Toxicology: Treatments [according to Master the Boards] Flashcards
When would you use Gastrointestinal Emptying and when not?
Gastric lavage may occasionally be useful in the first hour of ingestion. NOT in: Altered mental status: Caustic ingestion Acetaminophen overdose
When would you use Ipecac and when not?
there is no benefit in
using ipecac in the hospital
When would you use Cathartics and when not?
Cathartic agents such as sorbitol are always a wrong answer.
When would you use Forced Diuresis
and when not?
always a wrong
answer.
What kind of solution is used to do a Whole Bowel Irrigation?
polyethylene glycol electrolyte
solution (GoLYTELY)
When would you use Whole Bowel Irrigation
and when not?
almost always wrong.
Indications:
- massive iron ingestion,
- lithium, and
- swallowing drug-filled packets (e.g., smuggling)
The best initial management of altered mental status of
unclear etiology is____________?
an opiate antagonist and glucose-
Naloxone and dextrose.
___________ reverses
benzodiazepines, but can cause ______ from instant withdrawal
Flumazenil reverses
benzodiazepines, but can cause seizures from instant withdrawal.
Ojo: una parte del libro dice “don’t give FMZ”
Psychiatric consultation is indicated when ___________
the/an overdose is from a
suicide attempt,
BUT Psychiatric consultation is a wrong answer, WHEN___
specific antidotes and diagnostic tests are needed.
When would you use Charcoal and when not?
should be given to anyone with a pill overdose.
it is not dangerous in
anyone.
Acetaminophen overdose Treatment is
If a clearly toxic amount of acetaminophen has been ingested (more than 8–10 grams), the answer is N-acetylcysteine.
Acetaminophen overdose (passed 24hs)
there is no therapy.
Acetaminophen overdose w. unclear amount of ingestion
get a drug level.
Aspirin Overdose Treatment is
alkalinizing the urine, which increases the rate of aspirin
excretion
Treatment of TCA overdose
is with sodium bicarbonate. which protects the heart
Caustics
Use water in high volumes. Endoscopy is
performed to assess the degree of damage.
Carbon Monoxide Poisoning
100% oxygen,
Severe disease is treated with hyperbaric
oxygen.
Methemoglobinemia
The best initial therapy is
100% oxygen.
Methemoglobinemia.
The most effective therapy is
methylene blue, which decreases the half-life of
methemoglobin.
Methemoglobinemia. most
accurate test is
methemoglobin level.
Organophosphate (Insecticide) Poisoning and Nerve Gas.
Initial treatment and Especific.
Pralidoxime is the specific antidote for organophosphates.
Pralidoxime reactivates acetylcholinesterase. BUT It does not work as
instantaneously as atropine.
Digoxin Toxicity
- Control potassium
- give digoxin-specific antibodies when CNS and
cardiac involvement.
Lead Poisoning most accurate test is
lead level
Lead Poisoning best initial diagnostic test is
increased
level of free erythrocyte protoporphyrin
Lead Poisoning Treatment
Chelating agents:
Succimer (oral)
Ethylenediaminetetraacetic acid (EDTA) and dimercaprol
(BAL) [parenteral]
Mercury Poisoning
Chelating agents such as dimercaprol and
succimer are effective
Toxic Alcohols: Methanol and Ethylene Glycol
fomepizole and dialysis.
Snake Bites
Pressure
Immobilization decreases movement of
venom
Antivenin
Black widow Spider Bites
Calcium, antivenin
Brown recluse Spider Bites
Debridement, steroids,
dapsone
Dog, Cat, and Human Bites
- Amoxicillin/clavulanate
- Tetanus vaccination booster if more than 5 years since last injection
