Final - Toxicocolgy Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Final - Toxicocolgy > Flashcards

Flashcards in Final - Toxicocolgy Deck (98):
1

Initial things to do when a poisoning happens:

what things are used for stabilization?

ABC management (airway, breathing, circulation)
Vital signs
IV access
Oxygenation

2

Anion Ga
what is the equation?

(Na + K) - Cl - HCO3

3

Anion gap is present when the value of the equation is ______

is above 14

4

Normal reference range of osmolarity

285 - 300

5

Osmolar Gap = ________ - ________

measured osmolarity - calculated osmolarity

6

How to calculate osmolarity?

(2 x Na) + (BUN/2.8) + (Glu/18) + (EtOH/4.6)

7

Osmolar gap is present when ____

greater than 10

8

generic decontamination strategies when pt presents with a poisoning?

-Activated charcoal
-cathartics (accelerates defecation)
-gastric lavage (stomach pump)
-whole bowel irrigation (hella polyethylene glycol)
-hemodialysis

9

Activated Charcoal:
issues with it?

hard to administer (tastes AWFUL)
can not give when airway is unprotected (aspiration risk)

10

dose of activated charcoal?

1 - 2 GRAMS/kg (use actual body weight)

aka 50 - 100 grams in an adult

11

what drugs are examples of cathartics

magnesium citrate
sorbitol

12

complications from gastric lavage?

vomiting
aspiration
mechanical injury

13

whole bowel irrigation is good when what types of poisonings?

-sustained release products
-body packers/stuffers aka bags of cocaine were swallowed
- iron
- lithium

14

Whole bowel irrigation:
keep doing it until what?

go until there is CLEAR rectal effluent

15

dose for adults with whole bowel irrigation?

1000 - 2000 mL/HOUR!!!!!

16

Hemodialysis is good when what types of poisoning?

alcohols
lithium
salicylates
theophylline

17

Signs and symptoms of opioid toxicity

N/V
Drowsiness
PINPOINT pupils
Hypotension
bradycardia
respiratory depression

18

drug to use when opioid overdose??

naloxone...

19

Naloxone:
use lower doses when _____

use higher doses when ____

use continuous infusions when ______

lower: when chronic opioid dependence to avoid withdrawal

higher: when if illicit drug use suspected (heroin, fentanyl and derivative)

continuous infusion: when longer acting opioid

20

APAP Toxicity:
what is a toxic dose?

7.5 - 15 grams

21

APAP Toxicity:
what are things that make someone a high risk candidate

-malnutrition/chronic illness
-concomitant CYP2E1 inducers (isoniazid)
-chronic alcohol ingestion

22

APAP Toxicity:
protective conditions?

acute alcohol ingestion
children

23

APAP Toxicity:
APAP gets converted to ______ (the toxic metabolite) by CYP ______

NAPQI; CYP 2E1

24

APAP Toxicity:
NAPQI --> _________ = necrosis

APAP-cysteine groups

25

APAP Toxicity- Timeline:
Peak AST/ALTs wont happen until how long after ingestion?

72 - 96 hours

26

APAP Toxicity - Timeline
____ and ____ rise first;
then ____ and ____ will rise

AST/ALT first

then bilirubin and PT

27

2 treatment options with APAP Toxicity?

NAC (N-acetylcysteine)
Activated charcoal

28

Which treatment option for APAP Toxicity is recommended within the first 4 hours of ingestion?

activated charcoal (get it before it absorbs!)

29

Which treatment option for APAP toxicity needs an APAP concentration obtained at least 4 hours AFTER ingestion? and why?

NAC
Why = because look at a nomogram to see if NAC would help or not

30

what nomogram is used to see if NAC is needed

Rumack-Matthew Nomogram

31

MOA of NAC?

glutathione analogue that can serve as an intracellular glutathione surrogate

32

how is NAC available (formulation wise)

PO and IV

33

How long to use NAC as treatment?

if IV = 21 hours
if PO = 72 hours

34

NAC is most effective within the first _____ hours of ingestion

8 hours

35

Salicylate Toxicity:
electrolyte disturbance(s)?

