Exam 6 - Toxicology Howell Flashcards by Rehman Hameed

most medication overdoses in adults are due to

a. analgesics
b. antidepressants
c. CV drugs
d. household cleaning substances

a. analgesics

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Difference between primary measured cations and primary measured anions

a. anion gap
b. osmolar gap

a. anion gap

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anion gap is present if > ____

a. 10
b. 14
c. 5
d. 2

b. 14

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osmolar gap is present if > ____

a. 10
b. 14
c. 5
d. 2

a. 10

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used for whole bowel irrigation

a. activated charcoal
b. golytely
c. hemodialysis

b. golytely

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hemodialysis is NOT effective for the which of the following medication overdose?

a. alcohols
b. lithium
c. salicylates
d. digoxin
e. theophylline

d. digoxin

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antidote for salicylate poisoning

a. sodium bicarbonate
b. flumazenil
c. benztropine
d. digibind

a. sodium bicarbonate

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sodium bicarbonate MOA when used as antidote for salicylates

a. urine alkalinization
b. inc sodium gradient of poisoned sodium channels
c. binds free drug and tissue bound drug released during equlibrium state
d. blocks parasympathetic activity to inc heart rate

a. urine alkalinization

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which is NOT an indication to use sodium bicarbonate in salicylate poisoning?

a. serum salicylate level > 20
b. anion gap metabolic acidosis
c. altered mental status

a. serum salicylate level > 20

(> 30)

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which type of toxicity is being described?
-CNS depression
-respiratory depression
-bradycardia
-hypotension

a. salicylate
b. sedatives
c. TCAs
d. antipsychotics

b. sedatives

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which type of toxicity is being described?
-N/V
-tinnitus and diaphoresis
-decreased GI motility
-hyperventilation
-seizures

a. salicylate
b. sedatives
c. TCAs
d. antipsychotics

a. salicylate

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which type of toxicity is being described?
-hypotension
-anticholinergic sx
-tachycardia
-seizures
-prolonged QRS

a. salicylate
b. sedatives
c. TCAs
d. antipsychotics

c. TCAs

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flumazenil MOA

competes with BZDs at BZD binding site of GABA complex

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T or F: flumazenil should be used in patients with seizures

(if pt has seizure history she does not recommend using flumazenil)

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which of the following is FALSE about TCAs pharmacokinetics?

a. initially is rapidly absorbed from the GI tract
b. half-life = 4-93 hours
c. highly lipophobic
d. acidemia increases the percentage of unbound TCA

c. highly lipophobic

(lipophilic)

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TCAs effects of QRS prolongation: QRS interval > 150 msec

a. inc risk of seizure activity
b. inc risk of cardiac arrhythmias
c. promotes unbinding of drug from proteins

b. inc risk of cardiac arrhythmias

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TCAs effects of QRS prolongation: QRS interval > 100 msec

a. inc risk of seizure activity
b. inc risk of cardiac arrhythmias
c. promotes unbinding of drug from proteins

a. inc risk of seizure activity

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TCAs effects of QRS prolongation: metabolic acidosis

a. inc risk of seizure activity
b. inc risk of cardiac arrhythmias
c. promotes unbinding of drug from proteins

c. promotes unbinding of drug from proteins

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sodium bicarbonate MOA when used as antidote for TCAs

b. inc sodium gradient of poisoned sodium channels

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which of the following is NOT an indication of sodium bicarbonate for TCA poisoning?

a. QRS interval > 100 msec
b. TCA induced arrhythmias or hypotension
c. metabolic alkalosis

c. metabolic alkalosis

(acidosis)

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we can d/c sodium bicarbonate for TCA poisoning when:
QRS < ____ msec
Resolution of ____ abnormalities
_______ stable

< 100
ECG
hemodynamically

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TCAs seizure management: what 2 drugs/classes are most commonly used? (one is a class; slide 41)

BZDs
phenobarbital

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first gen antipsychotics

a. D2 antagonism
b. 5HT2A/D2 antagonism

a. D2 antagonism

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second gen antipsychotics

a. D2 antagonism
b. 5HT2A/D2 antagonism

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b. 5HT2A/D2 antagonism

haloperidol, fluphenazine, chlorpromazine a. typical b. atypical

a. typical

aripiprazole, clozapine, olanzapine a. typical b. atypical

b. atypical

which type of toxicity is being described? -hypotension -tachycardia -QT/QRS prolongation -neuroleptic malignant syndrome (NMS) -extrapyramidal symptoms (EPS) a. salicylate b. sedatives c. TCAs d. antipsychotics

d. antipsychotics

two drugs for extrapyramidal symptoms (no doses)

