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Clin Therapeutics 1 > Exam 2 - Toxicology > Flashcards

Exam 2 - Toxicology Flashcards

(73 cards)

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1
Q

Most frequent exposures? (Hint: 8)

A

Analgesics, cosmetics, cleaning substances, sedative/hypnotic/antipsychs, foreign body/toys, antidepressants, cardiovascular drugs, topical preparations

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2
Q

Most fatal exposures? (Hint: 9)

A 
Sedative/hypnotic/antipsychotic 
CV drugs
Opioids
Antidepressants
APAP combinations
APAP alone
Stimulants/street drugs
Alcohol
Anticonvulsants
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3
Q

Important questions to ask for exposure history?

A 
What time, what quantity, what strength, if sustained release, and chronic use?
Co-ingestion? 
Intentional vs accidental?
Past medical and psych history?
Any symptoms?
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4
Q

What vital signs to check?

A

HR, RR, BP, temp

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5
Q

What to check in neuro exam?

A 
Mental status
Seizures
Pupils
Muscle tone
Reflexes
Ankle clonus
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6
Q

What two things to look at in HEENT exam?

A

Salivation

Lacrimation

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7
Q

What two things to look at in lung exam?

A

Wheezes

Rales

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8
Q

What to listen for in abdominal sounds?

A

Bowel sounds present or not.

Absent=peripheral anticholinergic

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9
Q

What to check on skin?

A

Flushed vs pale
Sweaty vs dry
Cool vs warm
Track marks

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10
Q

What two things to look at in GU exam?

A

Incontinence

Urinary retention

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11
Q

What are the 7 routine labs to order with toxic exposure?

A
  1. Chemistries
  2. CBC
  3. Serum tox
  4. Urine tox
  5. Salicylates
  6. Acetaminophen
  7. EtOH
    CCSUSAE
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12
Q

What are some other labs to order for toxic exposures?

A 
ABG
Lactate
Serum osmolarity
LFT
Coags
Specific drug concentrations
Co-oximetries
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13
Q

What types of changes on EKGs in toxic exposure?

A 
Arrythmias
Blocks
QRS interval
QTc interval
Terminal R in aVR (tall and wide R, d/t Na+ block)
ST changes
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14
Q

What are the two types of Interval Prolongation? Their causes?

A
  1. Depolarization abnormality QRS prolongation=TCA-like Na+ channel blockade
  2. Repolarization abnormality (prolonged JT interval/QTc)=blockade of inward-rectifying K+ (HERG) current
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15
Q

Drugs that cause Na+ blockade will appear as what on EKG? What type of abnormality?

A

QRS prolongation causing a Terminal R-wave in aVR.
DT: TCA, Type 1A and 1C, Benadryl, Cocaine, etc
Depolarization abnormality.

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16
Q

Drugs that cause blockade of K+ inward rectifying HERG current appear as what on EKG? What type of abnormality?

A

QT prolongation. Prolonged JT interval (QTc).

Repolarization abnormality.

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17
Q

What are the two types of interval prolongations and abnormalities?

A
  1. QRS prolongation causing depolarization abnormality

2. QRc/Prolonged JT prolongation causing depolarization abnormality

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18
Q

TCA, Type 1A and 1C antiarrythmics, Benadryl, and Cocaine can cause what on EKG? How treated?

A

Na+ channel blockade resulting in QRS prolongation due to depolarization abnormality.
Tx=Bicarb

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19
Q

Antipsychotics, Type 1A and III antiarrythmics, Cisapride, Terfanrine, and Methadone can cause what on EKG?

A

K+ (herg) inward current blockade QRc/Prolonged JT prolongation causing depolarization abnormality and Torsades. Tx=Mg2+.

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20
Q

What are the 4 steps in treatment of a poisoned patient?

A
  1. ABCs, including “Tox ACLS”
  2. Antidote
  3. Decontamination/Decrease Absorption
  4. Increase Elimination
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21
Q

What is the mainstay of care for a poisoned patient?

A

Supportive care. Part of ABCs.

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22
Q

ABCs for a poisoned patient include what sorts of things?

A 
Supportive care (mainstay).
Airway and oxygenation. 
BP support/control.
Blood glucose levels
Temperature control
"Tox ACLS"
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23
Q

What is the treatment of Torsades?

A

Mg2+

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24
Q

Tx for Coctaine VT?

