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US Pediatric Boards Edited > toxins/pharmacology > Flashcards

toxins/pharmacology Flashcards

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1
Q

What 4 toxins are not removed with charcoal?

A

CALM = cyanide, alcohol, lithium and heavy metals

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2
Q

A 3 y/o swallowed a battery 3 days ago. He is asymptomatic. What do you do?

A

Endoscopy. If in the esophagus or stomach it must be removed

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3
Q

When should swallowed coins be removed?

A

If proximal esophagus - endoscopy ASAP!

If middle to lower esophagus, observe 24 hours if asymptomatic and if does not pass then endoscopy needed

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4
Q

What are 3 initial manifestations of Tylenol toxicity?

A

Anorexia, nausea and vomiting

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5
Q

How long is the latent phase of acetaminophen toxicity?

A

1-4 days with significant rise of liver enzymes

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6
Q

What are the important 4hr post Tylenol ingestion levels to remember?

A 
>150 = moderate toxicity
>300 = severe toxicity
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7
Q

Female ingested Tylenol 2 days ago. Acetaminophen level 4 hr post ingestion was 250 and she was treated with N acetylcysteine. Today LFTs are normal. What is her prognosis?

A

LFTs can be normal until 4 days after ingestion even after severe overdose! Pt is still in danger…

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8
Q

What is the initial management of acetaminophen ingestion ?

A

Charcoal then 4 hour post ingestion level

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9
Q

If >150mg/kg has been ingested, what should you do?

A

Immediately give N acetylcysteine, even before obtaining post ingestion levels

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10
Q

If a patient had wintergreen odor on breath, what should you be concerned about?

A

Aspirin ingestion

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11
Q

What is the initial treatment of salicylate ingestion?

A

Charcoal then 3-6hr post ingestion level

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12
Q

How do you manage ibuprofen ingestion ? What should you NOT do?

A

Do give supportive care and test for co-ingestion of aspirin or Tylenol
Do not give ipecac or gastric lavage,

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13
Q

What occurs physiologically after aspirin ingestion?

A

Respiratory alkalosis due to increased breathing –> buildup of organic acids and anion gap metabolic acidosis

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14
Q

What is the formula for anion gap?

A

Na - (Cl + bicarb)

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15
Q

What is the treatment for anion gap metabolic acidosis secondary to aspirin ingestion and why?

A

Sodium bicarb to alkalinize the urine

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16
Q

Which ingestion is associated with hypoglycemia ?

A

Ethyl alcohol

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17
Q

At what blood alcohol level can coma, respiratory depression and death occur?

A

> 0.4

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18
Q

What products contain methanol?

A

Rubbing alcohol, Windshield washer fluid, cooking fuel, perfumes and antifreeze

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19
Q

Clinical presentation of methanol ingestion …

A

Acidosis, increased anion gap and CNS depression

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20
Q

What is the antidote to methanol toxicity and why?

A

4-methypyrazole or ethanol –> alcohol dehydrogenase antagonist which slows conversion to formaldehyde

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21
Q

What are the classic symptoms of opiate toxicity?

A

Responsive to painful stimuli
Pinpoint but reactive pupils
Respiratory depression
Bradycardia, hypotension and low temperature

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22
Q

How can you differentiate opioid toxicity from dka?

A

Dka has rapid deep breathing with no miotic pupils

Opiates cause shallow breathing with miotic pupils

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23
Q

How can you differentiate opioid toxicity from organophosphate poisoning?

A

Both have pinpoint pupils but only organophosphate shave sweating, tearing and wheezing

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24
Q

What toxicity would be suspected in a person with dilated pupils and violent behavior?

A

Pcp

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25
Q

What is propoxyphene and what can it cause ?

A

Narcotic analgesic that can cause ventricular arrhythmia, seizures and pulmonary edema

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26
Q

What is the mechanism of action of organophosphates?

A

Acetylcholinesterase inhibitor

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27
Q

What are the classic signs of organophosphate poisoning?

A

DUMBBELS = diarrhea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, salivation

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28
Q

What are the muscarinic effects of cholinergics and how are they treated?

A

Bronchospasm and increase pulmonary secretions - give atropine

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29
Q

What are the nicotinic effects of cholinergics and how are they treated?

A

Neuromuscular effects / treat with pralidoxime

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30
Q

What are the life threatening signs associated with TCA ingestion and when does this occur?

A

Dysthymia and hypertension occurs within 24 hours

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31
Q

What medications classically are known to have anticholinergic side effects?

A

Tricyclics, pupil dilator agents and antispasmodics

32
Q

What are the anticholinergic signs?

A 
Blind as a bat (dilated pupils)
Red as a beet
Hot as a hare
Dry as a bone
Mad as a hatter
Bowel and bladder lose their tone
Heart runs alone
33
Q

How do you manage TCA ingestion?

A

Charcoal
alkalinization of urine
EKG monitoring for wide QRS

34
Q

How do you treat a widening QRS after TCA poisoning?

A

Sodium bicarb boluses until QRS <100 msec

35
Q

What are symptoms of beta blocker ingestion?

A

Depressed sensorium, bradycardia, hypotension and diaphoresis

36
Q

What types of testing is invalid if a patient is taking TCAs and why?

A

TCAs render allergy testing unreliable because they interfere with histamine response

37
Q

What occurs on labs and imaging after hydrocarbon ingestion?

A

Hypoxemia and ARDS (diffuse bilateral infiltrates on cxr)

38
Q

How do you treat an asymptomatic patient after hydrocarbon ingestion?

