EXAM ONE Flashcards
(233 cards)
1
Q
What is the Phone Number to the Poison Center?
A
(800) 222-1222
2
Q
Skin Decontamination
A
- Contaminated skin should be washed thoroughly with SOAP and WATER
- Shower to wash body
- Clothing should be removed while bathing the skin with a stream of water
3
Q
Some skin poisonings such as ____ require decontamination.
A
Hydrofluoric Acid
4
Q
Ocular Irrigation
A
- Irrigate eyes for 15 minutes
- Dispose contacts
- Ophthalmic topical anesthetics can be used
5
Q
When irrigating the eyes for 15 minutes, what type of liquids can be used?
A
- Plain water
- Sterile water
- Normal saline
6
Q
What are the 2 techniques used to prevent GI absorption [GI Decontamination]?
A
- Gastric Emptying
- Prevention of Xenobiotic Absorption
7
Q
What can be used for gastric emptying?
A
- Orogastric Lavage
- Syrup of Ipecac
8
Q
What can be used for prevention of xenobiotic absorption (more common)?
A
- Activated Charcoal
- Hemodialysis
- Urinary Alkalinization
9
Q
What are the 3 techniques used to Enhance Elimination [GI Decontamination]?
A
- Multiple Dose Activated Charcoal MDAC
- Hemodialysis
- Urinary Alkalinization
10
Q
Define Gastric Decontamination
A
Techniques utilized to decrease xenobiotic absorption from the GI tract
11
Q
In terms of GI decontamination, as time passes from the time of exposure the ___ of decontamination ____.
A
Effectiveness, DECREASES
12
Q
Any potential benefit from GI decontamination is UNLIKELY after how many hours from the ingestion has elapsed?
A
2 HOURS
13
Q
The risk of the produce increases in GI contamination as the patient’s level of ____ DECREASES.
A
Consciousness
14
Q
Syrup of Ipecac MOA
A
- INDUCE EMESIS
- Direct effect on STOMACH and CNS
- Stimulates CHEMOTACTIC trigger zone
15
Q
Syrup of Ipecac Toxicity
A
Myocardial Toxicity
16
Q
Syrup of Ipecac should not be used in patients who are expected to rapidly deteriorate before emesis can occur, what types of poisonings would cause that?
A
- TCAs
- Beta Blockers
- Camphor
17
Q
Complications of Emesis
A
- Aspiration
- Sharp Objects Ingested
- Dehydration/Electrolyte Imbalance
- Need for rapid admin of antidotes
18
Q
Aspiration Risk with Emesis occurs when?
A
Ingestion of POORLY absorbed Hydrocarbons
19
Q
Define Gastric Lavage
A
Pumping the Stomach
20
Q
When is Gastric Lavage considered (rarely used)?
A
- Potentially life-threatening poisoning and presentation within 1 hour
- Potentially life-threatening poisoning with drug with anticholinergic effects and presentation with 4 hours
- Ingestion of sustained release preparation of significantly toxic drug
21
Q
When is Gastric Lavage Contraindicated?
A
Corrosive ingestions or esophageal disease
22
Q
What are the complications of Gastric Lavage?
A
- Increased absorption of small tablets
- Aspiration
- Esophageal Rupture
- Bradycardia, cardiac arrest, asystole
23
Q
Cardiac Arrest/Bradycardia is a complication of gastric lavage with what type of drug poisonings?
A
- Propranolol
- CCBs
24
Q
Do we recommend gastric lavage anymore, yes or no?
A
NO
25
When would you consider Activated Charcoal?
1. Toxin in the Stomach
2. Benefit outweighs Risk
26
What is the dosing of Activated Charcoal?
1 gram/kg
MAX: 100 grams
27
What are the indications for Activated Charcoal?
Drug ingested is adsorbed by charcoal and has significant potential for toxicity AND ___
1. Time since ingestion <1-2 hrs OR
2. Drug has significant enterohepatic recirculation OR
3. Drug delays gastric emptying and time since ingestion is <4 hrs OR
4. Drug is in a controlled release form and time since ingestion is <12-18 hrs
28
Define Whole Bowel Irrigation WBI
A technique that uses large volumes of iso-osmolar solution that is not absorbed
29
What is an iso-osmolar solution?
