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MRCEM INTERMEDIATE > Toxicology & Pharmacology > Flashcards

Toxicology & Pharmacology Flashcards

1
Q

How to calculate dose of naloxone infusion needed

A

60% of dose needed to reverse respiratory depression, including total of divided doses

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2
Q

At what dose of paracetamol OD does NAC need to be started

A

> 75mg/kg

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3
Q

Cholinergic features

DUMBELS

A

DIRRHOEA
URINATION
MIOSIS
Bronchorrhea
EMESIS
LACRIMATION
SALIVATION

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4
Q

Pralidoxime antidote for

A

Antidote for toxic exposure to organophosphate anticholinesterase pesticides

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5
Q

Anticholinergic toxidrome

A

Tachycardia, hyperthermia, dilated pupils, warm and dry skin, urinary retention, agitation

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6
Q

Cholinergic toxidrome

A

Salivation, lacrimation, urination, diarrhoea, bronchorrhoea, bronchospasm, bradycardia, vomiting

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7
Q

Hallucinogenic toxidrome

A

Hallucinations, panic, seizures, hypertension, tachycardia, tachypnoea

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8
Q

Sympathomimetic toxidrome

A

Tachycardia, hypertension, dilated pupils, agitation, seizures, hyperthermia, sweating

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9
Q

Examples of Anticholinergic drugs

A

Antihistamines, tricyclic antidepressants, carbamazepine, phenothiazines

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10
Q

Examples of Cholinergic drugs

A

Carbamates, organophosphates insecticides, some mushrooms

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11
Q

Examples of Hallucinogenic drugs

A

LSD, Phencyclidine , Magic Mushrooms

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12
Q

Examples of Sympathomimetic drugs

A

Amphetamines, cocaine, MDMA

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13
Q

Calcium channel blockers antidote

A

Calcium chloride/gluconate

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14
Q

Lead antidote

A

Calcium disodium EDTA

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15
Q

Neuroleptic malignant syndrome antidote

A

Dantrolene

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16
Q

Serotonin syndrome antidote

A

Cyproheptadine (Periactin®)

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17
Q

Ethylene glycol & methanol antidote

A

Fomepizole

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17
Q

Benzodiazepines antidote

A

Flumazenil

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18
Q

Cyanide antidote

A

Hydroxocobalamin

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19
Q

Dabigatran antidote

A

Idarucizumab (Praxbind®)

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20
Q

Sulfonylureas antidote

A

Octreotide (Sandostatin®)

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21
Q

Anticholinergic syndrome antidote

A

Physostigmine

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22
Q

Heparin antidote

A

Protamine sulfate

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23
Q

Organophosphate insecticides, nerve gases antidote

A

Pralidoxime (2-PAM, Protopam®)

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24
Q

Seen on a VBG early with salicyclate OD

A

Low CO2, respiratory acidosis

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25
Q

Hallmark for TCA poisoning on ECG

A

+ve R wave in aVR

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26
Q

Precipitants of methaemoglobinaemia

A

Local anaesthetics
Chloroquinine
Metoclopramide
Nitrates
Phenytoin

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27
Q

ECG findings in patients on digoxin (non toxic)

A

Down sloping ST depression
Flattened or inverted T waves
Shortened QT interval

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28
Q

Digoxin toxicity ECG findings

A

Bradycardia
PR and QR prolongation

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29
Q

Fomepizole treats what?

A

Used to treat methanol and ethylene glycol poisoning.

Should be used when suspected and patient has a metabolic acidosis with raised osmolar gap

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30
Q

Ways to reduce risk of local anaesthetic toxicity

A

Calculate doses
Reduce dose in frail patients
Use USS
Combine with adrenaline

Diluting doesn’t reduce this risk

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31
Q

Electrolyte imbalances causing digoxin toxicity

A

Hypercalcaemia
Hypokalaemia
Hypomagnesia

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32
Q

Most concerning ECG finding in serotonin OD

and why?

A

QT prolongation

Leads to torsades

33
Q

Most common ECG finding in TCA OD

A

QRS prolongation

34
Q

Arterial blood gas in carbon monoxide poisoning

A

Metabolic acidosis
Raised lactate
Normal pO2

35
Q

Antidote for salicylate overdose

A

Sodium bicarb

36
Q

When to give sodium bicarbonate in a TCA OD

A

QRS > 120 msecs / hypotensive unresponsive to fluids

37
Q

Salicylate initial ABG findings

A

Respiratory alkalosis (increased resp rate)

38
Q

Biochemistry results caused by loop diuretics

A

Hyponatraemia
Hypokalaemia
Hypocalcaemia
Hypomagnesaemia
Hypochloraemic alkalosis

39
Q

The only anticonvulsant therapy thought to be associated with the development of Dupuytren’s contracture is …

40
Q

Which electrolyte disturbance is most dangerous for a patient taking digoxin?