Hypokalemia
Hypo/hyper natremia

36

Salicylate Toxicity - Concentrations:
Mild toxicity: > ____ mg/dL
Severe toxicity: > ____ mg/dL

mild: > 30
severe: > 80

37

Signs/Sxs of Salicylate Toxicity?

-N/V
-tinnitus and vertigo (seen at mild toxicity)
-decreased GI motility
-altered mental status (seen at severe toxicity)
-seizures (seen at severe toxicity)
-lethargy coma (seen at severe toxicity)

38

Salicylate Toxicity - Concentrations:
For analgesic properties: ___ - ___ mg/dL
For anti-inflammatory properties: ___ - ___ mg/dL

analgesic: 10 - 15
anti-inflame: 15 - 20

39

Salicylate Toxicity:
will see an ____ anion gap = metabolic _____

an elevated anion gap

metabolic acidosis

40

Salicylate Toxicity:
Antidote option?

sodium bicarbonate

41

MOA of Sodium bicarbonate with salicylate toxicity?

urine alkalinization

42

Indications for sodium bicarbonate in Salicylate Toxicity?

-Serum salicylate level > 30 mg/dL
-Anion gap metabolic acidosis
- altered mental status

43

Sedatives Toxicity: Signs and Symptoms?

similar to opioids (but NO pinpoint pupils)
- CNS depression
-Respiratory depression
-Hypotension
-Bradycardia

44

what is the drug that is competes with BZDs and the GABA binding site?

flumazenil

45

Flumanezil: used when in sedative toxicity?

used almost never.....
can cause seizures.....and then benzos cant be given to fix the seizure because the drug was given

46

TCA Toxicity -- Signs and Symptoms?

- altered mental status
- hypotension
- tachycardia
- PROLONGED QRS
-seizures
-anticholinergic symptoms

47

how to treat sedative toxicity?

just supportive care -- avoid FLUMAZENIL

48

TCA PK:
highly hydro- or lipo- philic

lipophilic

49

TCA Antidote?

Sodium Bicarbonate

50

MOA of Sodium Bicarbonate for TCAs?

increase of sodium gradient of poisoned sodium channels

51

Monitor what when giving sodium bicarbonate?

Serum pH 7.45-7.55
Monitor QRS/ECG

52

Antipsychotics:
1st gen: _____ antagonism
2nd gen: ________ antagonism

1st: D2 only
2nd: 5HT2A AND D2 antagonism

53

Antipsychotics Toxicity: Signs and Symptoms?

-hypotension
-tachycardia
-QT/QRS prolongation
-EPS (extrapyramidal symptoms)
-NMS (neuroleptic malignant syndrome)
-Sedation

54

what to give when extrapyramidal sxs present?

Benztropine
diphenhydramine

55

NMS symptoms?

Hyperpyrexia (fever of like 108!!)
altered mental status
"lead pipe" muscular rigidity

56

NMS:
how to treat?

stop offending agent (probably an atypical antipsychotic)
benzos
rapid external cooling
Dantrolene (muscle relaxant)

57

symptoms seen in serotonin syndrome?

altered mental status
autonomic instability
neuromuscular abnormalities

58

Serotonin syndrome: how to treat?

d/c agent
benzos
aggressive cooling
cyproheptadine

59

NMS or Serotonin Syndrome:
has a higher fever

NMS

60

NMS or Serotonin Syndrome:
will respond to cyproheptadine

serotonin syndrome

61

NMS or Serotonin Syndrome:
responds to bromocriptine

NMS

62

NMS or Serotonin Syndrome:
lasts > 24 hours

NMS

63

NMS or Serotonin Syndrome:
has DIFFUSE lead pipe rigidity

NMS

64

NMS or Serotonin Syndrome:
lower limbs are affected more than upper limbs

serotonin syndrome

65

Digoxin Toxicity: Signs and Symptoms:
Non cardiac??

