Tox 2 Flashcards by Sara Fieger

CCB symptoms

vasodilation and HoTN***

decreased perfusion = CNS and pulmonary manifestations

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severe CCB OD sxs

complete heart block
depressed myocardial contractility
vasodilation = CV collapse

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non DHP OD

sinus Brady
av block
HoTN

I.e. verapamil, diltizem

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DHP OD

TACHYCARDIA
peripheral vasodilation
HoTN

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pulm manifestations CCB toxicity

due to decreased perfusion

can be seen if given execss crystalloid

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CNS symptoms CCB toxicity

seizure
delirium
coma

secondary to hypo perfusion

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EKG findings CCB toxicity

sinus bradycardia

AV block

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lab findings CCB toxicity

hyperglycemia

lactic acidosis

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CI of oral activated charcoal

> 2 hrs

AMS, vomiting

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list of pharm tx CCB toxicity

atropine
Ca salts
IV crystalloid
pressers
cardiac pacing

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IV cyrstalloid CCB toxicity

HoTN management

over resuscitation = produce or worsen pulmonary edema

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pacing CCB toxicity

indicated if HoTN and severe Brady (< 30 bpm)

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digoxin tx for?

AF and symptomatic CHF

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digoxin MOA

inhibitor of Na-K ATPase

toxicity = increased intracellular Na, Ca, extracellular K

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digoxin Ca accumulation

augments inotrophy

results in PVC and dysrhythmia

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digoxin cardiac glycoside

increased vagal tone = reduction in conduction thru SA and AV nodes

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manifestations of gen digoxin toxicity

Syncope, dysrhythmia
GI distress, dizzy, HA, weak, confusion/AMS

**Bradycardia

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acute digoxin toxicity sxs

neuro manifestations

yellow green halo in vision (xanthopsia)

hyperkalemia***

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chronic digoxin toxicity sxs

renal function/decreased body mass

GI symptoms

Neuro (weakness, fatigue, confusion, delirium)

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how is digoxin toxicity diagnosed?

EKG

T wave flattening/inversion
scooped ST segment

dig level increase = 6 hrs after ingestion

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antidote of digoxin toxicity

Dig-Fab/Digibind

binds to digoxin in plasma, removes from tissues

given if HyperK presents

Lithium toxicity with what drug?

TZDs

also in renal insufficiency

succinylcholine and vecuronium prolonged effect

ADR of Lithium toxicity

fine postural hand tremor 
fatigue 
polyuria (loss of ability to concentrate urine) 
hypothyroid 
development of ataxia/dysarthria

Lithium toxicity tx

hemodialysis
IVF
ABCD

hemodialysis indications Lithium toxicity

impaired renal function seizure activity dysrhythmia lithium level >4.0 mEq

Carbon Monoxide | Patho

Colorless, odorless gas Combines with HgB to form COHgB which has greater affinity for O2 than tissues Decreased oxygen delivery to tissue

Carbon Monoxide | Sources of Exposure

Smoke, car exhaust, hibachi grill, kerosene heater, methylene chloride

CO S/S based on saturation | <5%

none/mild HA

CO S/S based on saturation | 10%

Slight HA, dyspnea on vigorous exercise

CO S/S based on saturation 20%

Throbbing HA, dyspnea with moderate exertion

CO S/S based on saturation 30%

Severe HA, irritability, fatigue, dim vision

CO S/S based on saturation 40-50%

tachycardia , confusion, lethargy, syncope,

CO S/S based on saturation 50-70%

Coma, death

CO S/S based on saturation >70%

Rapidly fatal

CO poison key Clinical features

Tachycardia, pallor skin (early), cherry red skin (late)

CO | Tx

Humidified oxygen | +/- HBO

Salicylate Toxicity | Clinical Features

Agitation, altered, diaphoretic, tinnitus, n/v, tachycardia and hyperventilation, fever

Salicylate Toxicity | Toxic Effects

1. Central respiratory stimulation (respiratory alkalosis and secondary metabolic acidosis) 2. Uncoupling of oxidative phosphorylation 3. Interference with lipid and carbohydrate metabolism 4. Acid Base abnormalities 5. Decreased PCO2 and respiratory alkalosis 6. Anion gap metabolic acidosis (lactic acidosis and ketoacidosis

Salicylate Toxicity labs

``` BMP (anion gap) ABG Glucose Cr Salicylate normal (NML 15-30) ```

Salicylate Toxicity tx

Activated charcoal Correction of fluid and electrolytes IV sodium bicarbonate Hemodialysis Intubation is dangerous in these patients (removes ability to compensate for acidosis)

acute Salicylate Toxicity

Single ingestion >300 mg/kg Hemodialysis: >100 mg/dL

chronic Salicylate Toxicity

Non specific symptoms (confusion, dehydration and metabolic acidosis) Hemodialysis: >60 mg/dL

Isopropranolol Clinical Features

CNS depression Hemorrhagic gastritis Pulmonary edema, hypoglycemia Severe HoTN

IsopropranololTx

ABCs IV hydration Hemodialysis

Methanol source

Windshield fluid, antifreeze, moonshine

Methanol Symptoms

12-18 hrs later ``` Visual change/blurring Scotomata Snow storm blindness Seizure Respiratory failure ```

Ethylene Glycol | Clinical Features

Flank pain Hematuria Oliguria seizure Respiratory failure

tx | Methanol and Ethylene Glycol

Supportive 4-MP fomepizole IV ETOH Sodium bicarbonate and hemodialysis

Anion Gap Metabolic Acidosis

Na - (Cl + HCO3) NML: 8-12 mEq/L If elevated, MUDPILES

MUDPILES

etiologies of anion gap metabolic acidosis ``` M methanol U uremia D DKA P paraldehyde I INH, Iron, Isopropyl alcohol L Lactic Acidosis E ethylene glycol S salicylates ```

Osmol Gap

Used to evaluate unexplained anion gap MC 2/2: methanol, ethylene glycol, isopropanol