Toxicology & Poisoning Flashcards
Top drugs of abuse?
- Analgesics
- GHB
- Lithium
- Antidepressants/Antipsychotics
- Alcohol
- Chemicals
- Pesticides
Approach to managing poisoning?
- History & examination
- ABG - Anion gap + Osmolar gap
- ECG
- Immunoassay (poorly specific)
- Chromatography (very specific)
Treatment TCA?
- ABCD
- Sodium bicarbonate (if QRS > 100 ms)
- Benzodiazepines (agitation or seizure)
- Activated charcoal
Drugs to avoid with TCA poisoning?
- Physiostigmine
- Flumazenil
- Class 1A (e.g - Procainamide)
- Class 1C (e.g - Flecainide)
Symptoms of antocholinergic poisoning?
- Dry mouth and skin
- Mydriasis
- Tachycardia
- Psychosis
- No bowel sounds
- Urinary retention
Symptoms of cholinergic toxidrome?
- Salivation
- Lacrimation
- Diarrhoea
- Emesis
- Sweating,
- Miosis
- Bradycardia
Drugs with anticholinergic effects?
- Antihistamines
- Atropine
- TCA
Drugs with cholinergic effects?
- Organophosphate
- Carbamate
Sedatives, hypnotics and opiates causes the follwoing toxidromes?
- Confusion
- Depressed mental status
- Slurred speech
- Respiratory depression
- Bradycardia
- Miosis
Beta or alpha adrenergic toxidromes?
- Tachycardia
- Hypertension
- Sweating
- Agitation
- Mydriasis
Drugs causing beta & alpha adrenergic toxidromes?
- Amphetamines
- Cocaine
- Phencyclidine
Beta-blocker toxidromes?
- Metoprolol
- Bisoprolol
Typical toxidromes?
- Organophosphate - Fasciculation
- Chloralhydrate - Myoclonus
- TCA, CO, ethanol, phenothiazines, amphetamines, cocaine & withdrawal - Epileptic seizures
Antidote anticholinergic poisoning?
Physiostigmine - Not with TCA
HDRM?
Hot as a hare, dry as a bone, red as a beet and mad as a hatter
Antodotes for cholinergics ?
- Atropine
- Pralidoxime for organophsophate
Treatment alpha adrenergic toxidrome?
Phentolamine
Nitroprusside
Management sedatives and hypnotics?
Naloxone
Flumazenil
Urinary alkalinization for phenobarbital
Management of extrapyramidal effects?
Diperidene
Paracetamol and cyanide treatment?
Acetylcysteine
Thiosulphate, Amyl nitrite and hydroxycobalamine
Ricin - Found in castor beans?
- Ribosome inhibiting protein
- Symptoms < 2 hours
- Abdominal pain, vomiting, diarrhoea, MOF, bleeding
Novichok?
- Acetylcholinesterase inhibitor - Cholinergic symptoms