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Toxicology > Toxicology - general > Flashcards

Toxicology - general Flashcards

1
Q

In the unconscious patient, which specific agents should be investigated with drug levels?

A

Carbamazepine
Ethanol
Salicylate
Sodium Valproate

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2
Q

Describe the enhanced elimination strategy for carbamazepine

A

Multidose activated charcoal

Haemodialysis

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3
Q

Describe the enhanced elimination strategy for phenobarbitone

A

Multidose activated charcoal

Haemodialysis

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4
Q

Describe the enhanced elimination strategy for Salicylate poisoning

A

Urinary alkalinisation

Haemodialysis

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5
Q

Describe the enhanced elimination and antidote strategy for toxic alcohols

A

Ethanol

Haemodialysis

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6
Q

Describe the enhanced elimination strategy for Sodium valproate

A

Haemodialysis

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7
Q

Antidote for isoniazid

A

Pyridoxine 1g per g of isoniazid up to 5g (70 mg/kg in children), as slow IV infusion 0.5g / min until seizures stop, then remainder (if any) over 4 hrs

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8
Q

Antidote for organophosphate poisoning

A

Atropine 1.2mg (50mcg/kg) IV Q5min double dose until dry

Pralidoxime 2g IV and then infusion 0.5g/hr (controversial)

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9
Q

Management of VT due to sodium channel blockade?

What medication to avoid?

A

Intubation, hyperventilation
Bolus IV NaHCO3 1-2 mmol/kg IV Q1-2 min
NO AMIODARONE
When pH >7.5, IV lignocaine 1.5 mg/kg then infusion 2mg/min

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10
Q

Management of tachycardia or acute coronary syndrome in setting of sympathomimmetic use

A

IV diazepam 5-10mg Q2-5min until

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11
Q

4 categories of agents causing corrosive injury to the oropharynx which can result in airway compromise

A

Alkalis
Acids
Glyphosate
Paraquat

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12
Q

Antidote in carbamate poisoning

A

Atropine 20-50 mcg/kg (1.2mg) IV Q5min doubling dose until dry

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13
Q

Toxicological cause of hypocalcaemia

A

Hydrofluoric acid ingestion

Extensive cutaneous burns

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14
Q

Management of VF due to hypocalcaemia

A

IV calcium gluconate 10% 60 to 90 mls IV bolus, repeated Q2min until defibrillation successful

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15
Q

How do you undertake high dose insulin therapy?

A

High dose insulin therapy

  • glucose 50% 50 mls IV bolus
  • short acting Insulin 1 unit/kg IV bolus

Then

  • glucose 25g/hr IV infusion via CVC titrate to euglycaemia
  • Short acting insulin 0.5 units/kg/hr IV, increased to 1-2 units/kg/hr
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16
Q

Management of SVT due to theophylline toxicity

A

IV beta-blocker titrate to effect

Urgent haemodialysis

17
Q

Management of calcium channel blocker toxicity

A

IV calcium gluconate 10% 60-90 mls

High dose insulin therapy

18
Q

Agents causing fast sodium channel blockade

A 
TCA
1A antiarrhythmics
1C antiarrhythmic 
II antiarrhythmic: diltiazem 
IV: propranolol 
Local anaesthetic 
Hydroxychloroquine, chloroquine 
Quinine 
Dextropropoxyphene 
Amantadine
Carbamazepine
19
Q

Agents causing prolonged QT

A 
Antipsychotics 
1A antiarrhythmic 
1C antiarrhythmic 
III: sotolol
TCAs
Antidepressants: escitalopram/citalopram, MAOI 
Antihistamines 
Chloroquine, hydroxychloroquine
Quinine
Fluroquinolones: moxifloxacin
Macrolides: azithromycin, erythromycin 
Methadone
20
Q

Causes of high osmolar gap

A 
Acetone 
Ethanol 
Ethylene glycol 
Methanol 
Isopropyl alcohol 
Propylene glycol 
Mannitol 
Non-toxicological: DKA, CRF, hyperlipid/protein, lactic acidosis, trauma/burns, shock
21
Q

Causes HAGMA

A 
HAGMA
Carbon monoxide, cyanide 
Alcohol, alcoholic ketosis 
Toulene
Metformin
Uraemia
DKA 
Paracetamol, paraldehyde, prolylene glycol 
Isoniazid, iron
Lactic acidosis 
Ethylene glycol
Salicylate, starvation ketosis
22
Q

Causes of NAGMA

A 
RACE
Renal: RTA, addisons 
Acetazolamide 
Chloride excess
Extra loss: diarrhoea, fistula (pancreatic, small bowel, ureterostomy etc)
23
Q

Causes metabolic alkalosis

A 
CLEVER PD
Contraction of volume (dehydration) 
Liquorice
Endocrine - conn's, cushings 
Vomiting, GI loss
Excess alkali - bicarb, antiacid, calcium
Renal - barters, gitleman
Post hypercapnoea 
Diuretic
24
Q

Agents requiring lower treatment threshold in pregnancy patients due to increased risk to foetus

A

Carbon monoxide
Methaemoglobinaemia induicing agents
Lead
Salicylate

25
Q

Tablets and poisons lethal to 10kg child in 1-2 tablets

A 
A Baby Could Collapse Very Dead Over Picking Some Theophylline Tablets, Now Other Poisons Can Have Same Catastrophe.
Amphetamine 
Baclofen 
Calcium channel blocker, carbamazepine, chloroquine
Clozapine 
Venlafaxine 
Dextropropoxyphene
Opioid 
Propranolol
Sulphonylureas 
Theophylline 
TCA - dothiepine 
Napthalene (mothball)
Organophosphate
Paraquat
Camphor
Hydrocarbon
Strychnine 
Corrosive
\+ toxic alcohols / essential oils
26
Q

N-acetylcystine reigmen

A

200mg/kg over 4 hrs, then 100mg/kg over 16 hrs.

27
Q

Iron overdose antidote

A

Desferrioxamine 15 mg/kg

28
Q

Ethanol dosing as antidote

A

Loading dose 600 mg/kg and infusion of 80-150 mg/kg/hr

29
Q

Naloxone dose

A

5-10 mcg/kg (max 400 mcg)

Infusion 10 mcg/kg/hr

30
Q

Anticholinergic effects

A 
Hyperthermia 
Myosin
Dry flushed skin
Delirium 
Urinary retention 
Tachycardia
31
Q

4 phases of iron overdose

A

6 hrs - GI irritation, hypotension
6-12 hrs - improving
12-24 hrs - metabolic acidosis, altered mental status, pulmonary oedema, coagulopathy/death
4-6 weeks - GI strictures

32
Q

Intervention level for toxicity in iron overdose

A

> 60mg/kg significant symptoms - AXR & lab investigations
100 mg/kg potentially lethal

33
Q

Management of oral hypoglycaemic overdose

A

5 mls/kg glucose 10%

Octreotide - inhibit insulin secretion from pancreas, 1 mcg/kg IV bolus and infusion

Toxicology (4 decks)

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