Clinical Toxicology Flashcards Preview

PPS 946 > Clinical Toxicology > Flashcards

Flashcards in Clinical Toxicology Deck (115):
1

Things activated charcoal are not effective for:

(Micoal)
Minerals
Iron
Cyanide
Organic Solvents
Alcohol
Lithium

2

Two types cathartics

Saline (Mg) and saccharides (sorbitol)

3

[True/False] Cathartics can enhance drug removal which decreases morbidity/mortality.

False.
Cathartics have never been shown to decrease morbidity/mortality.

4

Cathartics contraindications.

Ingestion of corrosives.

5

What is the best known drug removed by dialysis?

Ethanol

6

Naloxone

Opioid overdose

7

Diphenhydramine

Antipsychotics-acute dystonic reactions

8

Desferroxamine

Iron overdose

9

Dimercaprol (BAL)

Heavy Metal overdose

10

N-acetylcysteine

Tylenol overdose

11

Glucagon

For insulin and beta blocker overdose

12

Methylene blue

Nitrate overdose

13

Pralidoxime (2-PAM)

Organophosphate overdoses

14

CaNa2EDTA

Heavy Metal overdose

15

Sodium Thiosulfate

Cyanide overdose

16

Ethanol

Antifree (its metabolite-ethylene glycol) and methanol overdose

17

Pyridoxine (Vitamin B6)

INH overdose
Can be used in Ethylene Glycol Overdose

18

Phentolamine (alpha-1 antagonist)

Any alpha-1 agonist overdose
(Pseudophedrine)

19

Syrup of Ipecac Contraindications

20

Gastric Lavage Contraindication

Unprotected airway
Hydrocarbons
Corrosives

21

Cocaine Toxidromes

Sympathomimetic
Euphoria
CVAs are common
Rhabdomyalysis (muscle break down)
Hyperthermia
Possible seizures

22

Management of Cocaine Overdose
Anxiety/psychosis

Diazepam/haloperidol

23

Management of Cocaine Overdose
Sinus tachycardia

Observation/diazepam

24

Management of Cocaine Overdose
Hypertension

Labetalol

25

Management of Cocaine Overdose
Headache (HA)

CT scan (could be due to bleeding)

26

Management of Cocaine Overdose
Seizures

Phenytoin/diazepam/CT Scan

27

Management of Cocaine Overdose
MI

Nitrates, Calcium Channel blockers, avoid Beta-blockers

28

Management of Cocaine Overdose
Rhabdomyalysis

Alkalinization of urine (bicarbonate)

29

Management of Cocaine Overdose
CVA

Supportive

30

Carbon Monoxide Poisoning Treatment

Supplemental 100% oxygen

31

Carbon Monoxide Poisoning Treatment

Supplemental 100% oxygen

32

Two types cathartics

Saline (Mg) and saccharides (sorbitol)

33

[True/False] Cathartics can enhance drug removal which decreases morbidity/mortality.

False.
Cathartics have never been shown to decrease morbidity/mortality.

34

Cathartics contraindications.

Ingestion of corrosives.

35

What is the best known drug removed by dialysis?

Ethanol

36

Naloxone

Opioid overdose

37

[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.

False
Do not induce emesis in someone with a TCA overdose
Only do lavage if less than 1 hour post ingestion

38

TCA Overdose QRS interval meaning:
0.10-0.15
0.16
Below 0.10

Correlates with increased risk of seizures
Correlates with increased risk for both seizures and arrhythmia
Dose not rule out the possibility of toxicity

39

Dimercaprol (BAL)

Heavy Metal overdose

40

N-acetylcysteine

Tylenol overdose

41

Classical triad of opioid intoxication

Miosis (pupil constriction)
Respiratory Depression
Depressed level of consciousness

42

Methylene blue

Nitrate overdose

43

Pralidoxime (2-PAM)

Organophosphate overdoses

44

CaNa2EDTA

Heavy Metal overdose

45

Sodium Thiosulfate

Cyanide overdose

46

Ethanol

Antifree (its metabolite) and methanol overdose

47

Pyridoxine (Vitamin B6)

INH overdose

48

Phentolamine (alpha-1 antagonist)

Any alpha-1 agonist overdose
(Pseudophedrine)

