Poisoning & Overdose

Question 1

Drugs / classes (3) that cause mydriasis?

Answer 1

Sympathomimetics, meperidine, anticholinergics

Question 2

Drugs / classes (2) that cause miosis?

Answer 2

Opioids, cholinergics

Question 3

Time limit for activated charcoal?

Answer 3

1-2 hours

Question 4

Multiple doses of charcoal is effective for removing what? (5)

Answer 4

Carbamazepime, barbituates, theophylline, dapsone, quinine

Question 5

Alkaline urination (Ur pH > 7) effective for removing what (2)?

Answer 5

salicylates, barbituates

Question 6

Sx of ethylene glycol and methanol poisoning?

Answer 6

CNS, GI, cardiopulmonary

Question 7

Lab findings of ethylene glycol & methanol

Answer 7

HAGMA, Osm gap

Question 8

Buzzword: Oxalate crystals in urine”. What exposure?

Answer 8

Ethylene glycol

Question 9

Buzzword: “visual changes”. What exposure?

Answer 9

Methanol

Question 10

Tx ethylene glycol or methanol exposure?

Answer 10

Fomepizole or Ethanol

Question 11

Indications for HD in ethylene glycol or methanol poisoning?

Answer 11

Level >25-50, HAGMA, Osm gap >25, renal failure, visual symptoms

Question 12

Buzzword: “Antifreeze”. What exposure?

Answer 12

Ethylene glycol.

Question 13

Flumazenil treats BZD and what other drug overdose?

Answer 13

Zolpidem

Question 14

Contraindications for flumazenil?

Answer 14

• Concurrent TCA use.

- Chronic BZD use.

Question 15

Hyperglycemia is seen in what cardiac medication overdose?

Answer 15

CCBs.

Question 16

Tx (CCB overdose)

Answer 16

High dose insulin. Like, loads of it. 1 unit / kg bolus, then 1 unit/kg/hr.

Question 17

Avoid what sedative in sympathomimetic overdose?

Answer 17

haldol causes seizures.

Question 18

Tx (ACS secondary to cocaine)?

Answer 18

ASA, BZD, nitro, reperfusion. If no acute sympathomimetic symptoms, then use CCBs or BBs.

Question 19

Lab abnormality in synthetic marijuana overdose?

Answer 19

AKI

Question 20

Synthetic marijuana contaminated with what other toxin?

Answer 20

Brodifacon (rat poison / super-warfarin)

Question 21

Cyanide poisoning in what (4) settings?

Answer 21

• Metalwork.
• Smoke/Fire exposure.
• nitroprusside.
• Fruit pits.

Question 22

Tx (CN)?

Answer 22

Thiosulfate, hydroxycobalamin (B12)

Question 23

Sx (antidepressant OD)?

Answer 23

AMS (w/ TCAs), arrhythmias, hypotension, seizures

Question 24

Tx (antidpressant OD)?

Answer 24

• Blood alkalinization.
• If refractory, 3% saline, lipid emulsion.
• Vasopressor w/ alpha activity.

Question 25

Tx (Sulfonurea OD)?

Answer 25

octreotide inhibits insulin release.

Question 26

Toxic levels of lithium?

Answer 26

2.5-4

Question 27

Tramadol causes false positive for what test?

Answer 27

PCP on UDS

Question 28

Components of SLUDGE acronym for cholinergic syndrome?

Answer 28

- Salivation. - Lacrimation. - Urination. - Defication. - GI Upset. - Emesis.

Question 29

Treatment of cholinergic syndrome?

Answer 29

Atropine. Glycopyrollate is 2nd line. Pralidoxime for weakness. Avoid succinylcholine.

Question 30

3 agents / classes that cause cholinergic syndrome?

Answer 30

Organophosphates, carbamates, nerve gas

Question 31

Buzzword: Hookah smoking. Exposure?

Answer 31

CO

Question 32

Tx (CO)?

Answer 32

O2

Question 33

Exposure contained in hand sanitizer?

Answer 33

Ethanol, isopropyl alcohol

Question 34

Buzzword: "Topical Anesthetics". Exposure?

Answer 34

methemoglobinemia

Question 35

Tx (Methemoglobinemia)?

Answer 35

methylene blue

Question 36

Difference in mentation of neuroleptic malignant syndrome vs serotonin syndrome?

Answer 36

NMS is catatonic. Serotonin syndrome is agitated.

Question 37

Difference in muscle activity of neuroleptic malignant syndrome vs serotonin syndrome?

Answer 37

NMS is rigit. Serotonin is clonus, tremulous.