A

Observation x 6 hours with pulse oximetry.

39
Q

What ingestion should you consider in a patient with confusion and weakness but no fever?

A

Carbon monoxide

40
Q

You are presented with a patient who is lethargic, confused and in distress. Vitals are normal. What is the best treatment?

A

100% oxygen

41
Q

If suspected carbon monoxide poisoning but no improvement of symptoms despite 100% oxygen what should you consider?

A

Cyanide poisoning

42
Q

What are 3 options for treatment of cyanide poisoning ?

A

Hydroxocobalamin
Sodium thiosulfate
Nitrate

43
Q

When do you consider hyperbaric treatment after carbon monoxide toxicity?

A

Pregnancy, acidosis, cardiac involvement or neurological involvement

44
Q

What might have been ingested in a patient that appears drunk with oxalate crystals on urinalysis?

A

Ethylene glycol

45
Q

What is seen in the first phase of ethylene glycol toxicity?

A

Nausea, tachycardia, hypertension, metabolic acidosis and calcium oxalate crystals with hypocalcemia

46
Q

What is the cause of coma or cardio respiratory failure during phase 2 of ethylene glycol toxicity?

A

Large anion gap acidosis and hypocalcemia

47
Q

What occurs in phase 3 of ethylene glycol toxicity and how is it treated?

A

Acute tubular necrosis with renal failure requiring dialysis

48
Q

At what level is iron ingestion considered toxic?

A

40 mg/kg of elemental iron

49
Q

What lab findings are consistent with iron toxicity?

A 
4hour post ingestion level > 350
WBC >15
Glucose> 150
Elevated LFTs
Metabolic acidosis
50
Q

What are 4 major multisystem effects of iron ingestion?

A

Metabolic acidosis
Coagulopathy
Cardiovascular collapse
GI obstruction

51
Q

What is the appropriate treatment for significant iron toxicity? What is not used for iron toxicity?

A

Defuroxamine chelation

Not charcoal as poor absorption

52
Q

What are indications for iron chelation therapy?

A

Anion gap acidosis
Iron >500
Significant number of pills seen on KUB

53
Q

When can deferoxamine treatment be stopped?

A

When clinical improvement and urine no longer pink

54
Q

What are classic presenting signs on a patient following ingestion of caustic substance?

A

Coughing, drooling, difficulty swallowing and chest pain

55
Q

What is the initial management for suspected caustic substance ingestion?

A

Endoscopy within 48 hours

56
Q

What is recommended for treatment of alkali ingestion?

A

Observation 6 hours
Endoscopy if symptoms
No activated charcoal as will inhibit endoscopic exam

57
Q

What are PCBs and what can they cause?

A

Synthetic hydrocarbons that cause Pigmentation/rash, Cutting teeth early and Birthweight that is low

58
Q

How can you differentiate varicella vs smallpox lesions?

A

Smallpox - starts in face and extremities with lesions in same stage.
Chicken pox - starts centrally and spreads with lesions in varying stages.

59
Q

What is a lesion that starts as an itchy papule that becomes bullous w central necrosis that is black and painless?

A

Cutaneous anthrax

60
Q

What 5 medications are affected with use of St. John’s wort and why?

A 
OCPs
Iron
Digoxin
Anticoagulants
Antiretroviral drugs 
*induction of P450 increases drug elimination
61
Q

How is echinacea believed to act? When is it contraindicated?

A

Acts by modulating cellular immunity

Contraindicated in patients on immunosuppressants

62
Q

What 5 drugs can interact with ginseng?

A 
Anticoagulants
Anti platelets
Steroids 
Hypoglycemic medications
Diuretics
63
Q

When should valerian root not be used?

A

In patients using alcohol or other sedating drugs

64
Q

Isotretinoin and griseofulvin should be taken with what types of foods?

A

Fatty foods (the drugs are lipophilic)

65
Q

Which 3 medications should not be taken with dairy products ?

A

Tetracycline
Doxycycline
Ciprofloxacin

66
Q

When is steady state of a drug achieved?

A

After 4-5 half lives

67
Q

What 4 drugs cause inhibitory effects on hepatic enzymes and thus increased toxicity of many drugs?

A

Erythromycin
Ciprofloxacin
Cimetidine
Omeprazole

68
Q

What 4 medications are considered potent enzymatic inducers which decrease the levels of many other medications ?

A

rifampin
Phenobarbital
Carbamazepine
Phenytoin

69
Q

What 2 drugs decrease bioavailability of calcium, iron and magnesium?

A

Cephalosporins and fluoroquinolones

70
Q

What two drugs inhibit renal metabolism of digoxin and lead to toxicity?

A

Quinidine and amiodarone

71
Q

What is the appropriate medication to give for a patient with adrenal insufficiency who requires stress dosing?

A

IV hydrocortisone

72
Q

What are 4 major side effects of beta blockers ?

A

Sexual dysfunction
Insomnia
Bronchospasm
Bradycardia

73
Q

What type of drug is acetazolamide and how does it work?

A

Carbonic anhydrase inhibitor

Blocks teuptake of bicarb causing metabolic acidosis and alkaline urine

74
Q

What are two major side effects of LASIX use?

A

Ototoxicity

Renal toxicity

75
Q

What is the mechanism of action of loop diuretics and what electrolyte changes are seen?

A

Block absorption of Na and Cl
Wasting of Ca, K and H
Hypochloremic hypokalemic alkalosis

76
Q

What is the appropriate dosing of activated charcoal?

A

0.5-1 g/kg (max 100g)

US Pediatric Boards Edited (23 decks)

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