9) Toxic Flashcards
(165 cards)
1
Q
antidote?
A
Neutralizes a specific toxin
2
Q
cyanide) primary threat to life in a cyanide ingestion?
A
Cellular asphyxia
3
Q
What should be your primary concern for a patient who ingested drain cleaner?
A
Potential airway compromise
4
Q
Pt ingested fifty 325mg ASA tablets Med Rx
A
Activated charcoal
5
Q
Rx for a narcotic OD n unresponsive patient?
A
2 mg of Naloxone
6
Q
Lithium used to treat?
A
Bipolar disorder
7
Q
Which class of drugs is commonly abused to produce hyperactivity and exhilaration?
A
Amphetamines
8
Q
What are Versed Valium & Ativan examples of?
A
Benzodiazepines
9
Q
What medication is not appropriate for a patient experiencing severe muscle spasms after a black widow spider bite?
A
Sodium bicarbonate
10
Q
Continued use of a drug despite harmful effects?
A
Addiction
11
Q
type of substances cause injury by inducing liquefaction necrosis?
A
Alkalis
12
Q
What should you suspect in a Pt heating their home w/ wood & experiencing flu-like symptoms?
A
Carbon monoxide poisoning
13
Q
med combination is beneficial for a lithium OD
A
Mannitol and Sodium Bicarb
14
Q
Which class of mushrooms is responsible for over 90% of deaths from mushroom toxicity?
A
Amanita
15
Q
S/S would you least expect in a patient who took too many Cardizem tablets?
A
Warm, dry skin and tachycardia.
16
Q
How does a substance enter the body through the gastrointestinal tract?
A
Ingestion
17
Q
What best describes the MOA of activated charcoal?
A
It adsorbs toxins in the stomach
18
Q
How is alcohol classified?
A
CNS Depressant
19
Q
primary goal in prehospital care for a pit viper bite?
A
Slow absorption of the venom
20
Q
Med class would likely cause hypertension after eating cheese and drinking red wine?
A
Monoamine Oxidase Inhibitors
21
Q
What S/S suggest ingestion of Amanita mushrooms?
A
Abdominal cramping, watering eyes, vomiting, diarrhea, and sweating.
22
Q
What reduces the half-life of carboxyhemoglobin to approximately 22 minutes?
A
Hyperbaric oxygen therapy
23
Q
a pharmaceutical agent is used for something other than its intended use?
A
Substance abuse
24
Q
What do copious secretions, lacrimation, vomiting, and evidence of urination and defecation suggest?
A
Cholinergic exposure
25
What statement indicates possible cyanide exposure?
"I have been burning carpets and old furniture all day."
26
What is a highly toxic, odorless, tasteless gas from incomplete combustion?
Carbon monoxide
27
Narcan act as an antagonist to?
Opiate meds; Heroin, Morphine, fentynl
28
most important question to ask a pt who ingested 30 tabs of Lexapro & 24 tablets of Tylenol PM?
"How long ago did you take these medications?"
29
poison def
Any substance that damages body function
30
toxin def
Poisonous substance from bacteria, animals, plants
31
substance abuse def
Misuse of substances for effect
32
overdose def
Toxic dose of a drug
33
routes of poison entry?
Ingestion, inhalation, absorption, injection
34
rx for ingested poisons?
Gastric lavage (within 1hr), activated charcoal (1-2 g/kg)
35
rx for inhaled poisons?
Move PT to fresh air, call HazMat for toxic gases, consider CPAP/advanced airway
36
rx for carbon monoxide poisoning?
100% O2, CPAP, monitor for arrhythmias
37
rx for beta blocker overdose?
Glucagon (3-10 mg IVP, then 3-5 mg/hr infusion)
38
rx for calcium channel blocker overdose?
Calcium chloride (1-2 g IV), glucagon (3-10 mg IVP, then 3-5 mg/hr infusion)
39
S/S of tricyclic antidepressant overdose?
Wide QRS, seizures, tachycardia
40
med Rx for tricyclic antidepressant overdose?