PEG
30
What are the 4 indications of Whole Bowel Irrigation?
1. Massive ingestion of sustained release product
2. Body packers/stuffers
3. Substance not readily absorbed by activated charcoal
4. Pharmacobezors
31
What is an example of sustained release product that when consumed in massive amounts can cause poisoning?
Bupropion
32
When is Whole Bowel Irrigation Contraindicated?
1. Signs of drug absorption in a body pack/stuffer
2. GI tract not intact
3. Unstable airway
33
What are the Contraindications to Activated Charcoal? PHAILS
P: pesticides
H: hydrocarbons
A: alcohol, acid/alkali, aspiration
I: iron
L: lithium/liquids
S: solvents
34
Enhanced Elimination is used when?
Enhancing the elimination of a XENOBIOTIC from a poisoned patient
35
Enhanced Elimination is most commonly used in WEAK ACID drugs, why?
Weak acids are absorbed in the stomach, and be unionized in a pH of 1-2. When the drug passes the kidney if the pH of urine is ABOVE 7, the drug will be trapped and eliminated.
36
What type of toxicities is Enhanced Elimination induced for?
1. Salicylate
2. Barbiturate
3. Methotrexate
37
What are the methods of Enhanced Elimination?
1. Multidose Activated Charcoal
2. Urinary Alkalinization with Sodium Bicarb
38
If performing Urinary Alkalinization for Enhanced Elimination, what should be added to the therapy regimen?
POTASSIUM
39
What is the MOA of Multi-Dose Activated Charcoal?
1. Interrupt enterohepatic and enters-enteric recirculation
2. AKA GUT dialysis
40
Multi-Dose Activated Charcoal MDAC is indicated for toxicity from drugs known to adsorb to AC with high enterohepatic or entero-enteric recirculation, list those drugs.
1. Theophylline
2. Phenobarbital
3. Dapsone
4. Carbamazepine
5. Quinine
41
List the Toxin characteristics that allow for a xenobiotic to be cleared via Hemodialysis.
1. Small volume of distribution
2. Highly water soluble
3. Low protein binding
4. Low molecular weight
42
What are examples of Xenobiotics that could be cleared via Hemodialysis?
1. Alcohols
2. Lithium
3. Salicylates
4. Valproic Acid
5. Theophylline
6. Sotalol
43
What is the most frequent Adverse Effect of Hemodialysis?
Hypertension
44
Define Toxidrome
Clinical constellation of s/s that is very suggestive of a particular poisoning or category of intoxication
45
What are the 5 factors in Recognition of Toxidromes?
1. Anticholinergic
2. Cholinergic
3. Opioid
4. Seizure Toxidrome
5. High Anion Gap Metabolic Acidosis Toxidrome
46
What Vital Signs are common for Anticholinergic Toxidrome?
Hypertension and Tachycardia
47
What CNS Symptoms are common for Anticholinergic Toxidrome?
Hallucinations and Agitation
48
What Metabolic Symptoms are common for Anticholinergic Toxidrome?
Fever, Flushing, Dry
49
What Ocular Symptoms are common for Anticholinergic Toxidrome?
Mydriasis, Non-Reactive Pupil
50
List Symptoms associated with Anticholinergic Toxidrome
1. Dry
2. Decreased Bowel Sounds
3. Non-Reactive Pupils
4. Slightly Hyperthermic
51
List Symptoms associated with Sympathomimetic Toxidrome
1. Diaphoretic
2. Normal Bowel Sounds
3. Reactive Pupils
4. Very Hyperthermic
52
Anticholinergic Toxidrome Mnemonic
Dry as a Bone
Red as a Beet
Blind as a Bat
Mad as a Hater
Hot as Hades
53
List the Agents that are known to cause Anticholinergic Toxidrome
1. Atropine
2. Antihistamines
3. Antipyschotics
4. Antiepileptics (carbamazepine)
5. Benztropine (cogentin)
6. Antispasmodics (dicyclomine)
7. Muscle Relaxants (cyclobenzaprine)
8. Tricyclic Antidepressants (amitriptyline)
9. Plants (belladonna alkaloids)
54
What is the treatment for Anticholinergic Toxidrome Symptoms: Agitation, Tachycardia, and Seizures?