-benztropine -diphenhydramine

benztropine route of administration for extrapyramidal symptoms a. oral b. IV c. IM d. subQ

c. IM

which of the following is TRUE about the treatment of extrapyramidal symptoms? a. benztropine onset is 5 minutes b. diphenhydramine onset is 15-20 minutes c. diphenhydramine 1-2 mg/kg IV/IM should be given over several hours d. diphenhydramine should be continued with oral therapy for 3-4 days

d. diphenhydramine should be continued with oral therapy for 3-4 days (a. is 15-20 min; b. is 5 min; c. is several minutes)

which of the following is TRUE about neuroleptic malignant syndrome (NMS)? a. fever up to 104 F with vision problems b. caused by antipsychotics c. occur 3-6 hours after initiating therapy or adding a 2nd agent d. pts are often over 50 years of age and more often in females e. complications typically continue for 12 hours

b. caused by antipsychotics (a. is 108 F with altered mental status and muscular rigidity; c. is 3-9 days; d. is less than 40 and males; e. is 5-10 days)

tx of Neuroleptic Malignant Syndrome (3 drugs; no doses)

-BZDs -dantrolene -bromocriptine

which of the following drugs is NOT used as tx for NMS? a. BZDs b. dantrolene c. bromocriptine d. cyproheptadine

d. cyproheptadine

initial and maintenance dose of dantrolene for NMS

initial: 2.5 mg/kg to a max of 10 mg/kg maintenance: 2.5 mg/kg Q6H until resolved

bromocriptine dose for NMS

2.5 mg BID initially, inc to 5 mg TID (doses as high as 60 mg/day have been used)

serotonin syndrome triad of symptoms

-altered mental status -autonomic instability -neuromuscular abnormalities

serotonin syndrome develops within ____ hours of an inc in the precipitating medication

which of the following drugs is used as tx for serotonin syndrome? a. dantrolene b. cyproheptadine c. bromocriptine d. allopurinol

b. cyproheptadine

cyproheptadine dose and frequency for serotonin syndrome a. 2 mg PO Q2H; max dose 16 mg b. 2 mg PO Q1H; max dose 32 mg c. 4 mg PO Q1H; max dose 16 mg d. 4 mg PO Q1H; max dose 32 mg

c. 4 mg PO Q1H; max dose 16 mg

which of the following is FALSE about serotonin syndrome vs NMS? a. SS lasts < 24 hours b. SS has a lower fever c. NMS involves diffuse lead pipe rigidity d. SS affects upper limbs more than lower limbs

d. SS affects upper limbs more than lower limbs (other way around)

for digoxin toxicity, administer _______ _______ if presentation within 2 hours of ingestion

activated charcoal

digibind indications (4)

-Ventricular arrhythmias, bradycardia/2nd or 3rd degree heart block not responsive to atropine -Hyperkalemia (K > 5.5) with s/sx of toxicity -Serum digoxin concentrations > 10-15 ng/mL drawn at least 6 hours after time of ingestion -Ingestion > 10 mg in adults, > 4 mg in children

digoxin immune fab (Digibind) MOA

binds free digoxin and tissue bound digoxin released during equilibrium state

each vial of digibind binds ____ mg of digoxin a. 0.25 b. 0.5 c. 1 d. 2

b. 0.5

Digibind formula based on acute ingestion of known amount

-TBL = mg digoxin ingested * 0.8 -TBL/0.5 mg = # Digibind vials to administer

Digibind formula based on serum digoxin conc in adults

# Digibind vials = (digoxin conc (ng/mL) * pt's wt (kg))/100

T or F: digoxin toxicity only occurs with acute ingestion

F (acute and chronic)

CCB and BB toxicities: Bypasses beta receptor and acts directly on Gs to stimulate conversion of ATP to cAMP a. atropine b. calcium c. glucagon d. high dose insulin e. lipid emulsion

c. glucagon

CCB and BB toxicities: Enters open voltage sensitive calcium channels to promote calcium release from sarcoplasmic reticulum resulting in myocardial contractility a. atropine b. calcium c. glucagon d. high dose insulin e. lipid emulsion

b. calcium (calcium chloride or gluconate)

CCB and BB toxicities: Increased inotropy and increased intracellular glucose transport a. atropine b. calcium c. glucagon d. high dose insulin e. lipid emulsion

d. high dose insulin

CCB and BB toxicities: Limits bioavailability of lipophilic medication by creating a “lipid sink” a. atropine b. calcium c. glucagon d. high dose insulin e. lipid emulsion

e. lipid emulsion

CCB and BB toxicities: blocks parasympathetic activity to inc heart rate a. atropine b. calcium c. glucagon d. high dose insulin e. lipid emulsion

a. atropine

vasodilatory shock a. norepinephrine b. epinephrine

a. norepinephrine

cardiogenic shock a. norepinephrine b. epinephrine

b. epinephrine

we may need to premedicate glucagon with _______ and add PRN regimen due to N/V a. ethambutol b. ondansetron c. promethazine d. metoclopramide

b. ondansetron

lipid emulsion therapy max total dose

10 mL/kg

T or F: activated charcoal is effective for iron toxicity

iron toxicity antidote a. atropine b. deferoxamine c. norepinephrine d. flumazenil

b. deferoxamine

deferoxamine dosing: start at ____ mg/kg/hour; may increase to ____ mg/kg/hour if severe poisoning

15; 45

Exam 6 - Toxicology Howell Flashcards

(59 cards)