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SD- ER pt 2 > Toxicology Lecture > Flashcards

Toxicology Lecture Flashcards

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1
Q

MC antidepressants to cause OD related deaths

A

Tricyclic antidepressants

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2
Q

Altered mental status
Sinus tachycardia

serious toxicity seen within 6 hours:
coma, cardiac conduction delays, supraventricular tachycardia, hypotension, respiratory depression, premature ventricular beats, v tach, seizures

A

Tricyclic OD

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3
Q

R axis deviation
Terminal R wave in aVR
Widened QRS

ECG changes seen within ____ hours of a tricyclic OD

A

6 hours!

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4
Q

Shock
Prolonged QRS
Terminal R waves in aVR
Altered mental status

A

Tricyclic OD

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5
Q

MC tricyclic that is taken for OD

A

amitriptyline

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6
Q

Peak absorption is 1 hour
Toxic dose= 10-20 mg/kg

A

Tricyclic OD

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7
Q

O2, IV, monitor

BICARB!! 1-2 mEq/kg until blood pH equals 7.50-7.55

intubate if necessary

A

Tx for tricyclic OD

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8
Q

sx: agitation, confusion, tremor, rigidity, sweating, hyper-reflexia, anxiety, ataxia
ie. .a pt took a whole bottle of their SSRIs

A

Serotonin syndrome

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9
Q

SSRIs cause ____ symptoms

A

psych!

(hyperreflexia, rigidity, agitation)

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10
Q

Due to hyper-reflexia, rigidity, myoclonus etc…pts who OD on SSRIs (serotonin syndrome) can give themselves…

A

Rhabdo

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11
Q

Tx for serotonin syndrome?

A

Benzos

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12
Q

__-___% of patients on long term lithium therapy will develop toxicity

A

75-90%

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13
Q

Hand tremor, polyuria, rash
Nephrogenic diabetes insipidus

Neuro effects: memory loss, decreased mental status, fatigue, ataxia, dysarthria
N/V/D

Hypotension, conduction delays, ventricular dysrhythmias
QT prolongation, ST segment depression, T wave inversion

A

Lithium OD

very narrow therapuetic index, make sure these pts stay hydrated!

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14
Q

0-12 hours: CNS effects
pt appears intoxicated without smell of ethanol on breath

12-24 hrs: cardiopulmonary effects
tachycardia, tachypnea, HTN
CHF, ARDS, circulatory collapse

24-72 hours: renal effects
flank pain, CVA tenderness, acute tubular necrosis with acute renal failure

A

Ethylene glycol OD

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15
Q

Metabolic acidosis with elevated anion gap and elevated osmolal gap

A

Ethylene glycol OD

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16
Q

Serum osmolal= 10
Calculated osmolal= 3.8

..what are you missing?

A

Ethylene glycol OD!

conversion factor for Ethylene Glycol= 6.2, which is the difference between the serum and calculated levels

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17
Q

Ethylene glycol= 6.2
Methanol= 3.2
Ethanol= 4.6

A

conversion factors

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18
Q

Fomepizole=DOC!

Also give bicarb to correct acidosis

end game=dialysis!!

(but this is expensive, so cheap alcohol will also work)

A

Treatment for ethylene glycol OD

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19
Q

What is MUDPILES?

A

causes of elevated anion gap

  • *M**ethanol
  • *U**remia
  • *D**KA
  • *P**ropylene glycol
  • *I**nfection/isonizid
  • *L**actic acidosis
  • *E**thylene glycol/ethanol
  • *S**alicylates
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20
Q

Na- (Bicarb + Cl)

A

Anion gap

normal= 12 or under

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21
Q

What is a normal anion gap?

A

12 or under

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22
Q

Kussmal’s breathing (hyperventilation)
Tinnitis

A

Aspirin OD!

23
Q

If a pt has kussmal’s respirations, you can pretty much assume they are in what?

A

Metabolic acidosis

(body is trying to blow off CO2 to compensate)

24
Q

less than 150 mg/kg ingestion of aspirin

A

non toxic to mild

25
Q

150-300 mg/kg of aspirin

A

mild to moderate toxicity

26
Q

300-500 mg/kg of aspirin

A

serious toxicity!

27
Q

>500 mg/kg of aspirin

A

Potentially life threatening

28
Q

For a suspected aspirin OD, you must repeat serum salicylate levels ever 2 hours for __ hours

A

6 hours

(toxic levels are usually apparent within 6 hours)

29
Q

increased anion gap metabolic acidosis, metabolic alkalosis and respiratory alkalosis

A

Aspirin OD

30
Q

Is the Done monogram useful for Aspirin ODs?

A

NO

31
Q

Monitor urine pH and maintain at 7.5-8.0

(alkalize the urine)

A

Aspirin OD

32
Q

What is the ultimate treatment of choice for Aspirin OD?

A

Dialysis

33
Q

For an Aspirin OD, gastric lavage can be done within the first…

A

60 mins

34
Q

What is the max dose for Tylenol in adults?

A

4 grams

35
Q

MC cause of acute liver failure in US?

A

Tylenol

36
Q

What age group does the best with Tylenol ODs?

A

Kids under 5

(bc they have more Glutathione in liver, which makes it easier to metabolize Tylenol)

37
Q

What is the worst possible thing you could do in addition to ODing on Tylenol

A

Drinking alcohol with it!!

(same enzyme metabolizes both)

38
Q

phase 1 (0-24 hrs)

asymptomatic to N/V
Subclinical bump in LFTs (this is the first sign!)

A

Tylenol OD

39
Q

Phase 2 (18-72 hours)
RUQ pain
N/V
Continued increase in LFTs

A

Tylenol OD

40
Q

Phase 3 (72-96 hours)

Jaundiced
Coagulopathy
Fatality
Liver necrosis
Renal failure

A

Tylenol OD

41
Q

When is the max absorption in a Tylenol OD?

A

4 hours

(so get labs right away and repeat at 4 hours)

42
Q

Plot levels at 4 hours on _______ _______ to determine if hepatic toxicity is likely

A

Rumack Nomogram

43
Q

Can you use the Rumack Nomogram if 2+ drugs wee taken or if the pt delays the trip to the ER?

A

NO

44
Q

What should the blood pH be in a Tylenol OD?

A

Normal!

(if pt has acidosis, there must be another agent on board)

45
Q

N-acetylcysteine (NAC) is the antidote for….

A

Tylenol OD

46
Q

What is the time frame you want to give N-Acetylcysteine in?

A

best if within 8 hours

(but can give anytime, even if pregnant)

47
Q

pH <7.3
Grade 3+ encephalopathy
PT >100
Serum Cr > 3.4

A

Liver transplant requirements

48
Q

True or False..

N-acetly-p-benzoquinoneimine (NAPQI) is the toxic metabolite of Acetaminophen

A

True

49
Q

Bradycardia + hypotension

serious ingestion when >1 gram
onset= 15 mins - 2 hours

A

Verapamil OD

(physiologically, this combination does not make sense)

50
Q

DOC for CCB (Verapamil) OD?

A

CaCl 10%
10-20 mg q30 minsx 8 hours

51
Q

DOC for beta-blocker OD

A

Glucagon

52
Q

Time to peak effect of opiates for the following methods:

IV
Crush/snort
IM
Oral
Transdermal

A 
IV= 10 mins
Snort= 10-15 mins
IM= 30-45 mins
Oral= 90 mins
Transdermal= 2-4 hours
53
Q

Pressors and Atropine can be given as support tx (CaCl=DOC!!)

*often see high grade blocks of ECG

A

Verapamil OD

SD- ER pt 2 (6 decks)

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