49

Syrup of Ipecac Contraindications

Less than 6 months
Seizing or comatose patients
Corrosive substances

50

Gastric Lavage Contraindication

Unprotected airway
Hydrocarbons
Corrosives

51

Cocaine Toxidromes

Sympathomimetic
Euphoria
CVAs are common
Rhabdomyalysis (muscle break down)
Hyperthermia
Possible seizures

52

Management of Cocaine Overdose
Anxiety/psychosis

Diazepam/haloperidol

53

Management of Cocaine Overdose
Sinus tachycardia

Observation/diazepam

54

Management of Cocaine Overdose
Hypertension

Labetalol

55

Management of Cocaine Overdose
Headache (HA)

CT scan (could be due to bleeding)

56

Management of Cocaine Overdose
Seizures

Phenytoin/diazepam/CT Scan

57

Management of Cocaine Overdose
MI

Nitrates, Calcium Channel blockers, avoid Beta-blockers

58

Management of Cocaine Overdose
Rhabdomyalysis

Alkalinization of urine (bicarbonate)

59

Treatment of Organophosphate Poisoning

Flushing of body
Atropine for CNS and nicotininc effects
2-PAM for CNS effects

60

When there is inadequate tissue oxygenation is metabolic alkalosis or acidosis present?

Metabolic acidosis

61

Carbon Monoxide Poisoning Treatment

Supplemental 100% oxygen

62

What two medications are chemically and structurally similar to TCAs?

Carbamazepine
Cyclobenzaprine

63

TCA Cardiac Toxicity Signs

Tachycardia and HTN
Vasodilation
Myocardial depression and cardiac conduction from inhibition of fast Na+ channels

64

TCA CNS Toxicity

Sedation/coma from anticholinergic effects
Seizures from NE and Serotonin reuptake inhibition

65

Clinical Presentation of TCA toxicity

TCA
Tonic-clonic seizures
Cardiac
Anticholinergic

66

TCA Bicarbonate Mechanisms

Increases plasma protein binding
Stabilization of fast Na+ channels

67

What is your optimum pH of the blood when treating TCA overdose?

7.45-7.55

68

[True/False] You can induce emesis when someone overdoses on TCAs or do gastric lavage.

False
Do not induce emesis in someone with a TCA overdose
Only do lavage if

69

TCA Overdose QRS interval meaning:
0.10-0.15
0.16

Correlates with increased risk of seizures
Correlates with increased risk for both seizures and arrhythmia
Dose not rule out the possibility of toxicity

70

TCA Contraindications

Physostigmine
Flumazenil

71

What vasopressors can be used in a TCA overdose if needed?

NE and phenylephrine
Dopamine should be avoided secondary to depletion of amines.

72

Classical triad of opioid intoxication

Miosis (pupil constriction)
Respiratory Depression
Depressed level of consciousness

73

Signs of Beta-Blocker Overdose

Bradycardia and depression of inotropy (force of contraction)

74

Treatment of Beta-Blocker Overdose

Glucagon 3mg IV
Can follow-up with continuous infusion.
Monitor for hyperglycemia

75

Where does hydrocarbon toxicity mainly come from?

Aspiration
Pneumonitis

76

Group 1 Hydrocarbons

Greases (non-toxic)

77

Group 2 Hydrocarbons

Kerosene, gasoline

78

Group 3 Hydrocarbons

Ring hydrocarbons-benzene

79

Group 4 Hydrocarbons

Chlorinated hydrocarbons: carbon tetrachloride

80

Hallmarks of Phencyclidine (PCP) toxicity

Violent or bizarre behavior

81

What is the primary concern of PCP toxicity?

Self-induced injury.

82

What can achieve chemical calming in PCP toxicity?

Haloperidol or diazepam

83

What are the characteristics of Theophylline toxicity?

N/V, agitation
Dysrhythmias and seizures

84

What levels of Theophylline does toxicity begin?

20mg/L

85

What are life threatening levels of Theophylline toxicity?

50-60mg/L

86

What exacerbates Theophylline toxicity?

Hypokalemia

87

What do seizures due to Theophylline toxicity respond to?

Phenytoin
Diazepam

88

In severe seizures due to Theophylline toxicity what do you want to consider to treat it?

Hemoperfusion

89

What three deleterious effects do organophosphates have on the body systems?