A

Lidocaine and bicarb

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25
Tx for wide-complex tach with Term-R in aVR?
Bicarb, Lidocaine
26
Tx for Hydrocarbon VT?
Beta-blockers like Esmolol. DO NOT GIVE EPI!
27
What would NEVER be given with Hydrocarbon VT?
Epi
28
Huffing is inhalation of what?
Hydrocarbons
29
Tx for Propoxyphene VT?
Narcan (Naloxone)
30
Tx for Bupivicaine PEA?
Intralipid
31
Antidote for BZD overdose?
Flumazanil
32
Antidote for Opioid OD?
Narcan
33
Antidote for central anticholinergic OD?
Physostigime
34
Antidote for TCA, Saliculates, and Toxin-induced acidosis?
Bicarb
35
Antidote for CCD OD?
Calcium, Insulin
36
Antidote for BB OD?
Calcium, Glucagon
37
Antidote for Digoxin OD?
Digibind
38
Antidote for Iron OD?
Deferoxamine
39
Antidote for lead OD?
EDTA, BAL, Succimer
40
Antidote for Thalium OD?
Prussian Blue
41
Antidote for Methanol, Ethylene glycol, wiper fluid, antifreeze?
Fomepizole
42
Antidote for Isoniazid OD?
VitB6
43
Antidote for Organophosphate OD?
2-PAM
44
Antidote for Cyanide OD?
Hydroxycobalamin
45
Antidote for Sulfonylureas?
Octreotide
46
Antidote for Methemoglobinurea?
Methylene Blue
47
Antidote for Hydrofluroic Acid?
Calcium
48
Antidote for Valproic Acid?
L-Carnitine
49
Antidote for APAP OD?
NAC if acute levels at 4h or chronic use has elevated LFT or ACE
50
How to accomplish decontamination/decrease absorption?
Remove from exposure to toxin. Activated charcoal, whole bowel irrigation
51
When to use Activate Charcoal for Decon/Decrease Absorption? When contraindicated?
Studies don't support use. | CI=Airway protection, metal, EtOH, hydrocarbon, caustic
52
When to use Whole Bowel Irrigation for decon/decrease absorption?
For massive injection. Body packers, body stuffers, metals. GyLytely 1-2L/hr
53
Body Packer vs Body Stuffer
Packer=smuggling drugs in body in large quantities | Stuffer=smaller quantities
54
When to alkalize urine to increase elimination? What is used? How does it work?
ASA overdose. IV Bicarb increases elim 20x. Induced ion trapping in distal tubule.
55
Forced Diusesis w/IV fluids useful for when trying to increase elimination?
Drugs excreted unchanged in urine, like Lithium. Rarely used.
56
Hemodialysis useful for when trying to increase elimination?
``` Good for low molecular weight, uncharged, non-plasma bound, low Vd drugs. Aspirin Lithium Methanol Ethylene Glycol Valproic Acid (Always Like My Excellent Vancomycin) ```
57
Charcoal Hemoperfusion useful for when trying to increase elimination?
Rare. Supplanted by Flux Hemodialysis.
58
Multidose Activated Charcoal useful for when trying to increase elimination?
GI Dialysis, drugs that form Bezoars, or enterohepatic circulation Ex: ASA, theophylline, phenobarb, dapsone, Amantia mushrooms
59
Coma, resp depression, and miosis (tiny pupils) is which toxidrome? Tx?
Opioid | Tx=Narcan
60
Agitated, hallucinations, mumbling, directable, picking, and variable wakefulness is which Toxidrome? Tx?
Central Anticholinergic | Tx=Physostigmine
61
Tachy, HTN, hyperthermic, mydriasis (large pupils), dry mucous membranes, dry and flushed skin, urinary retention, absent bowel sounds is which Toxidrime? Tx?
Peripheral Anticholinergic | Tx=BZDs
62
Tachy, HTN, hyperthermic, mydriasis, agitated delerim, thrashing, diaphoresis; bowel sounds present, normal tone and reflexes. Which Toxidrome and tx?
Sympathomimetics (from Amphetamine, cocaine, etc). | TX if VT=Lidocaine, Bicarb. Otherwise probably supportive.
63
Tachy, HTN, hyperthermic, mydriasis, agitated delerium, tremulous, disphoresis, ocular clonus, tremors, hyperreflexia, increased muscle tone, foot beating like crash, increases reflexes/tone. Which Toxidrome and tx?
Serotonergic (MAOI, Tramadol, Demerol) | Tx=Supportive?
64
Salivation, lacrimation, urination, diarrhea, GI upset, emesis, brochospasm and brady cardia (SLUDGE) is which toxidrome?
Cholinergic | Tx=Supportive?
65
Red flags when treating patient?
Acute mental status change, seizure, metabolic acidosis (anion gap), osmolar gap, PT with similar symptoms in close proximity
66
Amphetamine-like drugs ends in what?
-"one"
67
Examples of Amphetamine-like drugs?
MDMA/Molly, bath salts, khat
68
Which is the only legal synthetic cathinone (amphetamine-like drug)?
Bupropion
69
Synthetic cannabinoid symptoms look like what?
Looks like sympathomimetic but not
70
Non-cardiogenic pulmonary edema w/frothy sputum from opioid OD treated how?
Bipap
71
When does hearing loss return with synthetic opioid OD?
24-48h later
72
Synthetic opioid OD might require what to reverse?
Very high doses of Narcan
73
Do synthetic hallucinogens cause clonus, tone, and reflex problems?
Nope

Clin Therapeutics 1 (12 decks)

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