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CEN prep 2021 > Toxicology + poisoning > Flashcards

Toxicology + poisoning Flashcards

1
Q

True or false

organophosphates aggressively bind to cholinesterase molecules, stimulating their effect

A

false, they bind to cholinesterase molecules, inhibiting their effects and leaving acetylcholine unopposed in the neural synapses.

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2
Q

a disease condition caused by the absorption of metabolic or bacterial poisons

A

Toxicosis

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3
Q

Patient assessment for toxicosis can include (7)

A

If possible, access the bottle or container
Determine the medications that patient normally takes
Determine the time of exposure
Exposure acute or chronic
Determine if symptoms are related to the substance
Determine any prior treatment that was taken at home
Was the exposure intensional

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4
Q

constellations of S/S that suggest a specific type of poisoning is generally called what

A

Toxidrome

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5
Q

Cholinergic; symptoms of this toxidrome can be remembered with the acronyms

A

SLUDGE
DUMBELS
MTWT(H)FE

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6
Q

Symptoms of this toxidrome include hypoventilation, hypotension, and miosis

A

opioid

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7
Q

symptoms of this toxidrome include tachycardia, hyperthermia, and mydriasis

A

Anticholinergic

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8
Q

what is the rhyme for anticholinergic toxidrome?

A

Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter, the bowel and bladder lose their tone and the heart goes alone

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9
Q

Sedative/ Hypnotic; common causes of this toxidrome include

A

benzodiazepines, barbiturates, and ethanol

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10
Q

Sympathomimetic; common causes of this toxidrome include

A

amphetamines, cocaine, marijuana, and MDMA (ecstasy)

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11
Q

Toxicology screens or panels for drugs of abuse usually detect
(8)

A 
Amphetamines 
Barbiturates 
Benzodiazepines 
Cocaine 
Ethanol
Marijuana 
Opiates 
Phencyclidine (PCP)
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12
Q

general interventions for toxicological emergencies include what
(5)

A

Gastrointestinal Decontamination, External decontamination, Syrup of Ipecac, Gastric Lavage, Activated Charcoal

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13
Q

describe Gastric Lavage

A

has a limited benefit and is no longer used routinely. May be considered if the patient has taken a massive overdose or when the procedure can begin within 30 to 60 minutes of ingestion. Cannot be used to ingest large pills.
May be beneficial in patients who cannot absorb activated charcoal
Are known to produce significant morbidity.
Lavage must be in done with the patient lying on the left side

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14
Q

describe Gastrointestinal Decontamination

A

accomplished through gastric lavage, the administration of charcoal or binding agents, and whole bowel irrigation

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15
Q

describe External decontamination;

A

is accomplished through dermal or ocular decontamination

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16
Q

what is Syrup of Ipecac? -

A

once a mainstay of therapy in poisoned patients in the ED and at home, but no longer recommended.
No longer recommended because it causes protracted vomiting, is implemented in Mallory-Weiss Tears and electrolyte imbalances, and delays activated charcoal administration

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17
Q

Activated Charcoal, give 5 details

A
  • The preferred means of gastrointestinal Decontamination
  • Binds with chemicals and trap them before being absorbed
  • Best done without gastric emptying
  • May be used if the toxin cannot be identified
  • To be used as soon as possible after ingestion, most effective if within 60 minutes, especially if toxin is a sustained release medication
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18
Q

activated charcoal Adverse effects include

4

A

Abdominal distension
Risk of aspiration
Constipation, particularly with anticholinergic toxicity
Nausea and vomiting

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19
Q

Contraindications for activated charcoal include

A

Bowel Obstruction or perforation

CNS depression or seizures, unless the patient is intubated

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20
Q

Substances that are poorly absorbed by charcoal include

A

Acids, alkalis, cyanide, ethanol, ethylene glycol, fluoride, iron, lead, lithium, mercury, methanol, mineral acids or salts, organic solvents, potassium, zinc
Small molecules and elements

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21
Q

Indications for repeat does activated charcoal include ingestion of

A

Theophylline, Phenobarbital, Dapsone, Quinine, carbamazepine

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22
Q

gastric lavage must be done with the patient in what position?

A

Lavage must be in done with the patient lying on the left side

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23
Q

Other binding agents: this reduces the serum iron level

A

Milk of magnesia

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24
Q

Other binding agents: this has been effective at limiting the serum lithium level

A

Sodium polystyrene sulfonate (Kayexalate)

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25
Q

what is another name for Sodium polystyrene sulfonate

A

Kayexalate

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26
Q

The SLUDGE acronym stands for what?

A

Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Distress and Emesis

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27
Q

The DUMBELS acronym stands for what?

What toxidrome does it refer to?

A

An acronym used to remember the common symptoms of certain affections of a cholinergic toxidrome: (“diaphoresis/diarrhea, urination, miosis, bronchospasm/bradycardia/bronchorrhea, emesis, lacrimation, salivation”).

