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Phase 4 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Broadly speaking what are the types of management for toxicity?

A

Decreased Absorption

  • gastric lavage
  • activated charcoal
  • whole bowel irragation

Increased Elimination

  • Urine Alkalinisation
  • Haemodialysis

Reducing the rate of metabolite breakdown

Creating chemical complexes to bind with

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2
Q

Outwith medical management, what other assessment should be done into someone presenting with an overdose?

A

Psychiatric assessment

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3
Q

In paracetamol overdose - what important investigations should be done and how is it treated?

A 
LFTS 
Coagulation studies 
U&Es
Paracetamol levels
ABG - Acidosis can occur
  • Activated Charcoal within 1 hour
  • Acetylcysteine
  • supportive care
  • Antiemetics
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4
Q

What are some of the clinical sign seen with Aspirin overdose?

A

Hyperventilation
Bounding pulse
Peripheral vasodilation

Severe:
Pyrexia
Cerebral oedema
Bleeding - hypoprothrombinemia

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5
Q

How is Aspirin overdose treated?

A

Activated charcoal
- gastric lavage within 1 hour

Rehydration

Sodium Bicarbonate

Haemodialysis

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6
Q

What are some signs and symptoms of TCA overdose?

A

Convulsions

Mydriasis

  • dilated pupils
  • dry mouth

Arrhythmias

Urinary retention

Upper reacting planters

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7
Q

How is TCA overdose managed?

A

Supportive
Ventilatory
Anti-arrhythmic
Convulsion management

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8
Q

Which drug is used to treat Benzodiazepines?

A

Flumazenil

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9
Q

What is the definitive Carbon Monoxide poisoning test?

A

Carboxyhemoglobin Level

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10
Q

What are the typical symptoms of digoxin toxicity?

A

Bradyarrhythmias
- AV block

Yellow/ greenish vision

Ventricular Bigeminy

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11
Q

How is digoxin toxicity treated?

A

Digibind
Arrhythmia management
Monitor K+

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12
Q

What are the initial symptoms of opioid overdose?

A 
Confusion 
Myoclonus 
Vivid dreams Hallucination
Hypothermia 
Constipation
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13
Q

What are the signs and symptoms of severe Opioid toxicity?

A

Bradypnoea
Pinpoint pupils - Miosis
Altered GCS

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14
Q

How should sever opioid overdose be treated?

A

Naloxone
Oxygen therapy
**remember to ventilate the patient

*patient should be observed up to 6 hours after last naloxone

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15
Q

How is Beta blocker overdose treated?

A

Atropine
Fluids
Glucagon

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16
Q

How is ethylene glycol managed?

A

Fomepizole
- 1st line

Alcohol
- 2nd line

17
Q

How is Carbamoxide poisoning treated?

A

100% oxygen

Hyperbaric chamber

18
Q

How is warfarin overdose managed?

A

Vitamin K

Prothrombin complexes

19
Q

What drug is given to reverse Heparin?

A

Protamine

20
Q

At what levels should warfarin intervention be at?

A

INR 5-8 = Vitamin K

INR >8 , no bleeding = Vitamin K high dose orally

INR >8, Bleeding = IV Vitamin K

INR >8, large bleeding = IV Vitamin K, Prothrombin Complex concentrate or FFP if needed

21
Q

What criteria is used to assess the need for specialist help in paracetamol poisoning regarding liver functioning?

A 
Kings college hospital criteria in acute liver failure 
	- pH <7.3 
Or 
	- PT >100s 
	- Creatinine 
Encephalopathy >3

if these then liver transplant should be considered.

22
Q

How is Beta blocker overdose managed?

A

Atropine

if this fails then:
- Glucagon + 5% glucose

consider
- transcutaneous pacing

23
Q

What is the symptoms of anticholinesterase - nerve agents? and how are they treated?

A

SLUDGE

  • salivation
  • lacrimation
  • urination
  • Defecation
  • G.I upset
  • emesis

Atropine

24
Q

What is the King’s college criteria for paracetamol overdose?

A

<7.3 pH

INR> 100
Renal failure
Encephalopathy

25
Q

What do you want to know when someone comes in with overdose?

A

What have they taken? washed down with?
When was it taken?
How much?

26
Q

How is the diagnosis of serotonin syndrome made?

A

Using the:

- Hunter Serotonin Toxicity Criteria

27
Q

What is the main symptom in Anti-histamine overdose?

A

Hallucination

Monitor them closely.
- supportive treatment.

Benzodiazepines

28
Q

What are the presenting symptoms of SSRI toxicity and how is it treated?

A

Serotonin syndrome

Hyperthermia
Hypertension
Agitation
Diarrhea

Treatment:

  • IV magnesium (high risk of Detorde de pointes)
  • Cooling
  • Benzodiazepines
29
Q

What criteria is used to assess for serotonin syndrome?

A

Hunter serotonin syndrome criteria

30
Q

How is cyanide poisoning treated?

A

Sodium nitrite

Hydroxocobalamin
- B12

31
Q

What are the symptoms of organic phosphate poisoning? and how is it treated?

A

DUMBELS

  • Diarrhoea
  • Urination
  • Miosis
  • Bronchorrhea - excessive secretions
  • Emesis
  • Lacrimation
  • Salivation

**you become wet

Pralidoxime - binds to acetylcholinesterase

32
Q

How do you test the levels of TCA?

A

Urine sample

33
Q

What are the contraindications to a gastric lavage?

A

Ingestion of hydrocarbons

Ingestion of corrosive substances

If the airway cannot be protected

34
Q

How does TCA overdoses present and how are they managed?

A 
Mydriasis
Urinary retention 
Tachyarrhythmias - which can go into VT 
Seizures 
Metabolic acidosis

Management:

  • sodium bicarbonate (helps to manage the arrhythmias)
  • Cardiac input
  • Benzodiazepines
35
Q

What is the serious toxic dose of paracetamol requiring intervention?

A

150mg/kg

36
Q

How long after paracetamol ingestion do you wait to measure levels and why?

A

4 hours if satisfied a non staggered dose has been taken or timing of ingestion is known.
measured 4 hours later because levels are inaccurate before

37
Q

Generalised management of Cocaine overdose?

A

Diazepines
- for agitation and M.I and narrow complex tachy’s

GTN spray

Sodium bicarbonate
- for metabolic acidosis

Dantrolene for muscle relaxant

Phase 4 (49 decks)

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