Benzodiazepines
55
What is the treatment for Anticholinergic Toxidrome that UNSTABLE agitated delirium, severe tachycardia, or hyperthermia even with benzos given?
Physostigmine
56
Physostigmine must be given in the ICU, but when is it's use contraindicated?
For TCA Overdose
57
What are the Nicotinic Symptoms for Cholinergic Toxidrome?
M: mydriasis
T: tachycardia
W: weakness
H: hypertension
H: hyperglycemia
F: fasciculations
58
What are the Muscarinic Symptoms for Cholinergic Toxidrome?
D: diarrhea
U: urination
M: miosis
B: bradycardia
B: bronchorrhea
B: bronchospasm
E: emesis
L: lacrimation
S: swelling
59
List the Agents that are known to cause Cholinergic Toxidrome
1. Organophosphate Insecticides
2. Nerve Gas Agents
3. Carbamate Insecticides
4. Clitocybe and Inocybe Mushrooms
5. Medical ACh Inhibitors (donepezil)
6. Muscarinic Agonists (pilocarpine)
60
What is used for Cholinergic Toxidrome Treatment of Bradycardia, Bronchorrhea, and Broncospasm?
Atropine
61
What is used for Cholinergic Toxidrome Treatment of Seizures?
Benzodiazepines
62
What is used as a Reversal Agent for Cholinergic Toxidrome?
Pralidoxime 2-PAM
63
What are the symptoms of Opioid Toxidrome?
1. CNS Depression
2. Respiratory Depression
3. Bradycardia
4. Hypotension
5. Miosis
64
What is the antidote for Opioid Toxidrome?
Naloxone
65
What are the Vital Signs seen in Sympathomimetic Toxidrome?
Hypertension, Tachycardia
66
What are the CNS Symptoms seen in Sympathomimetic Toxidrome?
Excitation, Agitation, Seizures, Restless, Tremor
67
What are the Metabolic Symptoms seen in Sympathomimetic Toxidrome?
Hyperthermia
68
What are the Illicit Drugs that can cause Sympathomimetic Toxidrome?
1. Amphetamines
2. Cocaine
3. MDMA
4. Cathinone
5. Cannabinoids
69
What are the Decongestant Drugs that can cause Sympathomimetic Toxidrome?
1. Pseudoephedrine
2. Phenylephrine
70
What are the Stimulant Drugs that can cause Sympathomimetic Toxidrome?
1. Adderall
2. Concerta
3. Phenylephrine
71
What are the Thyroid Hormones that can cause Sympathomimetic Toxidrome?
1. Liothyronine T3
2. Levothyroxine T4
72
What are the Dieting Agents that can cause Sympathomimetic Toxidrome?
1. Ephedrine
2. Caffeine
73
Define Body Packer
Professional carries of well packed illicit drugs
74
Define Body Stuffer
Swallowing or Inserting relatively small amounts of loosely wrapped drug because of fear of arrest
75
What are the Supportive Treatment Measures in Sympathomimetic Toxidrome?
1. Cooling
2. IV Fluids
76
What are the Supportive Treatment Measures in Sympathomimetic Toxidrome?
1. Cooling
2. IV Fluids
77
What is given for agitation, restlessness, tachycardia, palpitations, hypertension in Sympathomimetic Toxidrome?
Benzodiazepines
78
If there is no response to Benzodiazepines for Dysrhythmia in Sympathomimetic Toxidrome, what protocol must be used?
ACLS
79
If there is no response to Benzodiazepines for HTN in Sympathomimetic Toxidrome, what must be avoided?
1. AVOID Vasodilator Nitroprusside
2. AVOID Beta Blockers ALONE
3. AVOID Monotherapy Alpha Stimulation
80
Seizure Differential OTIS
O: organophosphates
T: tricyclic antidepressantts
I: insulin, isoniazid
S: sulfonylureas, salicylates, sympathomimetics
81
Seizure Differential CAMPBEL
C: camphor, CO, cyanide
A: anticholinergics
M: methanol, methylxanthines , mushrooms
P: PCP, propranolol, plants
B: bupropion, benzodiazepine withdrawal
E: ethanol withdrawal, ethylene glycol
L: lead, lindane, lithium, lidogaine
82
High Anion Gap Differential CAT
C: cyanide, CO
A: aspirin, alcoholic ketoacidosis
T: theophylline, toluene
83
High Anion Gap Differential MUDPILES
M: methanol, metformin
U: uremia
D: diabetic ketoacidosis
P: paracetamol, phenformin
I: iron, isoniazid, ibuprofen
L: lactic acidosis
E: ethanol
S: starvation
84
What is ABCTR and it's role in approaching an unknown overdose?