N/V
abdominal pain
anorexia
confusion
VISION CHANGES!!! yellow halo

66

Digoxin Toxicity: Signs and Symptoms:
Cardiac??

Bradycardia
2nd/3rd degree heart block
arrhythmias
hyperkalemia

67

how to treat digoxin toxicity:
stop ______
_____ management
obtain _______ concentrations
monitor ______ changes
give ___________ (if within 2 hours of ingestion)
Consider administration of ________
__________ is NOT effective

stop dig
ABC management
obtain dig serum concentrations
monitor ECG changes
give ACTIVATED CHARCOAL (if within 2 hours of ingestion)
Consider administration of digibind
Hemodialysis is NOT effective

68

Digibind dosing done how?

0.5 mg of dig binds to one vial of digibind

69

CCB or BB or both toxicity?
hypoglycemia

BB

70

CCB or BB or both toxicity?
hypotension/bradycardia

both

71

CCB or BB or both toxicity?
bronchospasms

BB

72

CCB or BB or both toxicity?
arrhythmias/cadiogenic shock

bot

73

CCB or BB or both toxicity?
hyperglycemia

CCB

74

CCB or BB or both toxicity?
pulmonary edema

CCB

75

CCB or BB or both toxicity?
metabolic acidosis

CCB

76

potential options for combating CCB or BB toxicity?

atropine
calcium
vasopressor therapy
glucagon
High dose insulin therapy
lipid emulsion therapy

77

Calcium:
more effective for treating CCB toxicity or BB toxicity?

CCB

78

Calcium MOA for treating CCB toxicity?

Calcium opens Calcium channels = leads to myocardial contractility

79

what drugs are used for vasopressor therapy for BB toxicity?

epinephrine and norepinephrine (gotta use higher doses than normal to combat those beta receptors)

80

how does glucagon work for BB toxicity?

bypasses beta receptor and acts directly on Gs to stimulate conversion of ATP to cAMP

81

dosing for glucagon in BB toxicity?

minimum of 3 mg!!! 1 mg wont do the trick.

82

MOA of high dose insulin therapy for CCB and BB toxicity?

increased inotropy and increase intracellular glucose transport

83

dosing of insulin for CCB and BB toxicity?

like 1 unit/kg/hr IV
vs like normal insulin is 0.1 unit/kg/hr for DKA treatment

84

MOA of lipid emulsion therapy?

limits bioavailability of lipophilic medication by creating a lipid sink

85

Toxicology Tidbits Slide: (out of the 6 proposed methods for CCB/BB toxicity)
______ is not likely to be effective in either CCB or BB overdoses

atropine

86

Calcium Chloride vs gluconate:
______ has 3x more elemental Ca2+ in it but also has higher extravasation

Chloride

87

Toxicology Tidbits Slide: (out of the 6 proposed methods for CCB/BB toxicity)
______ therapy should be pre-medicated with anti-nausea meds

glucagon

88

Iron Toxicity Management:
Activated Charcoal: yay or nay?

Nay

89

Iron Toxicity:
Seen right away or in phases?

phases
(day 2 - 3 see hepatoxicity)

90

Iron Toxicity Management:
Whole bowel irrigation: yay or nay?

yay!

91

Iron Toxicity Management:
what is the iron antidote drug?

Deferoxamine (Desferal)

92

how does Deferoxamine work?

chelates iron and enhances renal elimination

93

which toxic alcohol is found in:
antifreeze, brake fluid/industry solvents

ethylene glycol

94

which toxic alcohol is found in:
rubbing alcohol, paint remover, cements, cleaners

isoproypyl alcohol

95

which toxic alcohol is found in:
windshield washer fluid, paint remover, copier fluid, some antifreeze/engine fuels

methanol

96

which toxic alcohol toxicity has an osmolar gap but NO anion gap

isopropyl alcohol

97

Ethylene glycol gets broken down to _____ acid which is the toxic metabolite

oxalic

98

For ethylene glycol toxicity:
give what to prevent it from getting metabolized to oxalic acid?

vitamins!! Thiamine; Mg2+; Pyridoxine