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Poison/Toxicology > Exam 1 > Flashcards

Exam 1 Flashcards

(110 cards)

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1
Q

If they breathe very rapidly, toxidrome?

A

stimulant - cocaine

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2
Q

If shallow, slow breathing, toxidrome?

A

Antidepressant - opioids, fentanyl, tranquilizers, high dose of anti-anxiety

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3
Q

If rapid HR, high BP, toxidrome?

A

Cocaine, crystal meth

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4
Q

If low HR, BP, toxidrome?

A

alcohol, antidepressant, opioid

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5
Q

Pinpoint pupils, toxidrome?

A

opioids = heroine, methadone, fentanyl

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6
Q

Dilated and reactive pupils, toxidrome?

A

stimulants

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7
Q

Dilated and unreactive pupils, toxidrome?

A

Anticholinergics - atropine, scopolamine

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8
Q

If frothy sputum from lungs, toxidrome?

A

Opioids

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9
Q

Flumazenil is used in what kind of overdose?

A

BZD

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10
Q

AT MUDPIES pneumonic

A
  • Alcohol
  • Toluene
  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Paraldehyde
  • Iron, Isoniazid
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates, strychnine
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11
Q

Avoid activated charcoal in what kind of OD?

A

Alcohols, cyanide, lithium

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12
Q

Multiple-dose AC useful in ___ (4)

A

Theophyline, phenobarbital, phenytoin, salicylate

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13
Q

Ion trapping: acidification vs alkalinization which one is clinically useful?

A

Alkalinization

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14
Q

Acidifying agent

A

Ammonium chloride, ascorbic acid

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15
Q

Alkalinizing agent

A

Sodium bicarbonate

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16
Q

Alkalinization useful in ___ (3)

A

Phenobarbital, salicylates, isoniazid

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17
Q

Drugs frequently dialyzed include ___ (6)

A

The SMELL
1. Salicylates
2. Methanol
3. Ethylene glycol
4. Long acting barbiturates
5. Lithium
6. Theophylline

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18
Q

APAP OD Stage II AST/ALT level

A

> 1,000 IU/L

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19
Q

APAP Stage III AST/ALT level

A

> 10,000 IU

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20
Q

APAP toxic levels in adults vs children

A
  • 7.5 g in adults
  • 150 mg/kg in children
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21
Q