A: Airway
B: Breathing
C: Circulation
T: Temperature
R: Rhythm
85
What is the concern with Airway?
If the patient is vomiting, roll them of their side to not block the airway
86
What is the concern with Breathing?
1. Respiratory Failure
2. Ventilatory
3. Hypoxia
4. Cellular Inhibitors
5. Hypercarbia
87
Define Ventilatory
No air moving
88
Define Hypoxia
No gas crossing to the blood
89
Define Cellular Inhibitors
no oxygen being used
90
What is the concern with Circulation?
1. BP, HR, Rhythm
2. Hypotension
3. Perfusion
91
Define Preload Hypotension
Volume Loss and Venodilation
92
Define Afterload Hypotension
Loss of Sympathetic Tone
93
When Diagnosing a Poisoning, what 4 things must be considered?
1. History
2. Clinical Lab Toxicology
3. Labs
4. Recognition of Toxidrome
94
What happens to the QRS in a TCA Overdose?
It becomes WIDER, aka takes longer to get conduction through the ventricles
95
What is the formula for Anion Gap?
(Na+) - [(Cl-) + (HCO3)] = Anion Gap
96
What is a normal Anion Gap range?
8-12 mEq/L
97
What is the formula for Osmolality?
2(Na+) + glucose/18 + BUN/2.8
98
What is the normal range for Osmolality?
290 mOsm/L or less
99
What is Osmolar Gap?
Different between calculated and observed
100
What is the normal range for Osmolar Gap?
<10 mOsm/L
101
What are the causes of Osmolar Gap?
1. Ethanol
2. Methanol
3. Isopropanol
4. Ethylene Glycol
102
What is the difference between pCO2 and HCO3?
pCO2 = partial pressure of carbon dioxide
HCO3 = plasma bicarb concentration
103
Define Acid Base Balance
Defines the interaction between the metabolic and respiratory systems of the body
104
What is the Henderson/Hasselbach Equation?
pH = 6.1 + log [(HCO3)/(pCO2 x 0.03)]
105
What are the units of pCO2?
mmHg
106
What are the units HCO3?
mEq/L
107
What are the units CO2?
mEq/L
108
What is the normal pH of Blood Gas?
7.35-7.45
109
What is the normal range of pCO2 in Blood Gas?
35-45 mmHg
110
What is the normal range of HCO3 in Blood Gas?
20-26 mEq/L
111
What is Base Excess BE?
A convention to tell how abnormal the HCO3 is
112
A low pCO2 hyperventilating suggests what?
Respiratory Alkalosis
113
How to calculate BE?
Subtract calculated HCO3 from theoretical normal
114
What do BE values mean?
Neg Number = below normal
Pos Number = above normal
115
What are the steps in recognizing the types of respiratory depression?
1. Assess the Metabolic
2. Assess the Respiratory
3. Is there Compensation
116
Below BE = what?
Metabolic Acidosis
117
Above BE = what?
Metabolic Alkalosis
118
Below Normal pCO2 = what?
Respiratory Alkalosis
119
Above Normal pCO2 = what?
Respiratory Acidosis
120
What is a toxin that can cause metabolic acidosis and quick breathing?
Salicylate Toxicity
121
What are the qualities of Normal Saline?
154 mEq/L sodium and chloride
pH 5.5
122
What liquids are used for resuscitative fluids?
1. Normal Saline
2. 5% Phasmanate
3. 25% Albumin
4. Lactated Ringer
123
What are the qualities of 5% Plasmanate?
5% plasma proteins/88% albumin
145 mEq/L sodium
0.25 mEq/L potassium
100 mEq/L chloride
124
What are the qualities of 25% Albumin?
