Toxicology Part 2

Question 1

Cardiogenic Effects of Cocaine

Answer 1

QRS widening and QT prolongs, Arrhythmias, MI’s, myocarditis, coronary artery dissection, acute HTN,

Question 2

Pulmonary Effects of Cocaine

Answer 2

seizures, stroke, crack dance movements, lethargy following high, cerebral vasoconstriction, hyperthermia, crack eye,

Question 3

CNS Effects of Cocaine

Answer 3

Asthma, Pulmonary hemorrhage
Pneumonitis, Pulmonary edema
Barotrauma from valsalva

Question 4

GI Effects of Cocaine

Answer 4

Intestinal ischemia/necrosis, colitis, splenic infarctions, GI bleeds and perforation

Question 5

Body stuffers

Answer 5

swallow loosely packed cocaine, may show signs of toxicity

Question 6

Body Packers

Answer 6

swallow well-packaged cocaine if 1 breaks = toxic

Question 7

Renal Effects of Cocaine

Answer 7

rhabdomyolysis

Question 8

Signs of rhabdomyolysis

Answer 8

tea colored urine, no RBCs in urine but + for blood, CPK

Question 9

What illegal drug can induce abruptio placenta?

Answer 9

COCAINE

Question 10

abruptio placenta clinical finding

Answer 10

bright red blood WITH pain

Question 11

Placenta previa clinical finding

Answer 11

bright red blood WITHOUT pain

Question 12

Cocaine is present in urine for

Answer 12

3 days

Question 13

Treatment for cocaine OD

Answer 13

benzodiazepines

Question 14

Haldol treatment for cocaine OD

Answer 14

NO - lowers threshold for seizures

Question 15

Mertopolol treatment for cocaine OD

Answer 15

NO - re-entry tachycardia

Question 16

How do you treat to wide QT prolongations?

Answer 16

alkalinization of serum to 7.45-7.50

Question 17

Patient who ODs on cocaine without symptoms? Treatment

Answer 17

Golytely and charcoal

Question 18

Patient who ODs on cocaine with symptoms? Treatment

Answer 18

benzos

Question 19

Opioid OD effects

Answer 19

Respiratory depression, Mental status changes, Pupil constriction: (Opioid OD or pontine stroke,)
Nausea/vomiting, Histamine release–>urticaria, bronchospasm
Urinary retention, Decreased GI motility, constipation, coma
Non-cardiogenic pulmonary edema

Question 20

Clinical diagnosis of Opioid OD

Answer 20

miosis, respiratory depression, coma,

Question 21

Opioids include

Answer 21

Dilaudid, demerol (bad pain med), morphine, heroin, vicodin, oxycontin, codeine, methadone (used to treat heroin addicts)

Question 22

Treatment of Opioid OD? Treatment of Heroin OD?

Answer 22

Narcan, can use methadone for heroin

Question 23

What might be on your differential for a Opioid OD patient?

Answer 23

Clonidine (for HTN), stroke, hypoglycemia, post-octal state, organophosphates, CO, sedatives

Question 24

Narcan will induce

Answer 24

withdrawal symptoms

Question 25

Alcohol can cause

Answer 25

malnourishment

Question 26

Minor EtOH withdrawal

Answer 26

6-12h, tremors, anxiety, dynamic vitals, sweating, diarrhea

Question 27

Major EtOH withdrawal

Answer 27

12-24h, nightmares, hallucinations

Question 28

Severe EtOH withdrawal

Answer 28

24h, seizures, "rum fits" (CAN DIE from seizures)

Question 29

Treatment for EtOH OD

Answer 29

Benzos, Thiamine

Question 30

Wernicke encephalopathy

Answer 30

Low thiamine, etoh abuse

Question 31

Wernicke encephalopathy Triad

Answer 31

ataxia, ophthalmoplegia, encephalopathy, reversible

Question 32

Korsakoff amnesia

Answer 32

Low thiamine, etoh abuse long term, Anterograde and/or retrograde amnesia, confabulation, apathy Chronic, non reversible

Question 33

Marijuana (K2) effects

Answer 33

Anxiety, HTN, horrible feelings of doom and dread, palpitations, diaphoresis

Question 34

Action of Coumadin/Warfarin

Answer 34

blocks synthesis of Vitamin K - dependent clotting factors (2, 7, 9, 10)

Question 35

Toxicity of Coumadin/Warfarin

Answer 35

hematuria, GI Bleed, bruising, intra-abdominal bleed

Question 36

Treatment of Coumadin/Warfarin toxicity

Answer 36

Vitamin K, fresh frozen plasma

Question 37

Treatment for Heparin toxicity

Answer 37

protamine sulfate

Question 38

Treatment for Pradaxa toxicity

Answer 38

NONE

Question 39

CO binds Hgb

Answer 39

250X greater than O2

Question 40

CO of 10-20% level

Answer 40

HA, N/V, dizziness, abd pain

Question 41

CO of 60% level

Answer 41

Coma, death, hypotension, seizures

Question 42

Who is at the greatest risk for CO poisoning

Answer 42

Fetus/newborn more susceptible due to higher affinity of CO for fetal hgb

Question 43

Would pulse ox indicate CO poisoning

Answer 43

No, can't distinguish b/w carboxyhgb and oxyhgb

Question 44

CO > 20% level

Answer 44

confusion, dyspnea, syncope

Question 45

Treatment for CO poisoning

Answer 45

100% oxygen or hyperbaric chamber

Question 46

Half-life of CO

Answer 46

5 hours, reduced with 100% O2 condition