Poisoning and Toxidromes

Question 1

What are the main alterations to mental status with sympathomimetic toxins?

Answer 1

• Hyperalert
• Agitation
• Hallucinations
• Paranoia

Question 2

How do sympathomimetics alter pupil size?

Answer 2

Cause myadriasis

Question 3

What changes to vital signs might you see in someone with sympathomimetic intoxication?

Answer 3

• Hyperthermia
• Tachycardia
• Hypertension
• Widened pulse pressure
• Tachypnoea
• Hypernoea

Question 4

What are examples of sympathomimetic agents?

Answer 4

• Cocaine
• Amphetamines
• Cathinones
• Ephidrine
• Pseudoephedrine
• Theophylline
• Caffeine

Question 5

What signs might you find in someone with sympathomimetic overdose other than changes in vital signs?

Answer 5

• Diaphoresis
• Tremors
• Hyperreflexia
• Seizures

Question 6

What alterations to mental status occur in anticholinergic overdose?

Answer 6

• Hypervigilance
• Agitation
• Hallucinations
• Delerium with mumbling speech
• Coma

Question 7

What changes occur to pupil size due to anticholinergic overdose?

Answer 7

Cause myadriasis

Question 8

What changes to vital signs can anticholinergic toxicity cause?

Answer 8

• Hyperthermia
• Tachycardia
• Hypertension
• Tachypnoea

Question 9

What signs might you see in someone with anticholinergic intoxication other than the changes you would see to vital signs?

Answer 9

• Dry flushed skin
• Dry mucous membranes
• DEcreased bowel sounds
• Urinary retention
• myoclonus
• Choreoathetosis
• Picking behaviour
• Seizures (rare)

Question 10

What are examples of anticholinergic drugs which can cause anticholinergic toxidrome?

Answer 10

• Antihistamines
• TCA
• Antiparkinson agents
• Antispasmodics
• Phenothiazines
• Atropine
• Cyclobenzarine

Question 11

What alterations to mental status can hallucinogenic intoxication cause?

Answer 11

• Hallucinations
• Perceptual distrotion
• Depersonalisation
• Synesthesia
• Agitation

Question 12

What is the most common type of pupil change seen in hallucinogen intoxication?

Answer 12

Myadriasis

Question 13

What changes to vital signs can hallucinogens cause?

Answer 13

• Hyperthermia
• Tachycardia
• Hypertension
• Tachypnoea

Question 14

What signs might you see in someone with hallucinogen intoxication other than the changes seen to their vital signs?

Answer 14

Nystagmus

Question 15

What are examples of hallucinogenic drugs which can cause hallucinogenic toxidrome?

Answer 15

• Phencyclidine
• LSD
• Mescaline
• Psilocybin
• MDMA
• MDEA

Question 16

What changes to metnal status can sedative/hypnotic agents as part of the sedative/hypnotic toxidrome?

Answer 16

• CNS depression
• Confusion
• Stupor
• Coma

Question 17

What are examples of sedative/hypnotic agents which cane cause toxidromes?

Answer 17

• Benzodiazepines
• Barbituates
• Carisoprodol
• Meprobamate
• Glutethimide
• Alcohols
• Zolpidem

Question 18

What changes to pupil size can sedative/hypnotic agents cause?

Answer 18

Variable - either myosis or myadriasis

Question 19

What changes to vital signs can hypnotic/sedative agents cause?

Answer 19

Often normal, but may develop

• Hypothermia
• Bradycardia
• Hypotension
• Apnoea
• Bradypnoea

Question 20

What other signs might be evident when assessing someone with sedative/hypnotic intoxication other than changes to their vital signs?

Answer 20

Hyporeflexia

Question 21

What changes to metnal status occur in opiod intoxication?

Answer 21

• CNS depression
• Coma

Question 22

What change to pupil size occurs in opiod intoxication?

Answer 22

Miosis

Question 23

What changes occur to vital signs in someone with opiod intoxication?

Answer 23

• Bradypnoea - apnoea characteristic
• Hypothermia
• Bradycardia
• Hypotension

Hypothermia, bradycardia and hypotension occur in large dose intoxication

Question 24

What other signs can be seen in opiod intoxication besides changes seen to vital signs?

Answer 24

• Hyporeflexia
• Pulmonary oedema
• Needle marks

Question 25

What are examples of opioids that cause intoxication?

Answer 25

* **Heroin** * **Morphine** * **Methadone** * **Oxycodone** * **Hydromorphone** * **Fentanyl** * **RemyFentanyl**

Question 26

What changes to mental status can occur in cholinergic intoxication?

Answer 26

* **Confusion** * **Coma**

Question 27

What changes to pupil size would you see in cholinergic intoxication?

Answer 27

Miosis

Question 28

What changes to vital signs might you see in cholinergic intoxication?

Answer 28

* **BRadycardia** * **Hyper/hypotension** * **Tachypnoea/bradypnoea**

Question 29

What other signs can cholinergic intoxication cause other than observed changes to vital signs?

Answer 29

* **Salivation** * **Urinary/faecal incontinence** * **Diarrhoea** * **Emesis** * **Diaphoresis** * **Lacrimation** * **GI cramps** * **Bronchoconstriction** * **Muscle fasciculations** * **Weakness** * **Seizures**

Question 30

What cholinergic drugs can cause chokinergic intoxication?

Answer 30

* **Organophosphate/carbamate insecticides** * **Nerve agents** * **Nicotine** * **Pilocarpine** * **Physostigmine** * **Edrophonium** * **Bethanechol** * **Urecholine**

Question 31

What changes to metnal status can occur in serotinin syndrome?

Answer 31

* **Confusion** * **Agitation** * **Coma**

Question 32

What changes in pupil size occur in serotonin syndrome?

Answer 32

Myadriasis

Question 33

What change in vital signs are often seen in serotonin syndrome?

Answer 33

* **Hyperthtermia** * **Tacycardia** * **Hypertension** * **Tachypnoea**

Question 34

What signs might you see other than changes to vital sign in serotonin syndrome?

Answer 34

* **Tremor** * **Myoclonus** * **Hyperreflexia** * **Clonus** * **Diaphoresis** * **FLushing** * **Trismus** * **Rigidity** * **Diarrhoea**

Question 35

What toxidromes are associated with myadriasis?

Answer 35

* Hallucinogenic toxidrome (usually) * Serotonin syndrome * Sympathomimemtic toxidrome * Anticholinergic toxidrome

Question 36

What toxidromes are associated with miosis?

Answer 36

* **Opiod toxidrome** * **Cholinergic toxidrome**

Question 37

What toxidromes are associated with hyperthermia, hypertension, tachypnoea and tachycardia?

Answer 37

* **Sympathomimetic toxidrome** * **Anticholinergic toxidrome** * **Hallucinogenic toxidrome** * **Serotonin syndrome**

Question 38

What toxidrome often presents with respiratory depression?

Answer 38

Opioid toxidrome