130-160 mEq/L sodium
125
What are the qualities of Lactated Ringer?
130 mmol/L sodium
109 mmol/L chloride
28 mmol/L lactate
4 mmol/L potassium
1.5 mmol/L calcium
126
What are the 4 Categories of Chemical Weapons?
1. Blister Agent
2. Choking Agent
3. Blood Agent
4. Nerve Agent
127
Blister agents are Vesicants, name 2 known examples
1. Mustard Gas H
2. Lewisite
128
Name 3 known Choking Agents
1. Phosgene CG DP- industrial chemical
2. Methyl Isocanate
3. Anhydrous Ammonia - most available, its a fertilizer
129
Name 2 known Blood Agents
1. Hydrogen Cyanide AC
2. Cyanogen Chloride
130
Name 3 known Nerve Agents
1. Tabun GA
2. Sarin GB
3. Soman GD
131
What is the MOA of Nerve Agents?
Inhibit AChE just like organophosphates
132
High Solubility Irritant Gases, name 2 agents and where it affects the body
1. Isocyanate
2. Anhydrous Ammonia: common fertilizer
AIRWAYS
133
Medium Solubility Irritant Gases, name the agent and where it affects the body
1. Chlorine
AIRWAYS, BRONCHI, ALVEOLAR
134
Low Solubility Irritant Gases, name the agent and where it affects the body
1. Phosgene
ALVEOLAR, BRONCHI
135
What is used in Cyanide Treatment?
Hydrocoalblamin
--> + cyanide = cyanocobalamin aka Vitamin B12
136
If you give Atropine for Mascarininc s/s from Nerve Agents, what must be given with it?
2-PAM
137
If you give 2-PAM for nicotinic/muscarinic s/s from Nerve Agents, what can it do?
Reverse neuromuscular blockage
138
What are the historical sources of lead in U.S. history?
1. Mining
2. Lead Paint
3. Gasoline (EPA mandates removal now)
139
What are the contemporary sources of lead in the U.S.?
1. Herbal Remedies
2. Cheap Jewelry
3. Retained Bullets
4. Stained Glass
5. Clay Pots
6. Indoor Firing Ranges
140
What are 2 considerations in the relationship of health?
1. Medical Diagnosis
2. Statistical or Epidemiologic Diagnosis
141
What are individual symptoms of lead poisoning compared to a epidemiological risk?
1. Anemia >40
2. Colic >50
3. Lead Lines
4. Peripheral Neuropathies
5. Encephalopathy >70
142
What is the nemesis of Lead?
Hemoglobin
143
Lead Encephalopathy MOA
1. Cells unable to maintain homeostasis
2. Apoptosis
3. Edema
4. Blood Flow decreases
144
What population studies are used to understand the clinical impact of Lead?
1. Multiple Regression
2. Multiple Comparisons
3. Variables not Independent
145
What is the main treatment MOA for Lead Poisoning?
Chelation
146
What levels of Lead Poisoning would you consider therapy?
>70 mcg/dL = medical emergency
45-70 mcg/dL = oral chelation
<45 mcg/dL = no benefit chelator
147
List the 4 Chelator Agents
1. Calcium Disodium EDTA = IV serious cases
2. BAL British AntiLewisite = IM
3. d-Penicillamine
4. Succimer/Dimercaptosuccinic Acid
148
Define Acrodynia
Mercury Poisoning
149
What are the S/S of Acrodynia?
1. Sweating
2. Swollen Red feet/hands
3. Painful to Touch
4. Desquamating
150
How to define Acrodynia?
Urine - Random Heavy Metal Screen
151
List 2 forms of Mercury Hg
1. Mercuric Nitrate - convert hide into felt
2. Calomel/Mercurous CI - medical creams
152
Mercury Poisoning binds to SH groups in proteins, where does acute and chronic poisoning take place in the body?
Acute = Renal and GI
Chronic = Neurological
153
We all ingest Arsenic mostly in water, but is arsenic toxic?
NO, but Arsenic TRIOXIDE IS TOXIC
154
What are the symptoms of Iron Poisoning?
1. Shock
2. Acidosis
155
When should you treat iron poisoning?