Sodium bicarb
41
SSRI OD serotonin syndrome
Mild: Tachycardia, diaphoresis, mydriasis; Severe: Hypertension, acidosis, seizures
42
SSRI OD Rx
Benzodiazepines, fluids
43
What are the signs and symptoms of opiate overdose?
Respiratory depression, miosis
44
opiate OD Rx
Naloxone (0.4-2 mg IV/IM/IN)
45
What are cholinergic agents associated with?
SLUDGEM/DUMBELS
46
What is the treatment for cholinergic agents?
Atropine + Pralidoxime (DuoDote)
47
What is the treatment for snakebite?
Keep PT calm/supine, no ice/tourniquet, transport ASAP
48
activated charcoal contraindications
Altered mental status, ingestion of caustics, acids, or hydrocarbons, late presentation (>1 hour post-ingestion)
49
What are the late signs of carbon monoxide poisoning?
Cherry-red skin
50
What are the symptoms of chlorine gas exposure?
Pulmonary edema, bronchospasm
51
S/S of beta blocker overdose?
Profound bradycardia, heart blocks, hypoglycemia (especially in pediatrics), mental status depression
52
What advanced treatment is considered for calcium channel blocker overdose?
Consider high-dose insulin euglycemia therapy (HIET), vasopressors (dopamine, norepinephrine) if refractory shock
53
What are the advanced signs and symptoms of tricyclic antidepressant overdose?
QRS >100ms = seizure risk, QRS >160ms = ventricular dysrhythmias, terminal R wave in aVR >3mm = severe toxicity
54
What is the first-line treatment for tricyclic antidepressant overdose?
Sodium Bicarb (1-2 mEq/kg IV push)
55
What are the early signs of serotonin syndrome in SSRI overdose?
Diaphoresis, tremors, tachycardia, mydriasis
56
What are the severe cases of serotonin syndrome in SSRI overdose?
Hyperthermia (>106°F), DIC, multi-organ failure
57
What is the treatment for serotonin syndrome?
Cooling measures, benzodiazepines for agitation, cyproheptadine (serotonin antagonist)
58
What are the signs and symptoms of cyanide poisoning?
Hypoxia with normal SpO2, metabolic acidosis
59
What is the treatment for cyanide poisoning?
Hydroxocobalamin (Cyanokit) - 5g IV over 15 min, sodium thiosulfate if kit unavailable
60
What are the early signs of salicylate poisoning?
Tinnitus, nausea, vomiting
61
What are the late signs of salicylate poisoning?
Metabolic acidosis, respiratory alkalosis, hyperthermia
62
What is the treatment for salicylate poisoning?
Sodium bicarbonate drip (urine alkalinization), hemodialysis for severe toxicity (>100 mg/dL level)
63
What is indicated if acetaminophen level is >150 mcg/mL at 4 hours post-ingestion?
NAC is indicated
64
What is the IV NAC dosing for acetaminophen poisoning?
150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours
65
What should be monitored after Narcan administration in opiate overdose?
Monitor for re-sedation after Narcan wears off (~30-90 min half-life)
66
What is the starting dose of Narcan for chronic opiate users?
Start with low-dose Narcan (0.1-0.2 mg IV) to avoid withdrawal
67
What is required for nerve agents in cholinergic poisoning?
Atropine + 2-PAM ASAP
68
What is required for organophosphate poisoning?
Requires large doses of Atropine (2-4 mg IV q5 min)
69
What are the symptoms of anticholinergic overdose?
"Hot as a hare" (hyperthermia),
"Red as a beet" (flushed skin),
"Dry as a bone" (dry mucosa, no sweating),
"Blind as a bat" (mydriasis, blurry vision),
"Mad as a hatter" (delirium, hallucinations)
70
What is the treatment for anticholinergic overdose?
Benzodiazepines for agitation, physostigmine (if severe delirium & no QRS widening)
71
What are the symptoms of snakebite envenomation?
Local swelling, ecchymosis, DIC, shock
72
What is the treatment for snakebite envenomation?
Keep limb neutral position, no ice, no tourniquet, CroFab antivenom for rattlesnake/cottonmouth bites
73
What are the symptoms of a black widow spider bite?
Muscle spasms + neurotoxin symptoms
74
What is the treatment for black widow spider bite?
