Toxicology I and II

Question 1

Poisoning is ______ AND ______

Answer 1

situational and quantitative

substance can be poisonous IN THE RIGHT CIRCUMSTANCES AND/OR AT THE RIGHT DOSE

Question 2

Two main determinants of toxicity

Answer 2

dose

timing - to build up to CONCENTRATION of toxicity

Question 3

Common toxicities for children

Common for adults

(name some for both)

Answer 3

plants, cosmetics, salicylates, hydrocarbons, detergents, acetaminophen

barbiturates, CO, salicylates, alcohol, narcotics, acetaminophen, work place accidents

Question 4

Therapeutic index (TI) =

Answer 4

LD50/ED50

higher therapeutic index = SAFER DRUG

Question 5

Drug removal by emesis options (2)

Contraindicatiosn

Answer 5

Apomorphine
Ipecac

petroleum hydrocarbon solvent - chemical pneumonitis
caustic acid or alkali agent

Question 6

3 Broad options for removal of drug from the body

Answer 6

Emesis induction
Gastric lavage
Activated charcoal and cathartics

Question 7

Antidotes that CHELATE TOXICANTS (4 toxins and their associated antidotes)

Answer 7

Organophosphates - PRALIDOXIME

Cyanide - AMYL NITRITE, SODIUM NITRITE, SODIUM THIOSULFATE with O2

Botulinum toxin - trivalent anti-toxin

Heavy metals - chelators (EDTA, deferoxamine, BAL, DMSA) complex with heavy metals to reduce toxicity

Question 8

Common characteristic of heavy metal chelators

Answer 8

sulfide groups

Question 9

DMSA (succimer) used for

Answer 9

arsenic, mercury, LEAD POISONING

Question 10

Cyanide antidote kit (3)

MOA

Answer 10

amyl nitrite

sodium nitrite - converts Hb to metHb (metHb binds cyanide)

sodium thiosulfate converts cyanometHB into thiocyanate and Hb

Question 11

Alcohol antidote (3)

MOA

Answer 11

Ethanol, Fomepizole and Hemodialysis (in patients who are symptomatic)

Ethanol and fomepizole both inhibit ALCOHOL DEHYDROGENASE

Question 12

Carbon monoxide poisoning treatment

indicator of high levels?

Answer 12

pure O2, hyperbaric chamber if symptomatic

cherry red appearance in some (blood appears cherry red as well)

Question 13

Warfarin overdose therapy

Answer 13

Vitamin K injection

prothrombin complex or FFP with severe bleeding

Question 14

Opioids overdose therapy

Answer 14

Naloxone - SHORT DURATION OF ACTION, faster onset

Naltrexone - LONGER DURATION OF ACTION, slower onset

Question 15

Methemoglobinemia therapy

MOA

Answer 15

METHYLENE BLUE

causes a direct chemical reduction of methemoglobin back to hemoglobin

Question 16

Sympathomimetic (CNS Stimulants) toxidrome (4 signs)

3 drugs?

Answer 16

mydriasis, HTN, tremor, hyperthermia

Cocaine, amphetamines, PCP

Question 17

Sedative/Hypnotics Toxidrome

drugs

Answer 17

coma, decreased respiration, miosis or mydriasis, hypotension

alcohol, barbiturates, benzo’s

Question 18

Opioid toxidrome

Drugs

Answer 18

coma, respiratory depression, PINPOINT miosis, opiate triad

opiates, morphine, oxycodone, hydrocodone

Question 19

Anticholinergic toxidrome

Mnemonic?

drugs?

Answer 19

agitation, mydriasis, fever, dry skin, flushing, urinary retention

HOT as a hare, DRY as a bone, RED as a beet, BLIND as a bat, MAD as a hatter

anti-cholinergics and antidepressants

Question 20

Cholinergic toxidrome

Answer 20

miosis, salivation, lacrimation, urination, defecation, (SLUDGE)

organophosphates, nicotine

Question 21

TCA Toxidrome

Answer 21

coma, agitation, mydriasis, dysrhythmia, convulsions, hypotension

TCA’s - amitryptiline, imipramine, desipramine

Question 22

Salicylate Toxidrome

Answer 22

can have increased respiration, TINNITUS, agitation early alkalosis, late acidosis, hyperpyrexia

aspirin, ASA

Question 23

Acidic substance treatment

Answer 23

ABC’s, demulcents, lots of water, steroids for esophageal strictures, analgesics, antibiotics

Question 24

Alkaline substance treatment

Answer 24

ABC’s, demulcents, lots of water, analgesics, steroids, NO GASTRIC LAVAGE OF EMETICS

Question 25

Benzodiazepine antagonist

Answer 25

FLUMAZENIL

Question 26

Acetaminophen antidote drug

Answer 26

N-ACETYLCYSTEINE