Normal serum APAP concentration

A

10-30 mcg/mL

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22
Q

Normal ALT level

A

4-36

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23
Q

Normal AST level

A

8-33

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24
Q

Normal bilirubin level

A

0.1-1.2

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25
Normal Creatinine level
0.7-1.3
26
Normal glucose level
70-100 mg/dL
27
Normal INR
0.8-1.1
28
Normal lactate
0.5-2.2
29
Normal phosphate
2.8-4.5
30
Normal Prothrombin time (PT)
11-13.5 sec
31
Activated charcoal dose and time given
- 1 g/kg - Within 1-2 hrs of ingestion
32
APAP OD antidote name and time given
- N-acetylcysteine (NAC) - Within 8 hrs of ingestion
33
When do we treat APAP OD with antidote?
Treat if 150 mcg/mL or above at 4 hrs of ingestion
34
NAC oral dose: loading, maintenance & regimen duration
- Loading: 140 mg/kg - Maintenance: 70 mg/kg Q4H x17 doses - Duration: 72 hrs
35
NAC IV dosing for 3-bag regimen: first, second, last
1. 150 mg/kg over 1 hr 2. 50 mg/kg over 4 hrs 3. 100 mg/kg over 16 hrs
36
NAC high dose regimen
- 150 mg/kg over 1 hr - 250 mg/kg over 20 hrs
37
D/c NAC if:
1. Serum APAP undetectable 2. AST downward trend: 2 consecutive decreasing AST values, AST <1,000 IU, AST/ALT ratio of 0.4 3. INR <2
38
Normal pH level
7.35 - 7.45
39
Normal PaCO2
35-45
40
Normal HCO3
22-26
41
Metabolic acidosis lab
1. pH <7.35 2. HCO3 <22
42
Metabolic alkalosis lab
1. pH >7.45 2. HCO3 >26
43
Respiratory acidosis lab
1. pH <7.35 2. PaCO2 >45
44
Respiratory alkalosis lab
1. pH >7.45 2. PaCO2 <35
45
Causes of metabolic acidosis
**MUDPILES** Methanol, Uremia, DKA, Paraldehyde, Isoniazid/Iron/Ibuprofen, lactic acidosis, Ethylene glycol, Salicylate
46
Anion Gap calculation
AG = Na - Cl - HCO3
47
Causes of non-anion gap metabolic acidosis
**HARDUP** Hyperchloremia/alimentation, Acetazolamide, **Renal tubular acidosis, Diarrhea**, Ureterosigmoid fistula, Pancreatic fistula
48
When is NaHCO3 given in metabolic acidosis?
pH <7.15, toxin excretion, life-threatening hyperK+
49
Metabolic alkalosis treatment
1. Treat underlying disorder 2. IV saline, K+ supplementation 3. Acetazolamide
50
Respiratory acidosis treatment
1. Underlying disorder 2. Improve airway function with bronchodilators, mechanical ventilation
51
Respiratory alkalosis treatment
1. Underlying disorder 2. Correct breathing with mechanical ventilation
52
Adrenergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity
1. up 2. up 3. up 4. up 5. mydriasis 6. agitated 7. yes 8. 0
53
Anticholinergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity
1. up 2. up 3. 0 4. up 5. mydriasis 6. delirious 7. no 8. down
54
Cholinergic BP, HR, RR, T, pupils, mental status, sweat, bowel activity
1. down 2. down 3. 0 4. 0 5. miosis 6. altered 7. yes 8. up
55
Opioid BP, HR, RR, T, pupils, mental status, sweat, bowel activity
1. down 2. down 3. down 4. down 5. miosis 6. depressed 7. no 8. down
56
Salicylates in alkalotic system
Ionized -> not permeable to cell membranes -> trapped outside the cell/ inside the plasma = :)
57
Salicylate respiratory effects
Respiratory alkalosis - High pH -> salicylate ionized -> trapped in plasma - Eventually can't breathe as fast/deep -> low pH -> unionized -> move into the cell
58
What happens to salicylates inside the cell?
Uncoupling mitochondrial oxidative phosphorylation -> increase CO2 production -> increase pyruvic and lactic acid production
59
Why is hypoK not good in salicylate OD?
HypoK prevents alkalinization of urine
60
When do you perform hemodialysis for salicylate OD?
- Levels >80-100 mg/dL, OR - >60 mg/dL with renal failure, altered mental status, CHF, poor response
61
Which IV BZD contain propylene glycol as a solvent?
Lorazepam and Diazepam
62
Beer's criteria drugs
Zolpidem, zaleplon, eszopiclone, diphenhydramine, doxylamine, hydroxyzine, lithium, clonazepam
63
Non BZD IV sedatives given bolus IV push
Etomidate, ketamine, propofol
64
Non BZD IV sedatives given continuous IV
Propofol, dexmedetomidine
65
Which Non BZD IV sedative is HoTN neutral or up?
Ketamine
66
What is a major SE for propofol?
HoTN, PRIS
67
Lithium toxicity risk factors
- Older age: decreased GFR - Low output HF - DDI - Decreased sodium intake