41
Q

How much adrenaline in an adult / child autoinjector

A

0.3mg

0.15mg

42
Q

BP medication which actually lowers your risk of gout

A

Calcium channel blockers

43
Q

If given in 3rd trimester SSRIs are associated with

A

(antidepressant) discontinuation syndrome and persistent pulmonary hypertension of the newborn.

44
Q

Methionine is an alternative antidote to

A

NAC (paracetamol)

45
Q

fetal warfarin syndrome

A

nasal hypoplasia, bone stippling, bilateral optic atrophy and intellectual disability

46
Q

Calcium channel OD, IV calcium dose options (2)

A

10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children), or;
10% calcium chloride 20 mL IV (0.2 mL/kg in children) via central venous access

47
Q

Salicylate OD, common clinical features include

A

Nausea and vomiting
Tinnitus
Deafness
Sweating and dehydration
Hyperventilation
Cutaneous flushing

48
Q

The indications for DigiFab in acute toxicity

A

Cardiac arrest
Life-threatening arrhythmia
Potassium level >6.5 mmol/l
>10 mg digoxin ingested (adult)
>4 mg digoxin ingested (child)
Digoxin level >12 ng/ml

49
Q

When furosemide and macrolide antibiotics are prescribed together, what is the risk?

A

Hypokalaemia, potentially increasing the risk of torsades de pointes

50
Q

Non drug factors that increase the half-life of theophylline include:

A

Heart failure
Cirrhosis
Viral infection

51
Q

Non drug factors that decrease the half-life of theophylline include:

A

Smoking
Heavy drinking

52
Q

What dose of activated charcoal should be administered in children?

53
Q

The two drugs that are associated with the highest risk of developing drug-induced lupus

A

Procainamide and hydralazine

54
Q

Above what digoxin level is toxicity usually seen?

55
Q

Theophylline toxicity metabolic results

A

Mild metabolic acidosis
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Hypo- or hypercalcaemia
Hyperglycaemia

56
Q

Over what threshold level are toxic effects generally seen with Lithium?

A

1.5 mmol/l

57
Q

What do calcium channel blocker ODs do to BGL?

A

Hyperglycaemia

58
Q

Arthus reaction

A

In-situ formation of antigen/antibody complexes following the intradermal injection of an antigen.

Type III hypersensitivity

59
Q

Benzodiazepines antidote

A

Flumazenil

60
Q

Beta blockers antidotes

A

Atropine
Glucagon
Insulin

61
Q

Ethylene glycol / methanol antidotes

A

Ethanol
Fomepizole

62
Q

Heparin antidote

A

Protamine sulphate

63
Q

Isoniazid antidote

A

Pyridoxine

64
Q

Organophosphates antidotes

A

Atropine
Pralidoxime

65
Q

Sulphonylureas antidotes

A

Glucose
Octreotide

66
Q

Thallium antidote

A

Prussian blue

67
Q

The most common ECG change seen in TCA overdose

A

Sinus tachycardia

68
Q

Normal serum osmolality

A

between 275 and 295 milliosmoles per kilogram (mOsm/kg)

69
Q

Foxglove causes what type of toxicity?

70
Q

MOA of TCAs (5)

A

Anticholinergic effects
Direct alpha-adrenergic blockade
Blockade of noradrenaline reuptake at the preganglionic synapse
Blockade of sodium channels
Blockade of potassium channels

71
Q

Normal anion gap

72
Q

Causes of type A lactic acidosis

A

All to do with resp / cardiac

Shock (including septic shock)
Left ventricular failure
Severe anaemia
Asphyxia
Cardiac arrest
CO poisoning
Respiratory failure
Severe asthma and COPD
Regional hypoperfusion

73
Q

Causes of type B lactic acidosis

A

Renal failure
Liver failure
Sepsis (non-hypoxic sepsis)
Thiamine deficiency
Alcoholic ketoacidosis
Diabetic ketoacidosis
Cyanide poisoning
Methanol poisoning
Biguanide poisoning

74
Q

Which supplement should people taking warfarin avoid? (2)

A

Omega 3

St. John’s wort

75
Q

Flumazenil dosing

A

The dose is 200 μg every 1-2 minutes (max dose 3mg/hour)

76
Q

Arthus reaction

A

In-situ formation of antigen/antibody complexes following the intradermal injection of an antigen. They are rarely reported following vaccination and can occur after tetanus toxoid-containing ort diphtheria toxoid-containing vaccines. They are an example of a type III hypersensitivity reaction.

77
Q

Examples of enzyme-inducing anticonvulsants include:

A

Carbamazepine
Phenytoin
Phenobarbitol
Topiramate

78
Q

Anti epileptic associated with gum hypertrophy

79
Q

Drugs that cause gynaecomastia include:

A

Cimetidine
Omeprazole
Spironolactone
Digoxin
Furosemide
Finasteride
Some anti-psychotics.

MRCEM INTERMEDIATE (19 decks)

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