Iron >500 mcg/dL and merits CHELATION
156
What is the 5th leading cause of death almost those >65 years?
Drug Related Problem
157
Over ___% of prescription medications are taken by the elderly >65 years.
30%
158
___% of OTC medications are consumed by older people.
40-50%
159
Increased likelihood of significant ___ ___ interactions with increased number of medications
drug-drug
160
Define AGS Beers Criteria
List of approximately >130 medications and doses considered to be potentially inappropriate for the elderly
161
Use of Medications from the Beers Criteria are associated with what?
1. Decreased quality of life
2. Increased risk of hospitalizations
3. Prolongation of hospitalizations
162
What 3 Drug Classes are known to cause adverse drug events in elder >65 yrs?
1. Anticoagulants
2. Diabetes Agents
3. Opioid Analgesics
163
What are the PK Absorption changes in Aging?
1. Decreased first pass effect with oral admin
2. HF impacts absorption
3. Percutaneous, subcutaneous, and IM absorption unknown, expected delayed
164
What are the PK Distribution changes in Aging?
1. Body Composition Changes
165
What are the PK Metabolism changes in Aging?
1. Liver Size, Blood Flow DECLINE with age
2. Phase 1 Metabolic Pathways diminish
166
What are the Phase 1 Metabolic Pathways that diminish?
1. Oxidation
2. Reduction
3. Hydrolysis
167
Are the Phase 2 Metabolic Pathways diminished with age, yes or no?
NO
168
What are the PK Elimination changes in Aging?
1. Lose 10% of renal function
169
What are the Pharmacodynamic Changes of Aging?
1. Alterations in receptor affinity
2. Alterations in receptor number
3. Enhanced or diminished post receptor response
170
Hypochlorite Solutions
-Bleach Products
-Irrigate affected area with water
171
Formulation of Chloride Gas
Bleach + Acid
172
Treatment for Chloride Gas and Chloramine Gas
1. Fresh Air
2. Supplemental Air
3. Steroids
4. Bronchodilators
173
Formulation of Chloramine Gas
Bleach + Ammonia
174
Where do Detergent poisonings occur?
1. Skin
2. GI tract
3. Pulmonary tract
175
What pH causes for an Acidic Poisoning?
pH <7, any product
176
What is the MOA of Acidic Poisoning?
Denatured proteins clump together to form Coagulum, --> cardiovascular/skin necrosis
177
What pH causes for a Basic Poisoning?
Any product pH >7
178
What are common agents that causes Basic Poisoning?
1. Oven Cleaners
2. Drain Clog Removers
179
What is the MOA of Basic Poisoning?
Denatured fat treats a weat/soapy substance -> slimy skin
180
How does Hydrofluoric Acid cause poisoning?
1. Liberation of fluoride ions > complex with positive ions
2. Salt complex causes tissue injury decreased Ca and Mg, and increased K
3. Causes dysrhythmias
181
How does Hydrocarbons cause poisoning?
1. GABA Receptor Agonist
2. Destroys surfactant, leads to respiratory distress, hypoxia, pulmonary edema
3. GI Irritation
182
Halogenated Hydrocarbons have what increased risk?
Increased risk of sudden sniffing death syndrome
183
Methylene Chloride is metabolized to what?
Carbon Monoxide
184
Toulene can cause ____ acidosis.
Metabolic
185
Where does poisoning occur with Hydrogen Peroxide?
1. Local tissue injury
2. Gas formation
186
Where does poisoning occur with Boric Acid?
Good GI/Poor Dermal Absorption
187
Shampoos are what?
Irritants
188
Conditioners are what?
Irritant, Emollient/Laxative
189
Mousse/Gel are what?
Irritant, Emollient/Laxative
190
Relaxers are what?
Corrosive
191
What symptoms are seen with Dyes Poisoning?
1. Vomiting
2. Painful Swelling of Mouth/Throat
192
Permanents (hair product) are what?
Corrosive
193
Nail Polish/ Polish Remover is what?
Minor Irritant
194
Acetone a common nail polish remover is known to cause what?
Drowsiness
195
Acetonitrile found in nail glue remover is known to cause what?
Cyanide Toxicity
196
Toothpaste main AE from massive ingestion is what?
N/V/D
197
Denture Cleaners are what?