68
Qualitative toxicology test is best for
BZD
69
Quantitative toxicology test is best for
Lithium
70
Activated charcoal is NOT for:
**Lithium**, alcohol, cyanide, hydrocarbons
71
C/I for using flumazenil as antidote for BZD OD
1. Seizure 2. Coingestion that provokes seizures, arrhythmias 3. Long-term BZD 4. TCA use on EKG 5. Hypoxia 6. Hypoventilatioin 7. HoTN 8. Head trauma
72
Warfarin antidotes
1. AC 2. Vitamin K 3. Fresh Frozen Plasma (FFP) 4. Prothrombin Complex Concentrate (PCC)
73
4-Factor PCC must be administered with __?
Vitamin K
74
Management of INR 4.5-10.0
- Hold warfarin - Resume when INR therapeutic
75
Management of INR 10.0+
- Hold warfarin - Administer 2.5 mg Vit K PO
76
Management of INR with any major bleeding
- Hold warfarin - Administer 5-10 mg Vit K as a slow IV infusion
77
Dabigatran antidotes
1. AC 2. FFP 3. Idarucizumab (Praxbind) Hemodialysis
78
Rivaroxaban, Apixaban antidotes
1. AC 2. 4F-PCC 3. Andexanet alfa (recombinant FXa)
79
Enoxaparin antidote
Protamine sulfate
80
Phenobarbital clinical manifestations
Coma, HoTN, bradycardia...
81
Phenobarbital treatment
1. ABCs 2. AC 3. Enhance elimination: urinary alkalinization, hemodialysis, MDAC
82
Phenobarbital MDAC dosing
- 25-50g Q2-6H - Never exceed 24 hrs
83
Phenobarbital MDAC monitoring
- Prior to every dose 1. Normal bowel sounds 2. Aspiration risk
84
Phenobarbital when to d/c MDAC
Reversal of life-threatening CNS, respiratory and/or CV symptoms
85
Phenobarbital hemodialysis indicated for...
Severe toxicity - Renal or hepatic failure - Pulmonary edema - Coma - Serum phenobarbital >100 mcg/mL
86
Phenytoin acute toxicity >20
nystagmus
87
Phenytoin acute toxicity >30
Ataxia, poor coordination, tremor
88
Phenytoin acute toxicity >50
Lethargy, confusion, slurred speech, stupor
89
Phenytoin IV only s/s
Cardiotoxicity (HoTN), dermal toxicity (Purple glove syndrome)
90
Phenytoin chronic toxicity
Frontal bossing, gingival hyperplasia, cerebellar effects, hepatotoxicity, agranulocytosis
91
Phenytoin treatment
1. ABC 2. AC 3. MDAC 4. Cardiac - IV fluid bolus
92
Valproic acid toxicity results in...
Hyperammonemia --> encephalopathy
93
Phenobarbital vs Valproic acid: target channel
Chloride vs Sodium
94
Valproic acid clinical manifestations
Seizures, **hypernatremia**, hepatotoxicity
95
Valproic acid treatment
1. ABCs 2. AC 3. Antidote = levocarnitine 4. MDAC, hemodialysis
96
Valproic acid antidote levocarnitine PO or IV dose?
- PO: asymptomatic, 330 mg 3 times daily, max 3g/day - IV: symptomatic: loading dose 100 mg/kg, maintenance dose 15 mg/kg (max 6 g/day)
97
Carbamazepine toxicity clinical manifestation
Seizures, tachycardia, HoTN, QT prolongation, respiratory depression, **hyponatremia**
98
Carbamazepine treatment
1. ABCs 2. AC 3. MDAC, hemodialysis (seizures, coma) 4. QRS: sodium bicarbonate 5. Hyponatremia: hypertonic saline
99
What antiepileptics cause hyponatremia?
Lamotrigine, Oxcarbazepine
100
What antiepileptics cause seizures?
Lamotrigine, Oxcarbazepine, Rufinamide, Tiagabine, Topiramate, Vigabatrin, Zonisamide
101
Antiepileptics treatment
1. ABCs 2. AC 3. QRS: sodium bicarb 4. HoTN: IV fluids, vasopressors prn 5. Seizures: BZD > propofol > barbiturates
102
Selective BB
Acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol
103
Nonselective BB
**카라 핀 풀어써, 팀?** - Carvedilol, labetalol, pindolol, propranolol, sotalol, timolol
104
Intrinsic sympathomimetic activity (ISA) of BB
Partial agonists --> both beta agonist & antagonist
105
Membrane stabilizing activity of BB
Block sodium channels similar to class I antiarrhythmics
106
Vasodilatory agents of BB
Alpha1 antagonism, beta2 agonism, NO mediated, CCB
107
CCB vs BB: hyper vs hypoglycemia
- CCB = hyperglycemia - BB = hypoglycemia in children
108
CCB/BB HDIET is reserved for...
Significant poisoning, myocardial dysfunction
109
Digoxin toxicity s/s
- Tachy- & Bradyarrhythmia - GI, color vision aberrations, yellow halos around lights, hyper-/hypoK
110
Digoxin treatment - DSFab MoA and indication
- Create [ ] gradient which causes digoxin to diffuse out of cells which can then be bound and excreted - Life-threatening dysrhythmias

Poison/Toxicology (3 decks)

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