Benzodiazepines (Diazepam 2.5-10 mg IV for spasms), calcium gluconate (0.1-0.2 mg/kg IV)
75
What are the symptoms of a brown recluse spider bite?
Necrotic ulcer, hemolysis, DIC
76
What is the treatment for brown recluse spider bite?
Supportive wound care, antibiotics if infected
77
What are the advanced details of scorpion sting?
Bark scorpion venom: Neurotoxic, leads to cholinergic crisis
78
What is the treatment for scorpion sting?
Benzodiazepines for muscle spasms, scorpion-specific antivenom
79
What are some neurotoxins that cause excessive neurotransmitter release?
Black widow venom, scorpion venom, organophosphates cause overstimulation of the nervous system.
80
What is the treatment for neurotoxin-induced overstimulation?
Benzodiazepines (Midazolam, Diazepam) increase GABA, which inhibits excitatory pathways.
81
What is an example of a neurotoxin that induces hyperpolarization?
Tetrodotoxin (pufferfish poison) blocks voltage-gated Na+ channels, leading to paralysis.
82
What is the treatment for tetrodotoxin poisoning?
Supportive care (mechanical ventilation), no antidote.
83
What does black widow spider venom cause?
Massive acetylcholine & catecholamine release leading to severe muscle spasms, cramping, tachycardia, hypertension.
84
What is the treatment for black widow spider envenomation?
Benzodiazepines (Diazepam 2.5-10 mg IV) to relax muscles and Calcium Gluconate to reduce excessive neurotransmitter release.
85
What are organophosphates and their effects?
They block AChE, causing excess acetylcholine at synapses and cholinergic crisis (SLUDGEM).
86
What is the treatment for organophosphate poisoning?
Atropine (blocks muscarinic ACh receptors) and Pralidoxime (2-PAM) to reactivate AChE.
87
What is the effect of tetanus toxin on the CNS?
Blocks GABA & Glycine release, leading to uncontrollable muscle contractions (spastic paralysis).
88
What are the signs and symptoms of tetanus toxin effect?
Trismus (lockjaw), risus sardonicus, opisthotonos.
89
What is the treatment for tetanus toxin effect?
Benzodiazepines (Midazolam, Diazepam) for muscle relaxation and Tetanus Immunoglobulin (TIG).
90
What causes hypokalemia and its effects?
Low extracellular K+ makes it harder to reach threshold potential, leading to muscle weakness and paralysis.
91
What are common causes of hypokalemia?
Diuretics, alkalosis, diarrhea.
92
What is the treatment for hypokalemia?
Potassium replacement (KCl IV if severe, PO if mild) and monitor ECG for U waves, prolonged QT.
93
What is hyperkalemia and its effects?
Increased extracellular K+ makes depolarization easier, leading to prolonged action potentials and dysrhythmias.
94
What does the ECG show in hyperkalemia?
Peaked T waves, widened QRS, eventual sine wave pattern.
95
What is the treatment for hyperkalemia?
Calcium Gluconate (stabilizes cardiac membrane), Insulin + Dextrose (shifts K+ into cells), Sodium Bicarbonate (if acidosis is present).
96
What is the pharmacodynamics of benzodiazepines?
They bind to GABA-A receptors, increasing chloride influx, resulting in neuronal hyperpolarization and CNS depression.
97
What are the uses of benzodiazepines?
Organophosphate toxicity (seizures), alcohol withdrawal, black widow spider envenomation.
98
What is naloxone (Narcan) used for?
It is a competitive antagonist at opioid (mu) receptors, reversing opioid-induced respiratory depression.
99
What is the half-life of naloxone?
Approximately 30-90 minutes, which may necessitate repeat doses.
100
What is flumazenil used for?
It is a competitive antagonist at GABA-A receptors, used for benzodiazepine overdose, but carries a risk of seizure in chronic users.
101
What is the role of sodium bicarbonate in TCA overdose?
It increases serum pH, shifting the drug off cardiac sodium channels and narrowing the QRS complex.
102
What does glucagon do in beta blocker and CCB overdose?
It increases cAMP in cardiac cells, bypassing β-receptor blockade, improving inotropy and heart rate.