Irritant
198
Mouthwash is what?
1. Eye Irritant
2. Intoxication
199
What is ingredients found with Fluoride Toxicity?
1. Sodium Fluoride 128
2. Sodium Monofluorophosphate 37
3. Fluoride Ion 218
200
What is the equation for mg/kg dosing when dealing with fluoride content?
(concentration [%])(amount ingested [oz])(constant)/ patient weight [kg]
201
Calculate the recommendation for a child 11.4 kg who had a massive ingestion of Fluoride: 1/2 of 4oz tube of NaF 0.15%
(0.15)(2)(128)/11.4 = 3.37 mg/kg
Give the child 4-6 ounces of milk
202
What is the threshold for emergency room referral with fluoride toxicity mg/kg?
>8 mg/kg
203
Moth balls are what?
GI Irritant
204
T/F, you can safely monitor ingestion of <1 mothball at home.
True
205
Camphor is what?
1. CNS Stimulant
2. GI/Ocular irritant
206
Camphor can cause what symptoms with toxicity?
CNS Stimulant = Seizures
207
Where do Button Batteries most commonly proceed to that does not lead to serious toxicity?
Stomach
208
If Button Batteries are ingested it is a medical emergency, yes or no?
YES
209
Desicants (Silica Gel/Ageless Oxygen) toxicity can be managed at home, yes or no?
YES
210
Define Forensic Toxicology
The study of the harmful effects of chemicals on living organisms and its application to the law
211
Regulatory Importance of Forensic Toxicology
Concerned with heath hazards, risl
212
Workplace Importance of Forensic Toxicology
Concerned with occupational risk/impairment/liability
213
Judicial Importance of Forensic Toxicology
Concerned with criminal/civil injury or death
214
Public Health Importance of Forensic Toxicology
Concerned with epidemiological assessment
215
Define Human Performance Toxicology
Effects of legal and illegal drugs on skills acquisition, learning, and performance
216
What are established criteria for recognizing effects of of human performance toxicology?
1. Field Sobriety Tests
2. Drug Recognition Experts
3. Predicting/Interpreting behaviors
217
What are 3 Sectors to consider in Forensic Drug Testing?
1. Military
2. Criminal/Civil Justice System
3. Private Sector (employment/sports/TDM)
218
What is the oldest form of toxicology?
Postmortem Toxicology
219
Why is Postmortem Toxicology complex?
1. Diversity of drugs/poisons
2. Quantity/quality of specimen
3. Extractions
4. Interpretation
220
What are the 2 Questions that are most important in a Medical Examiner's Office?
1. Cause of Death COD
2. Manner of Death MOD
221
What are Causes of Death?
1. Natural disease
2. Injury
3. Drug/Poison
222
What are Manners of Death?
1. Natural
2. Accident
3. Suicide
4. Homicide
5. Unknown
223
Living Assumptions are Normal ADME, what falls under these assumptions
1. Medical Conditions
2. Illness
3. Injury
224
In Deceased personnel, what ends and what begins?
1. Breathing ceases
2. Blood flow ceases
3. Digestion slowly ceases
4. Metabolism slowly ceases
5. Decomposition starts
225
Define Postmortem ADME
A: incomplete distribution
D: postmortem redistribution
M: endogenous and microbial
E: not so much
226
For present forensics, which part of postmortem ADME is the MOST important and LEAST controlled?
D: redistribution
227
Postmortem Redistribution is influenced by what?
1. Drug Chemistry
2. Drug PK
3. Distribution Mechanism
228
Postmortem, where is the blood collected and why?
Femoral Vein, because no distribution occurs there
229
Define Antemortem
1. Blood/Serum
2. Urine
3. Oral Fluid
4. Breath
5. Sweat
6. Hair
7. Nails
Before Death
230
What is the testing approach for Postmortem?
1. Testing
2. Screening
3. Confirmation
231
Screening is the preliminary identification of drug/drug classes what are the 2 possible results?
1. Negative
2. Positive
232
Confirmation in postmortem provides what?
Greater sensitivity and specificity of drug/metabolite
233
What is the difference between Antemortem and Postmortem?
Antimortem: what you see is what you get
Postmortem: convoluted due to decomposition