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28
Q

Opioid; Symptoms of this toxidrome include (3)

A

hypoventilation, hypotension, and miosis

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29
Q

Anticholinergic; symptoms of this toxidrome include (3)

What is the lyric that describes this toxidrome?

A

tachycardia, hyperthermia, and mydriasis
Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter, the bowel and bladder lose their tone and the heart goes alone

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30
Q

Sedative/ Hypnotic; common causes of this toxidrome include these (3)

A

benzodiazepines, barbiturates, and ethanol

31
Q

Sympathomimetic; common causes of this toxidrome include (4)

A

amphetamines, cocaine, marijuana, and MDMA (ecstasy)

32
Q

Toxicology screens or panels for drugs of abuse usually detect (8)

A 
Amphetamines 
Barbiturates 
Benzodiazepines 
Cocaine 
Ethanol
Marijuana 
Opiates 
Phencyclidine (PCP)
33
Q

Gastrointestinal Decontamination - is accomplished through these three interventions

A

gastric lavage, the administration of charcoal or binding agents, and whole bowel irrigation

34
Q

Syrup of Ipecac - what is it and why is it no loner used?

A

once a mainstay of therapy in poisoned patients in the ED and at home, but no longer recommended.
No longer recommended because it causes protracted vomiting, is implemented in Mallory-Weiss Tears and electrolyte imbalances, and delays activated charcoal administration

35
Q 
Gastric Lavage - 
Is it still used?
Who might benefit from it?
In what timeframe should it be done?
How should the patient be positioned?
A

has a limited benefit and is no longer used routinely. May be considered if the patient has taken a massive overdose or when the procedure can begin within 30 to 60 minutes of ingestion. Cannot be used to ingest large pills.
May be beneficial in patients who cannot absorb activated charcoal
Are known to produce significant morbidity.
Lavage must be in done with the patient lying on the left side

36
Q

Activated Charcoal
The preferred means of ____ ____.
Binds with chemicals and trap them before being ____.
Best done without gastric emptying.
May be used if the toxin cannot be ____.
To be used as soon as possible after ingestion, most effective if within __ minutes, especially if toxin is a sustained release medication

A

gastrointestinal Decontamination
absorbed
identified
60

37
Q

Adverse effects of Activated Charcoal include

4

A

Abdominal distension
Risk of aspiration
Constipation, particularly with anticholinergic toxicity
Nausea and vomiting

38
Q

Contraindications of Activated Charcoal include

4

A

Bowel Obstruction or perforation

CNS depression or seizures, unless the patient is intubated

39
Q

Procedure for administration of Activated Charcoal includes

A

Measure the dose, mix with water and shake vigorously, give the mixture orally or with a gastric tube

40
Q

Substances that are poorly absorbed by Activated Charcoal include
(18) answers but generally what?

A

Acids, alkalis, cyanide, ethanol, ethylene glycol, fluoride, iron, lead, lithium, mercury, methanol, mineral acids or salts, organic solvents, potassium, zinc
Small molecules and elements

41
Q

Indications for repeat dose activated charcoal include ingestion of

A

Theophylline, Phenobarbital, Dapsone, Quinine, carbamazepine

42
Q

Whole Bowel Irrigation entails the administration of an ____ ____ ____ (PEG) solution, such as ____, or ____, orally or through ____ ____ to remove the poison from the gastrointestinal tract as quickly as possible by ____ expulsion. Because ____ ____ is minimally absorbed, it is not likely to produce fluid and electrolyte imbalances.

A 
Isotonic Polyethylene Glycol
GoLYTELY
Colyte
gastric tube
rectal
polyethylene glycol
43
Q

indications for the administration of an Isotonic Polyethylene Glycol (PEG) solution, such as GoLYTELY, or Colyte include (3)

A

Ingestion of drugs that are not well bound to charcoal
Sustained release or enteric coated drugs
Toxic solid objects, such as balloons or condoms filled with cocaine or heroin

44
Q

contraindications for the administration of an Isotonic Polyethylene Glycol (PEG) solution, such as GoLYTELY, or Colyte include (6)

A 
Bowel obstruction
Ileus
Gastrointestinal hemorrhage
Absent gag reflex unless intubated 
Compromised airway 
Hemodynamically unstable
45
Q

Procedure for the administration of an Isotonic Polyethylene Glycol (PEG) solution, such as GoLYTELY, or Colyte include

A

Protect the patients airway
Insert a gastric tube if the patient will not or cannot drink the prescribed amount of solution
Administer 1 to 2 L per hour for an adult, half that for pediatric, orally through a gastric tube until the rectal effluent is clear or the FB has passed

46
Q

Dermal Decontamination
When is it indicated?
Why should you not use a neutralizing agent?
When is it contraindicated?

A

Indicated when the skin has been exposed to toxic substances
Do not use a neutralizing agent because it may cause an exothermic reaction that produces heat
Contraindicated in exposure that might react with water, such as phosphorus. Consult the poison control center or a hazardous materials professional if you have questions about the substance.

