General Principles

Question 1

criteria used to determine whether the exposure is nontoxic are as follows:

Answer 1

(1) an unintentional exposure to a clearly identified single substance,
(2) an estimate of the dose is known, and
(3) a recognized information source (e.g., a poison control center) confirms the substance as nontoxic in the reported dose

Question 2

True or false

Asymptomatic patients with nontoxic exposures may be discharged after a short period of observation, providing they have access to further consultation and a safe discharge destination.

Answer 2

True

Question 3

What are the three antidotes  indicated before cardiopulmonary stabilization

Answer 3

Naloxone for opiate toxicity,
cyanide antidotes for cyanide toxicity, and
atropine for organophosphate poisoning

Question 4

are often administered empirically as a cocktail in cases of altered mental status

Answer 4

TONG

thiamine

oxygen

naloxone

glucose

Question 5

administered for sodium channel–blocker toxicity with cardiovascular complications, such as wide QRS complex tachydysrhythmias

Answer 5

Sodium bicarbonate

Question 6

Drug-induced seizures are treated with titrated doses of__________________, with the exception that isoniazid-induced seizures require____________.

Answer 6

IV benzodiazepines

pyridoxine

Question 7

second-line agents for benzodiazepine-resistant seizures (once isoniazid-induced seizures are excluded)

Answer 7

Propofol and barbiturates

Question 8

What is the intervention for Calcium channel blocker or beta-blocker overdose?

Answer 8

High-dose insulin infusion

Question 9

What is the intervention for Local anesthetic agents Lipophilic cardiotoxins overdose?

Answer 9

IV lipid emulsion

Question 10

Antidote for  Hydrogen sulfide

Answer 10

Sodium nitrite (3% solution)

Question 11

Antidote for  Hypermagnesemia

Answer 11

Calcium gluconate 10%
9 milligrams/mL elemental Ca

Question 12

Antidote for  Calcium channel blockers

Answer 12

Calcium chloride 10%
27.2 milligrams/mL elemental Ca

Question 13

Antidote for  Nitroprusside

Answer 13

Hydroxocobalamin

Question 14

Antidotes for Clonidine

Answer 14

Naloxone

Question 15

Antidote for Isoniazid

Answer 15

Pyridoxine

Question 16

Used for Urinary alkalinization

Answer 16

Sodium bicarbonate

Question 17

Wernicke’s syndrome Wet beriberi antidote

Answer 17

Thiamine

Question 18

True or false

There is no role for phenytoin in the treatment of toxin-induced seizures; it has neither theoretical nor proven efficacy, and it may worsen toxicity.

Answer 18

True

Question 19

Agitation is treated with titrated doses of___________

____________________are often used as second-line agents for toxin-induced agitation ‘

Answer 19

benzodiazepines

antipsychotic agents

Question 20

True or false

 First genera- tion antipsychotics, such as haloperidol have been associated with QT- interval prolongation and cardiac dysrhythmias

Answer 20

True

Question 21

Patients with core temperatures of ______C (>102.2°F) require aggressive active cooling measures to prevent complications

Answer 21

> 39°

Question 22

core temperature ______C (<90°F) is an indication for active rewarming

Answer 22

<32°

Question 23

Several toxidromes associated with hyperthermia are treated with specific pharmaceutical agents:

1. sympathomimetic
2. serotonin
3. neuromuscular malignant syndrome

Answer 23

1. benzodiazepines
2. cyproheptadine
3. bromocriptine

Question 24

is a nontoxic, diagnostic, and therapeutic antidote. It is a competitive opioid antagonist administered IV, IM, or intranasally to reverse opioid-induced deleterious hypoventilation

Answer 24

Naloxone

Question 25

Patients should be observed for_________ after adminis- tration of IV naloxone.

Answer 25

2 to 3 hours

Question 26

True or false  serum acetaminophen concentration is a routine screening test in poisoned patients because early acetaminophen poisoning is often asymptomatic and does not have a readily identifiable toxidrome at the time when antidotal treatment is most efficacious.

Answer 26

True

Question 27

Identify the toxidrome Altered mental status, mydriasis, dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mucous membranes Seizures, arrhythmias, rhabdomyolysis

Answer 27

Anticholinergic Atropine, Datura spp., antihistamines, antipsychotics

Question 28

Identify the toxidrome  Salivation, lacrimation, diaphoresis, vomiting, urination, defecation, bronchorrhea, muscle fasciculations, weakness Miosis/mydriasis, bradycardia, seizures

Answer 28

Cholinergic Organophosphate and carbamate insecticides Chemical warfare agents (sarin, VX)

Question 29

Identify the toxidrome  CNS depression, ataxia, dysarthria, odor of ethanol

Answer 29

Ethanolic

Question 30

Identify the toxidrome  Dystonia, torticollis, muscle rigidity Choreoathetosis, hyperreflexia, seizures

Answer 30

Extrapyramidal Risperidone, haloperidol, phenothiazines

Question 31

Identify the toxidrome  Hallucinations, dysphoria, anxiety Nausea, sympathomimetic signs

Answer 31

Hallucinogenic Phencyclidine Psilocybin, mescaline Lysergic acid diethylamide

Question 32

Identify the toxidrome  Altered mental status, diaphoresis, tachycardia, hypertension Dysarthria, behavioral change, seizures

Answer 32

Hypoglycemic Sulfonylureas, insulin

Question 33

Identify the toxidrome Lead-pipe muscle rigidity, bradyreflexia, hyperpyrexia, altered mental status Autonomic instability, diaphoresis, mutism, incontinence

Answer 33

Neuromuscular malignant Antipsychotics

Question 34

Identify the toxidrome Miosis, respiratory depression, CNS depression Hypothermia, bradycardia

Answer 34

Opioid Codeine, heroin, morphine

Question 35

Identify the toxidrome Altered mental status, respiratory alkalosis, metabolic acidosis, tinnitus, tachypnea, tachycardia, diaphoresis, nausea, vomiting Hyperpyrexia (low grade)

Answer 35

Salicylate Aspirin Oil of wintergreen (methyl salicylate)

Question 36

Identify the toxidrome  CNS depression, ataxia, dysarthria Bradycardia, respiratory depression

Answer 36

Sedative/hypnotic Benzodiazepines Barbiturates

Question 37

Identify the toxidrome Altered mental status, hyperreflexia and hypertonia (>lower limbs), clonus, tachycardia, diaphoresis Hypertension, flushing, tremor

Answer 37

Serotonin SSRIs MAOIs Tricyclic antidepressants Amphetamines Fentanyl St. John’s wort

Question 38

Identify the toxidrome Agitation, tachycardia, hypertension, hyperpyrexia, diaphoresis Seizures, acute coronary syndrome

Answer 38

Sympathomimetic Amphetamines Cocaine Cathinones

Question 39

Alkalis produce greater injury than acids due to deep tissue penetration via liquefaction so that prolonged irrigation Of how long may be required?

Answer 39

(1 to 2 hours)

Question 40

primary indication for urinary alkalinization is

Answer 40

moderate to severe salicylate toxicity when criteria for hemodialysis have not been met.

Question 41

Admission is indicated if__________________________. In most cases, a ______hour observation period is sufficient to exclude the development of serious toxicity.

Answer 41

the patient has persistent and/or severe toxic effects or will require a prolonged course of treatment 6-hour