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Tox Flashcards

0
Q

Toxins most frequently dialyzed

A

ASA, Li, methanol, ethylene glycol, theophylline

drugs that are dialyzable:
blist med
barbituates, lithium, inh/iron, salycilates, thophylline, methanol, ethylene glycol, depakoate

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1
Q

Multi dose activated charcoal

A

GI dialysis
For drugs w/ large volume of distribution
Theophylline, phenobarbital, carbamazepine
-Quinine, salicylates, sustained release formulas

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2
Q

Serum osm

A
  • Should be done in the setting of persistent acidosis
  • Useful if elevated
  • Difference between measured osm and calculated osm >10 is always significant.
  • Abnormal osmolal gap does NOT rule out toxic alcohol ingestion
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3
Q

Methanol metabolism

A

MeOH -(via ADH)-> formaldehyde -Aldehyde dehydrogenase)-> formic acid -(Folate cofactor)-> CO2 + H2O

causes blindness and
basal ganglia necrosis -> parkinsonian

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4
Q

Physostigmine

A
  • anticholinergic antidote
  • indications: central & peripheral effects
  • contraindications: h/o severe bronchospasm, low heart rate, abnormal cardiac conduction
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5
Q

Indication for HD in toxic alcohols

A

presence of toxic metabolites of ethylene glycol and methanol

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6
Q

drugs assoc w/ hypoglycemia

A 
Tylenol
Salicylates
Insulin
Alcohol
Oral hypoglycemics
Check a glucose on all pts w/ AMS!!
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7
Q

indications for activated charcoal

A

if ingestion occurs w/in 1 hour & a rapid deterioration is expected (eg TCAs), or if a small decrease in toxin may be critical

1-2g/kg
optimal charcoal:toxin ratio is 10:1 by weight

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8
Q

contraindications to charcoal?

A
  • Contraindicated in ingestion of HYDROCARBONS, b/c toxicity from gastric absorption not a major concern
  • Caustics, acids or alkalis - b/c tox from burns
  • Trivial ingestions
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9
Q

indications for urine alkalinization in overdose

A

salicylates, phenobarb, INH
target urine pH of 7-8
Replace K to alkalinize urine - needed for HCO3 to be excreted

NO urine acidifications or forced diuresis - don’t work!

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10
Q

indications for HD in overdose

A

water soluable, small Vd
low protein binding
low molecular weight

eg: salicylates, toxic alcohols, Li, theophylline, phenobarbital

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11
Q

antidote for tylenol

A

NAC

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12
Q

antidote for arsenic

A

NAD, DMS

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13
Q

antidote for ASA

A

alkaline diuresis w/ IV NaHCO3

hyperventilate if intubated to keep alkalotic

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14
Q

antidote for BB

A

glucagon

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15
Q

antidote for barbituate

A

alkaline diuresis, HD

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16
Q

antidote for CCB

A

Ca, glucacon, glucose/insulin

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17
Q

antidote for carbamate

A

atropine

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18
Q

antidote for CO

A

100% O2, hyperbaric O2

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19
Q

antidote for warfarin

A

FFP, Vit K

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20
Q

antidote for cyanide

A

sodium nitrite, sodium thiosulfate or

hydroxycobalamin

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21
Q

antidote for digitalis

A

digibind, fab fragments

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22
Q

antidote for ethylene glycol

A

EtOH, dialysis, 4-MP

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23
Q

antidote for heparin

A

protamine

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24
antidote for hydrofluoric acid
Ca, Mg
25
antidote for Fe
deferoxamine
26
antidote for INH
Vit B6 (pyridoxine)
27
antidote for Pb
BAL, DMS, EDTA
28
antidote for MERCURY
BAL, DMS
29
antidote for methemoglobin
methylene blue
30
antidote for methanol
EtOH, dialysis, 4MP
31
antidote for nitrites
methylene blue
32
antidote for opiates
naloxone
33
antidote for organophosphates
atropine, 2-PAM
34
antidote for oral hypoglycemic agents
glucose, glucagon, octreotide
35
antidote for TCA
Sodium bicarbonate If seizing give benzodiazepine
36
causes of elevated anion gap metabolic acidosis
``` Ketones Uremia Lactic acid Toxic alcohols Salycilates ```
37
gastric lavage
only useful if <1H on in large overdoses where chargcoal wont work c/i: caustics, hydrocarbons, AMS w/o airway control, pt refusal
38
whole bowel irrigation
golytely to prevent intestinal absomrption dose 2L/hr per NGT until clear rectal effluent heavy metals, drug packers, sustained-release meds c/i: gi bleed, bowel obstruction/perf
39
gi decon
decontaminate before symptoms appear
40
Rumack-Matthew nomogram
acute Tylenol only the likelihood of hepatic toxicity given an acetaminaophen level and time Below nomogram line, hepatotoxicity unlikely to occur Above nomogram line, hepatotoxicity is probable and NAC is inidicated bt the two nomogram lines hepatotox is possible and clinical judgement is required 150--200 4 hour post ingestion level is the most important and accurate initial point for the nomogram line
41
NAC
repletes glutathione stores oral or iv forms available virtually 100% protection if given w/in 8 hours of ingestion
42
tylenol metabolization
Tylenol metabolized in liver to sulfate and glucuronide conjugates as these pathways become saturated, more APAP gets shunted towards the P450 pathway resulting in increasedd NAPQI detox of NAPQI depletes glutathione stores low glutathione stores leads to nonspecific action of NAPQI and damages cell NAC repletes glutathione stores thus preventing hepatotoxic effects of NAPQI
43
indications for HD in ASA overdose
AMS, cerebral/pulmonary edema, renal failure salicylate >100 mg/dL in acute overdose
44
where can ethylene glycol be found
antifreeze
45
where can methanol be found
wood alcohol | windshield wiper fluid
46
toxic alcohols
EtOH, isopropanol, MeOH, EtOH all cause an abnormal osmolar gap all are metabolized by ADH metabolism of isopropanol does not cause an elevated anion gap
47
toxic metabolites of ethylene glycol
glyoxylic acid | oxalic acid
48
indications for digibind
1 rhythm/conduction disturbance 2 K >5 mEq/dL 3 serum dig >10-15 in an acute ingestion 6 hours post ingestion or >4 in a chronic ingestion 4 acute dig ingestion of >10 mg (4 mg in a child) 5 empirically for undiagnosed bradycardia (clinical judgement) empiric tx for acute overdose is 10 vials (adult or child) empiric tx for chronic overdose is 5 vials in adult
49
Sulfonylurea poisoning
Dextrose then octreotide Octreotide a synthetic somatostatin analog, antagonizes release of insulin
50
Isopropanol
metabolized to acetone by ADH (alcohol dehydrogenase) causes ketosis w/o acidosis minimal toxicity
51
Glucagon
Insulin antagonist Relaxes smooth muscle of gi tract
52
Clonidine in overdose
Centrally acting alpha 2 agonist. Expressed level of consciousness Respiratory depression Mitosis May closely mimic opioid overdose
53
EKG changes in TCA OD
QRS widening Terminal R in aVR S in lead I
54
GHB OD
Intermittent bouts of agitation with quick return to coma Rapid full return to consciousness from comatose state
55
Linezolid
Has MAOI properties
56
Anticholinergic plants
Jimsonweed
57
Effexor in overdose
SNRI Has Na channel blocking properties Significant overdose can present with QRS prolongation Seizures Presentation and tx similar to TCA overdose
58
HF burn
Where do u find it? Silver cleaner What does burn look like? Mgmt?
59
Indications for 4MP in toxic alcohols
ethylene glycol and methanol ingestions

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