autonomic and toxicity

Question 1

definition of the autonomic nervous sys

Answer 1

innervates, smooth and cardiac muscle, glandular tissue and governs involuntary actions such as secretion, vasconstriction, peristalsis

Question 2

what functions does the parasym. have

Answer 2

flow of saliva, constricts the bronchi, peristalsis and secretion, release of bile, contracts the bladder.

Question 3

what functions are the sympathetic responsible for

Answer 3

dialtes pupils, inhibits saliva, accelerates HR, dilates the bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, adrenaline and norepi secretion, inhibits bladder contraction

Question 4

which has longer preganglionic nerves

Answer 4

parasym

Question 5

what is the mediator for neurotransmission for the parasym

Answer 5

ach

Question 6

where is the sympathetic outflow located>

Answer 6

the entire thoracic region of the spinal cord,

Question 7

where is the parasym outflow located

Answer 7

the brain and the sacral region

Question 8

what are the two main classes of pupil dilators

Answer 8

sympathomimetics and anticholinergics

Question 9

name some of the sympathomimetic pupil dilators

Answer 9

cocaine, amphetamines, methylphenidate

Question 10

name some of the anticholinergic pupil dilators

Answer 10

TCA, antihistamines, alcohols

Question 11

name some of the miotics

Answer 11

opioids, sedative-hypnotics, cholinergics (insecticides), phencyclidine, sympatholytics (clonidine, tetrahydrazoline)

Question 12

what causes salivation

Answer 12

cholinergic (insecticide)

Question 13

what innervates the sweat glands

Answer 13

sympathetics.

Question 14

where are the apocrine glands located

Answer 14

in the axilla and anal area

Question 15

where are the eccrine glands located

Answer 15

most numerous, palms, soles, forehead. they produce sweat that is free of proteins and fatty acids.

Question 16

what causes the skin to become red and flush

Answer 16

anticholinergics, disulfiram, boric acid, MSG, rifampin, carbon monoxide.

Question 17

what causes the skin to become pale and diaphoretic

Answer 17

sympathomimetics, cholinergics, LSD, PCP, arsenic, ASA.

Question 18

what is the mechanism for cocaine

Answer 18

inhibition of catecholamine reuptake and CNS stimulation

Question 19

what is the classic presentation for cocaine

Answer 19

euphoria followed by anxiety, agitation, psychosis, muscle rigidity, hyperactivity. seizures are usually brief and self-limited.

Question 20

what are two associated issues with cocaine

Answer 20

pneumothorax and pneumomediastinum

Question 21

where would a pediatric patient come in contact with cocaine

Answer 21

breast milk, secondary exposure, placental transfer.

Question 22

what are some amphetamines

Answer 22

methamphetamine, MDA, MDMA,

Question 23

what is phenylpropanolamine

Answer 23

decreased circulation non catecholamine sympathetic amine, indirect alpha adrenergic stimulator, releases peripheral norepinephrine

Question 24

what is the classic anticholinergic syndrome

Answer 24

warm-dry-flushed skin (red as a beat), dry mouth, mydriasis, tachycardia, ileus, delirium.

Question 25

what drugs cause anticholinergic syndrome

Answer 25

antihistamines, antipsychotics, antispasmotics, muscle relaxants, tricyclics

Question 26

what is antihistamine OD and what is the presentation

Answer 26

therapeutic H1 receptor antagonist. mimics anticholinergic poisoning. children are more sensitive than adults.

Question 27

treatment for anticholinergic syndroem

Answer 27

most just need supportive care. charcoal or lavage. physostigmine only indicated for coma, delirium, unstable vitals.

Question 28

where do we get organophosphates

Answer 28

farms, homes, pesticides, industry. rapidly absorbed through the skin, inhaled.

Question 29

mechanism of organophosphate toxicity

Answer 29

inactivates acetylcholinesterase. promotes accumulation of Ach in the cleft of all synapse.

Question 30

muscarinic effects of organophosphates

Answer 30

vomit, diarrhea, abdominal cramping, miosis, bronchospasm, bradycardia. excessive salivation and sweating. remember SLUD -salivation, lacrimation, urination, defecation.

Question 31

nicotinic effects of organophosphates

Answer 31

muscle fasciculations, tremor, weakness, death is caused by respiratory collapse. agitation, seizures, coma.

Question 32

what is the treatment for organophosphates

Answer 32

ABC and atropine, pralidoxime

Question 33

what are the possible causes of methemaglobinemia

Answer 33

nitrates (amyl nitrate, nitroglycerin, infectious diarrhea), benzocaine/lidocaine, quinone, sulfonamides, napthalene

Question 34

what is the treatment for metHb

Answer 34

remove offending agents and give supplemental O2. if levels> 30 give methylene blue

Question 35

when is methylene blue contraindicated

Answer 35

when there is G6PD deficiency