Toxins and Antidotes

Question 1

Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Doxepin, Imipramine)

Answer 1

Sodium Bicarbonate

Question 2

Amphetamines (Dextroamphetamine - Adderall, Amphetamine, Lisdexamphetamine - Vyvanse)

Answer 2

Ammonium Chloride

Question 3

Opioids (Morphine, Heroin, Codeine, Hydrocone, Fentanyl)

Answer 3

Naloxone, Naltrexone

Question 4

Benzodiazepines

Answer 4

Flumazenil

Question 5

Beta Blockers

Answer 5

Glucagon

Question 6

Theophylline (inhaler)

Answer 6

Beta Blockers

Question 7

Digitalis (for CHF)

Answer 7

Digibind

Question 8

Methemoglobin
-Can be from:
–Anti-malarials
–Acetaminophen
–Sulfonamides

Answer 8

Methylene blue, Vitamin C

Question 9

tPA, Streptokinase
–both used to dissolve blood clots
–thrombolytics

Answer 9

Aminocaproic acid

Question 10

Warfarin

Answer 10

Vitamin K and fresh frozen plasma

Question 11

Heparin

Answer 11

Protamine Sulfate

Question 12

Ethylene Glycol (Antifreeze)

Answer 12

IV ethanol infusion OR Fomepizole

Question 13

Acetaminophen
-Exam Findings
-Antidotes/Mgmt

Answer 13

-Exam: hepatic necrosis, n/v, diaphoresis, RUQ pain, jaundice, coagulation abnormalities

-Antidote: N-acetylcysteine or activated charcoal

Question 14

Salicylates (Aspirin, Pepto Bismol, Ben Gay)
-Exam Findings
-Antidotes/Treatment

Answer 14

-Exam: respiratory alkalosis –> high anion gap metabolic acidosis later, fever, seizures, coma, renal failure

-Antidote/Treatment: Resuscitation, IVF, Activated charcoal, sodium bicarbonate to alkalinize

Question 15

Bases (Oven Cleaner, Drain Cleaner, Bleach)
-Exam Findings
-Treatment/Antidote

Answer 15

-Exam: esophageal or gastric perforation, respiratory distress, irritated mucus membranes

-Treatment: supportive, emesis prevention, H20/milk as diluent, DO NOT DO gastric lavage!!!

Question 16

Hydrocarbons (Gasoline, Benzene, Petroleum, Kerosene, Motor Oil)
-Exam Findings
-Treatment

Answer 16

-Exam: aspiration pneumonitis, tachycardia, fever, mucosal irritation, vomiting, bloody diarrhea

-Treatment: supportive, ABX for PNA

Question 17

Anticholinergics (Antihistamines, Atropine, TCA’s)
-Exam Findings
-Treatments

Answer 17

-Exam: Sympathetic Stimulation (hyperthermia - no sweating, tachycardia, hypertension, hot/flushed/dry skin and mucus membranes, mydriasis (dilation)

-Treatment: Physostigmine
–TCA toxicity: Sodium bicarbonate

Question 18

On ECG, what should you expect with TCA overdose?

Answer 18

wide QRS, prolonged QT

Question 19

Cholinergics (Organophosphates, Insecticides, Pesticides, Chlorthion, Sarin gas)
-Exam Findings
-Treatment

Answer 19

-Exam: SLUDD-C (salivation, lacrimation, urination, diarrhea, emesis, miosis
-Nicotinic S/E in Kids: mydriasis, tachycardia, weakness, hypertension, garlic breath in arsenic

-Treatment: Atropine + Pralidoxime, remove contaminated clothes
–Atropine is an anti-cholinergic
–Pralidoxime reactivates cholinesterase enzyme

Question 20

Iron
-Exam Findings
-Treatment

Answer 20

-Exam: GI (nausea, vomiting, abdominal pain, shock, red urine)

-Treatment: Emesis with gastric lavage, Deferoxamine

Question 21

Cyanide

Answer 21

Hydroxocobalamin

-Binds to cyanide to make cyanocobalamin (b12) and is eliminated in the urine

Question 22

Sulfonylureas (Glipizide, Glimepiride, Glyburide)

Answer 22

Octreotide

Question 23

SSRI’s

Answer 23

Cyproheptadine

Question 24

Isoniazid

Answer 24

pyridoxine (vitamin B6)

Question 25

Calcium Channel Blockers

Answer 25

IV calcium, insulin, glucagon

Question 26

Heavy Metals
- Arsenic
- Copper
- Lead
- Mercury

Answer 26

Dimercaprol
EDTA
Penicillamine
Succimer (DMSA)

Question 27

Visual impairment in a patient with a toxic ingestion is highly suggestive of

Answer 27

Methanol posioning

Question 28

An increase in serum osmolality and high anion gap metabolic acidosis is suggestive of poisoning from which substances?

Answer 28

Methanol, Ethylene Glycol, or Isopropanol