47
Q 
Dermal Decontamination 
what is the first thing you do? 
What is the second thin you do? 
Brush away \_\_\_ substances
Rinse all areas of contact and skin folds with copious water for \_\_ to \_\_ minutes. 
What is the last thing you do?
A 
Don PPE
Remove clothing from the patient 
Dry
20 to 30
Properly dispose of contaminated clothing
48
Q

Ocular Decontamination
Flush with ___ or ____ ____ solution for __ to __ minutes, until a pH of __ is achieved. This is tested through the use what?

A

NSS or lactated ringers
20 to 30
7
of a pH strip by touching the lower eyelid gently with the strip

49
Q

Enhancing Elimination
After taking steps to eliminate absorption, the next priority in managing a toxicologic emergency is the enhancing of the elimination of the absorbed toxins.
What are 5 procedures you can do?

A 
Repeat dose of charcoal
Urine alkalinization 
Hemodialysis
Charcoal hemoperfusion
Continuous hemofiltration
50
Q

Urine Alkalinization

Manipulates the pH of urine to enhance the excretion of certain drugs such as (6)

A

Chlorpropamide (glipizide), 2,4-Dichlorophenoxyacetic acid, formate, methotrexate, phenobarbitol, salicylates

51
Q

Urine Alkalinization
Procedure
Administer ____ ____ as prescribed
During treatment, monitor the urine pH how often? Adjust to keep the urine pH between __ and __.
Administer ____, as prescribed, to avoid ____

A 
sodium bicarbonate
hourly
7.5 and 8.0. 
 potassium
hypokalemia
52
Q

Urine Alkalinization
Adverse effects
(6)

A

Hypernatremia, hypokalemia, alkalosis, fluid overload and pulmonary edema, QT prolongation (as shown in the image) and other dysrhythmias resulting from the electrolyte shift

53
Q

Enhancing Elimination
Hemodialysis , Hemoperfusion, and Hemofiltration
All three not only remove the ____ and ____ from the circulation, they also rapidly and effectively correct ____ and ____ imbalances.
Indications include the removal of these substances
(13)

A 
toxins
metabolites
acid-base
electrolyte
Acetaminophen (tylenol), antibiotics, bromide, ethanol, ethylene glycol, isopropanol, lithium, methanol, paraquat, phenobarbitol, salicylates, theophylline, digoxin
54
Q

Enhancing Elimination
Hemodialysis , Hemoperfusion, and Hemofiltration
Reserved for what type of situations?

A

Reserved for poisonings that may be lethal or cause severe acidosis, such as chronic salicylate poisoning

55
Q

Antidote Administration

Acetaminophen (tylenol);

A

N-acetylcysteine (Mucomyst)

56
Q

Antidote Administration

Anticholinergics;

A

Physostigmine (Antilirium)

57
Q

Antidote Administration

Benzodiazepines;

A

Flumazenil (romazicon)

58
Q

Antidote Administration

Beta-blockers;

A

Glucagon (GlucaGen)

59
Q

Antidote Administration

Calcium channel blockers;

A

Glucagon, calcium chloride, calcium gluconate (Calgonate, insulin (Humalog), and glucose

60
Q

Antidote Administration

Carbon monoxide;

A

Oxygen

61
Q

Antidote Administration

Cyanide;

A

amyl nitrite, sodium nitrite, sodium thiosulfate, and hydroxocobalamin

62
Q

Antidote Administration

Digitalis preparations;

A

Digoxin immune FAB (Digibind, DigiFab)

63
Q

Antidote Administration

Ethylene glycol;

A

Fomepizole (Antizol) and ethanol infusion

64
Q

Antidote Administration

Heavy metals;

A

Ethylenediaminetetraacetic acid (EDTA), dimercaprol (BAL in oil) and penicillamine (Depen)

65
Q

Antidote Administration

Heparin;

A

Protamine Sulfate

66
Q

Antidote Administration

Iron (Fesol); Deferoxamine (Desferal)

A

Deferoxamine (Desferal)

67
Q

Antidote Administration

Isoniazid (INH);

A

Pyridoxine (vitamin B8)

68
Q

Antidote Administration

Methanol;

A

Deferoxamine, fomepizole, and ethanol infusion

69
Q

Antidote Administration

Nitrates (ie; Nitrostat);

A

Methylene Blue

70
Q

Antidote Administration

Opiates;

A

Naloxone (Narcan)

71
Q

Antidote Administration
Atropine and pralidoxime (2-PAM)
Organophosphates;

A

Atropine and pralidoxime (2-PAM)

72
Q

Antidote Administration

Sulfonylureas;

A

Octreotide (Sandostatin)

73
Q

Antidote Administration

Tricyclic antidepressants;

A

Sodium Bicarbonate

74
Q

Antidote Administration

Warfarin (Coumadin);

A

Phytonadione (vitamin K)

CEN prep 2021 (36 decks)

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