Parasympathetic-SLUDGE
Nicotinic-muscle weakness
CNS-confusion, slurred speech, respiratory depression

90

Treatment of Organophosphate Poisoning

Flushing of body
Atropine for CNS and nicotininc effects
2-PAM for CNS effects

91

Characteristics of Barbiturate poisoning

Respiratory depression
Hypotension
Decreased level of consciousness

92

Clinical Presentation of Barbiturate poisoning

Slurred speech
Lethargy
Ataxia
Hypothermia
Coma
Death

93

Treatment of Barbiturate poisoning

Forced diuresis
Alkalinization of the urin
Multiple dose charcoal

94

Normal Plasma Blood levels of Barbiturates

15-40mg/L

95

Clinical Presentation of BZDs

Lethargy
Slurred speech
Ataxia
Respiratory Depression
Coma

96

Avoid ____ especially in ultra-short acting BZDs due to rapid progression to coma.

Emesis

97

What is indicated for pure benzo overdoses only?

Flumazenil

98

What is the dose of flumazenil for benzo overdose?

0.2mg IV repeat with 0.5mg every 1 min. until response is achieved or to a max dose of 3mg

99

How does methanol become toxic?

It is metabolized and its metabolites are toxic.
(formic acid)

100

How does methanol toxicity present itself?

Osmolar/anion gap.

101

What do you always draw in methanol toxicity?

ASA/APAP and ethylene glycol levels

102

Treatment of Methanol Toxicity

EtOH therapy: 10% EtOH in D5W over 30-60 minutes then start 1.39ml/kg/h of 10% EtOH solution.
EtOH bind alcohol dehydrogenase, preventing methanol metabolism

Folinic Acid and folic acid-enhances the conversion of formate to CO2 and H2O.

4-methylpyrazole/Fomepizole (4-MP)-blocks alcohol dehydrogenase without causing inebriation.

Hemodialysis-removes methanol and formate from the circulation

103

How is ethylene glycol toxic?

Glycolic acid accumulates and causes renal tubular damage. Glycolic acid is metabolized and the metabolites can cause acidosis and some can form oxalate crystals in tissues (within 1-3 hours).

104

Ethylene Glycol Toxicity
Stage 1

CNS Stage:
30 minutes to 12 hours
Characterized by intoxication, slurred speech, lethargy, ataxia.
Patients may complain of GI distress

105

Ethylene Glycol Toxicity
Stage 2

Cardiac Stage:
Occurs 12-48 hours after ingestion and is characterized by cardiac edema, cardiac dilation, and the development of arrhythmias.
Death is most common during this stage.

106

Ethylene Glycol Toxicity
Stage 3

Renal Stage:
Occurs 24-72 hours after ingestion
Characterized by development of acute renal failure, flank pain, and CVA tenderness on physical exam.

107

In Ethylene Glycol overdose what levels must you draw and what must you monitor?

Draw ASA/APAP levels
Place patients on an EKG monitor.

108

Treatment of Ethylene Glycol Toxicity

Gastric Lavage if less than 4 hours post ingestion
Bicarbonate for metabolic acidosis
Calcium Chloride or Calcium Gluconate for hypocalemia
Ethanol
4-MP
Thiamine, pyridoxin, and folate
Hemodialysis in cases with ARF or high serum EG levels (more than 50mg/L)

109

Childhood ingestions are usually single _____, _____, and _____ recognized.

Single chemical agents
Known
Promptly recognized

110

Adult/adolescent ingestions are usually multiple chemical agents, intentional, ____, and with _____ recognition.

Unknown
Delayed

111

What is the most common cause of toxic ingestions in the elderly?

Chronic overmedication (polypharmacy)

112

What do you want to identify in a patient that you believed has overdosed?

Substance
Amount
Route

113

What do you look for upon physical exam?

Vital signs
Coma grade/level of consciousness
Neurologic findings (seizures, nystagmus, miosis (cholinergics), mydriasis (anticholinergics), fixed dilated pupils)
Cardiac-(dysrhythmias)
Odors

114

What are some lab assessments that you can obtain during an overdose?

Electrolytes (anion gap)
Blood gases
Serum osmolality
EKG
Toxic Screen

115

Treatment Principals are?

Provide supportive care
Prevent absorption
Enhance elimination
Interrupt or alter metabolism
Provide specific antibiotics