103
What is hydroxocobalamin (Cyanokit) used for?
It binds cyanide, forming B12, which is excreted in urine.
104
What is high-dose insulin euglycemia therapy (HIET) used for?
It enhances myocardial metabolism, restoring contractility in CCB overdose.
105
What does magnesium do in torsades de pointes?
It blocks calcium influx at cardiac channels, stabilizing rhythm.
106
What is the pathophysiology of hyperglycemia and DKA?
No insulin leads to cells not using glucose, resulting in ketone production and metabolic acidosis.
107
What is the treatment for hyperglycemia and DKA?
IV Fluids (NS → D5 1/2 NS when BG <250 mg/dL) and IV Insulin Drip (0.1 U/kg/hr, no bolus in pediatrics).
108
What is hypoglycemia and its effects?
Low glucose causes catecholamine release (epinephrine, glucagon), leading to altered mental status, tachycardia, diaphoresis.
109
What is the treatment for hypoglycemia?
Dextrose (D10 in neonates, D25 in pediatrics, D50 in adults) and glucagon IM if no IV access.
110
What is the mechanism of action of depolarizing neuromuscular blockers?
They bind to nicotinic receptors, keeping Na+ channels open, resulting in flaccid paralysis.
111
What is succinylcholine used for?
Rapid sequence intubation (RSI).
112
What are the cautions for using succinylcholine?
Avoid in hyperkalemia, burns, crush injuries.
113
What are non-depolarizing neuromuscular blockers?
Competitive antagonists at nicotinic receptors that prevent depolarization, with slower onset and longer duration than succinylcholine.
114
What is lead poisoning and its effects?
It binds sulfhydryl groups, inhibits heme synthesis, leading to anemia and cognitive decline.
115
What is the treatment for lead poisoning?
EDTA or Succimer (chelators).
116
What is iron poisoning and its effects?
It has a direct corrosive effect and causes free radical damage, leading to GI distress and metabolic acidosis.
117
What is the treatment for iron poisoning?
Deferoxamine (binds free iron).
118
What is mercury poisoning and its effects?
It is neurotoxic and inhibits cellular metabolism, causing tremors, ataxia, and personality changes (Mad Hatter syndrome).
119
What is the treatment for mercury poisoning?
Chelation (Dimercaprol, Succimer).
120
Poison/Toxin National Hotline Phone#
1-800-222-1222
121
How can someone be exposed to a toxic substance?
Inhalation, ingestion, injection, absorption
122
What are the four portals of entry?
Inhalation, ingestion, injection, absorption
123
What is the most common way to be exposed to a toxic substance?
Ingestion
124
What is the difference between poisoning and overdose?
Poisoning: exposure to toxic substance (accidental or intentional)
Overdose: excessive amount of a drug or substance taken (usually intentional or recreational)
125
What key information should you obtain from someone who ingested a toxin or poison?
How long ago since your exposure
126
What medication do we administer to a patient who suffers from chronic alcoholism?
Thiamine 100mg
127
What is delirium tremens?
Life-threatening withdrawal syndrome in chronic alcoholics
128
What is the medical treatment for patients who ingest or inhale a toxin?
Support ABCs first, remove from source, administer O2, consider activated charcoal if ingestion was recent, consider antidotes if known toxin, IV access, cardiac monitor, vitals, transport
129
Rx of pt w/ surface-absorbed toxin
) Dry powder toxin Rx: brush off 1st, then flush w/ water; Liquid toxin Rx: flush thoroughly w/ water or saline
Brush Off
130
How does carbon monoxide kill us?
CO binds to hemoglobin w/ 200× the affinity of O2 → prevents O2 from binding → cellular hypoxia despite normal SpO2
131
What is hemoglobin bound with carbon monoxide called?
Carboxyhemoglobin (COHb)
132
What different things does a CO-Oximeter detect?
O2Hb (oxygen-bound hemoglobin),
COHb (carbon monoxide),
MetHb (methemoglobin)
133
What is the treatment for a patient that presents with CO poisoning?
Oxygen therapy and supportive care
134
How does cyanide kill us?
