Therapeutics + Toxicology

Question 1

Anion gap is calculated as:

Answer 1

(Sodium + potassium) - (chloride + bicarbonate)

Question 2

Ethylene glycol toxicity - blood gas

Answer 2

Metabolic acidosis with high anion gap and high osmolar gap

Question 3

Management of Ethylene glycol toxicity

Answer 3

Fomepizole

An inhibitor of alcohol dehydrogenase

Question 4

Local anesthetic toxicity can be treated with:

Answer 4

IV 20% lipid emulsion

Question 5

AIT type 1

Answer 5

Excess iodine-induced thyroid hormone synthesis

Goitre - Present

Carbimazole or potassium perchlorate

Question 6

AIT type 2

Answer 6

Amiodarone-related destructive thyroiditis

Goitre - Absent

Corticosteroids

Question 7

Management of Malignant hyperthermia

Answer 7

Dantrolene

Prevents Ca2+ release from the sarcoplasmic reticulum

Question 8

Management of Cyanide poisoning

Answer 8

Supportive measures:
100% oxygen

Definitive:
hydroxocobalamin (intravenously),

Also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

Question 9

Management of cocaine toxicity

Answer 9

Benzodiazepines

Beta Blockade is contraindicated in CVS problems

Question 10

Overdoses that can be dialysed

Answer 10

BLAST

Barbiturates
Lithium
Alcohols e.g. ethylene glycol
Salicylates
Theophyllines

Question 11

Organophosphate insecticide poisoning - mechanism

Answer 11

Inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission

Question 12

Management of Organophosphate insecticide poisoning

Answer 12

Atropine

Question 13

Drugs causing lung fibrosis

Answer 13

Amiodarone

Cytotoxic agents: busulphan, bleomycin

Anti-rheumatoid drugs: methotrexate, sulfasalazine

Nitrofurantoin

Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 14

Trastuzumab

Answer 14

(Herceptin) is a monoclonal antibody directed against the HER2/neu receptor

Cardiotoxicity

Question 15

Inducers of the P450 system

Answer 15

Antiepileptics: phenytoin, carbamazepine

Barbiturates: phenobarbitone

Rifampicin

St John’s Wort

Chronic alcohol intake

Smoking

Question 16

Inhibitors of the P450 system

Answer 16

Antibiotics: ciprofloxacin, erythromycin

Isoniazid

Cimetidine, Omeprazole

Amiodarone

Imidazoles: ketoconazole, fluconazole

SSRIs: fluoxetine, sertraline

Sodium valproate

Acute alcohol intake

Question 17

Osmolar gap

Answer 17

Measured osmolality - calculated osmolality

Question 18

Calculated osmolality

Answer 18

2Na + glucose + urea

Question 19

DRESS syndrome

Answer 19

Drug Reaction with Eosinophilia and Systemic Symptoms

Question 20

Management of cocaine toxicity

Answer 20

Benzodiazepines are generally first-line

Question 21

What medication to avoid in cocaine induced coronary vasospasm.

Answer 21

Beta Blockers

Question 22

Organophosphate poisoning - MOA

Answer 22

Inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission

Question 23

Management of Serotonin syndrome

Answer 23

Supportive including IV fluids

Benzodiazepines

More severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Question 24

Drugs causing lung fibrosis

Answer 24

Amiodarone

Cytotoxic agents: busulphan, bleomycin

Anti-rheumatoid drugs: methotrexate, sulfasalazine

Nitrofurantoin

Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Question 25

What is the appropriate advice to the patient regarding the safe cessation of anabolic steroid use?

Answer 25

Stop immediately - Tapering not required.

Question 26

Treatment of amiodarone induced thyrotoxicosis type 2

Answer 26

Corticosteroids Antithyroid drugs are favoured in AIT type 1 - where the pathophysiology involves excess thyroid hormone synthesis stimulated by the iodide load from amiodarone therapy

Question 27

HIT - management

Answer 27

Heparin anticoagulants must be withheld Bivalirudin (non-heparin anticoagulant)

Question 28

HIT - anti-thrombotic or pro-thrombotic?

Answer 28

Pro-thrombotic

Question 29

Causes of a high osmolar gap include:

Answer 29

Mannitol Methanol Ethylene glycol

Question 30

King's College Hospital criteria for liver transplantation (paracetamol liver failure)

Answer 30

Arterial pH < 7.3, 24 hours after ingestion OR Prothrombin time > 100 seconds Creatinine > 300 µmol/l Grade III or IV encephalopathy

Question 31

Salicylate overdose management

Answer 31

Urinary alkalinization with IV bicarbonate Haemodialysis

Question 32

Opioid/opiates overdose management

Answer 32

Naloxone

Question 33

Benzodiazepines overdose management

Answer 33

Flumazenil

Question 34

Tricyclic antidepressants overdose management

Answer 34

IV Bicarbonate

Question 35

Type 1 amiodarone induced thyrotoxicosis - define

Answer 35

Increased production of thyroid hormone, most likely as a result of the excess iodine load administered to the patient as a result of amiodarone treatment

Question 36

Type 2 amiodarone induced thyrotoxicosis - define

Answer 36

Destructive thyroiditis

Question 37

ECG changes of TCA poisoning

Answer 37

Sinus tachycardia Widening of QRS Prolongation of QT interval

Question 38

Treatment of Thallium Poisoning

Answer 38

Oral Prussian Blue

Question 39

Trimethoprim - pregnancy

Answer 39

Avoid for first three months

Question 40

Reduce ophthalmological complications in Methanol poisoning

Answer 40

Folinic acid

Question 41

Management for Iron Overdose

Answer 41

Desferrioxamine - a chelating agent

Question 42

Drugs for Heparin Induced Thrombocytopenia management.

Answer 42

Direct thrombin inhibitor: Argatroban Danaparoid

Question 43

Lithium toxicity can be precipitated by:

Answer 43

Any medicines that can impair renal function or induce hyponatraemia: ACE inhibitors Diuretics (particularly thiazides including bendroflumethiazide and indapamide) NSAIDs

Question 44

Management of Iron overdose

Answer 44

Whole bowel irrigation Desferrioxamine