Answer 5

Glucose levels are typically high if there is a legitimate OD, related to the effect CACB OD has on release of insulin AND insulin insensitivity.

Question 6

What is the dose for Hyperinsulinemic Euglycemic Therapy (HIET) in Overdose and how does it help?

Answer 6

HIET takes advantage of essentially ‘force feeding’ poisoned cardiac myocytes glucose to use as substrate for energy. Cardiac myocytes normally prefer FFA’s. This works for CACB AND ALSO B-Blocker overdoses.
ONE unit/kg bolus and 1 U/Kg/Hr gtt, with dextrose infusion (0.5-1gm/kg/hr) and Q30 min FSBG’s.

Question 7

What are three of the first signs of local anesthetic toxicity?

Answer 7

Light-headedness, tinnitus, metallic taste.