Blocks cellular respiration → cells can't use O2 even if plenty is available → rapid death
135
What does cyanide smell like?
Almonds
136
How do we treat a patient with suspected cyanide poisoning?
Rx: O2 Cyanokit
Meds: Old school: amyl nitrite, sodium nitrite, sodium thiosulfate; New: Hydroxocobalamin (Cyanokit) → turns urine red
137
What is the pathophysiology of cholinergic exposure?
Overstimulation of PSNS due to excessive acetylcholine (ACh) seen with organophosphates, nerve agents
138
How do we treat cholinergic exposure?
Atropine, Pralidoxime (2-PAM), airway support
139
How do we treat patients suspected of overdosing on beta blockers?
If unstable, administer Glucagon 3-10 mg IVP followed by 3-5 mg per hour infusion
140
What are the signs and symptoms of beta blocker overdose?
Bradycardia, hypotension, bronchospasm, AMS
141
How do we treat patients suspected of overdosing on calcium channel blockers?
1st Calcium Chloride 1-2Gs followed by IV infusion of the same dose per hour; 2nd Glucagon: 3-10 mg IVP followed by 3-5mg/Hr infusion
142
What are the signs and symptoms of calcium channel blocker overdose?
N/V, H/A & AMS, cardiac arrhythmias, bradycardia, heart blocks, profound hypotension
143
What are the signs and symptoms of cardiac glycoside (Digoxin) overdose?
N/V, visual disturbances (halos), bradycardia, arrhythmias
144
What are the signs and symptoms of ace inhibitor overdose?
Hypotension, hyperkalemia, angioedema
145
What is the treatment for tricyclic antidepressant overdose?
Na-Bicarb 1 ampule/50meq; if not working give another, beware of precipitation, influx of Na
146
What are the signs and symptoms of tricyclic antidepressant overdose?
Dry mouth, urinary retention and constipation, respiratory depression, seizures, tachycardia & arrhythmias (wide QRS complexes)
147
What are the signs and symptoms of MAO inhibitor overdose?
Tachycardia & palpitations, hypertension, hyperthermia, seizures
148
What is serotonin syndrome?
Mild: Tachycardia, shivering, diaphoresis and mydriasis; Moderate: Mild symptoms plus hypertension and hyperthermia; Severe: Severe hypertension & tachycardia, acidosis, rhabdomyolysis, & seizures
149
What is the treatment for lithium overdose?
Supportive care and possible dialysis
150
What are the most common salicylates?
Aspirin, Oil of Wintergreen, Pepto Bismol, other Rx meds with codeine
151
What does salicylate toxicity interrupt?
The normal function of the Kreb’s Cycle leading to anaerobic metabolic acidosis
152
What is the treatment for salicylate toxicity?
Na-Bicarb
153
What is a common symptom of salicylate toxicity?
Tinnitus
154
What is the most lethal mushroom?
Amanita phalloides (death cap) → liver failure
155
What does foxglove contain and what are its effects?
Contains digitalis-like compounds → bradycardia, arrhythmias
156
What does nightshade contain and what are its effects?
Contains atropine-like alkaloids → anticholinergic toxicity (dry mouth, tachycardia, hallucinations)
157
What are the identifying marks of a brown recluse spider?
Violin-shaped mark on back
158
What type of toxin does a brown recluse spider have and what is the treatment?
Cytotoxic venom Painless bite → necrotic ulcer over hours to days
159
What type of toxin does a black widow spider have and what is the treatment?
Neurotoxic venomCauses severe muscle cramps/spasms, abdominal rigidity, HTN, tachycardia
160
What is the most lethal scorpion?
Arizona bark scorpion
161
What type of toxin do pit viper snakes have and what are the effects?
Hemotoxic (damages blood vessels/tissues → swelling, bruising, coagulopathy)
162
What is a dry bite?
Defensive bite without venom
163
What are the identifying marks of a coral snake?
"Red on yellow, kill a fellow. Red on black, friend of Jack"
164
What type of toxin does a coral snake have and what are its effects?
Neurotoxic (affects nervous system → paralysis, respiratory depression)
165
How do coral snakes envenomate a person?
Little teeth saw
