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Tox Flashcards

1
Q

pt with tinnitus, hyperventilation, altered mental status, renal toxicity, which medication have they taken ?

A

aspirin

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2
Q

what is the metabolic abnormality in asa overdose?

A

respiratory alkalosis progressing to metabolic acidosis

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3
Q

mechanism of metabolic acidosis in asa overdose

A

asa uncouples oxdative phosphorlyatin results in anaerobic glucose metabolism, and lactic acidosis

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4
Q

treatment of asa overdose

A

alkalinizing the urine, which increases excretion

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5
Q

best initial test in TCA overdose

A

ECG

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6
Q

treatment of TCA overdose

A

sodium bicarbonate to protect against arrhythmia

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7
Q

management of caustic ingestion, eg. drain cleaner,

A

use water in high volumes to flush out the caustics; never reverse alkali with acid or vice versa = exothermic run and more damage

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8
Q

complication of caustic ingestion, eg. drain cleaner

A

mechanical damage to the oropharynx, esophagus and stomach including perforation

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9
Q

what exposure associated with carbon monoxide

A

gas heaters or wood-burning stoves, automobile exhaust particularly in closed environment

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10
Q

best initial therapy for carbon monoxide poisoning

A

100% oxygen, detaches CO from Hb and shortens half life of carboxyhemoglobin

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11
Q

treatment of severe carbon monoxide poisoning (severe = CNS, cardiac symptoms or metabolic acidosis)

A

hyperbaric oxygen

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12
Q

drugs associated with methemoglobinemia

A

benzocaine, nitrites and nitroglycerin, dapsone

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13
Q

symptoms of methemoglobinemia

A

SOB and cyanosis, headache, confusion, seizures, metabolic acidosis

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14
Q

best initial therapy for methemoglobinemia

A

100% O2

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15
Q

most effective therapy for methemoglobinemia

A

methylene blue

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16
Q

cyanosis + normal PO2

A

methemoglobinemia

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17
Q

abnormal brown blood is seen in which condition

A

methemoglobinemia

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18
Q

best initial therapy in organophosphate poisoning with salivation, lacrimation, urination,defecation and SOB

A

atropine

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19
Q

adjuvant therapy in organophosphate poisoning

A

pralidoxime

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20
Q

what electrolyte abnormality predisposes patients to digoxin toxicity

A

hypokalemia because K and dig compete for the binding at the same site on Na/K ATPase and therefore less K = more dig bound

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21
Q

GI: N,V, abdo pain, hyperkalemia, confusion, visual disturbance: yellow halos around objects, rhythm disturbance: any arrhythmia on ECG = toxicity of ____

A

digoxin toxicity

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22
Q

best initial tests in digoxin toxicity

A

ECG and K

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23
Q

treatment of digoxin toxicity

A

digoxin-specicif c antbidoes

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24
Q

symptoms in lead poisoning (5)

A
  1. abdominal pain (lead colic)
  2. ATN (renal tubule toxicity)
  3. sideroblastic anemia
  4. peripheral neuropathies ie. wrist drop
  5. CNS abnormalities: memory loss and confusion
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25
most accurate test in lead poisoning
lead level
26
best initial test in lead poisoning
increased level of free erythrocyte protoporphyrin
27
most accurate test for sideroblastic anemia
Prussian blue stain - detects increased iron built up in RBC mitochondria
28
treatment of lead poisoning
succimer is PO, EDTA and dimerparpol are IV chelating agents
29
mercury toxicity
orally ingested: neuro problems, inhaled: lung toxicity that presents as interstitial fibrosis; neuro problems include nervous, jittery, twitchy and sometimes hallucinations
30
treatment of mercury toxicity
no therapy for reverse lung toxicity; chelating agents
31
intoxication and metabolic acidosis and increased anion gap
toxic alcohosl- methanol or ethylene glycol
32
wood alcohol, cleaning solutions, paint thinner may be source of ___
methanol
33
antifreeze contains ___
ethylene glycol
34
toxic metabolite of methanol
formic acid/formaldehyde
35
initial diagnostic abnormality in methanol poisoning
retinal inflammation
36
complication of methanol poisoning
ocular toxicity
37
toxic metabolite of ethylene glycol
oxalic acid/oxalate
38
complication of ethylene glycol poisoning
renal rtoxicity
39
initial diagnostic abnormality in ethylene glycol poisoning
hypocalcemia, envelope-shaped oxalate crystals in urine
40
best initial therapy for methanol/ethylene glycol poisoning
fomepizole - inhibits alcohol dehydrogenase and formation of toxic metabolite
41
definitive therapy for toxic alcohol ingestion
dialysis is only way to remove from body
42
death from snake bites due to 2 things
1. hemolytic toxin: hemolysis and DIC | 2. neurotoxin: respiratory paralysis, ptosis, dysphagia, diplopia
43
treatment of snake bites
pressure, immobilization decreases movement of venom, antivenin
44
black widow spider bite presentation
abdominal pain, muscle pain, hypocalcemia
45
treatment of black widow spider bite
calcium, antivenin
46
brown recluse spider bite presentation
local skin necrosis, bull, and blebs
47
treatment of brown recluse spider bite
debridement, steroids, dapsone
48
treatment of dog, cat or human bites
amoxicillin/clavulanate, tetanus booster
49
bacteria in cat bites
Pasteurella multocida
50
bacteria in human bites
Eiekenella corrodens
51
indication for rabies vaccine
animal has altered mental status or bizarre behaviour; attack was unprovoked by a stray dog that cannot be observed or diagnosed
52
agents causing mitosis of pupils
``` COPS cholinergic, clonidine, carbamates opioids, organophosphates phenothiazines, pilocarpine, pontine hemorrhage sedative-hypnotic ```
53
agents causing mydriasis of pupils
SAW sympathomimetics anticholinergics withdrawal syndromes
54
agents causing coma
``` LETHARGIC lead, lithium ethanol, ethylene glycol, ethchlorvynol TCA, thallium, toluene heroin, hemlock, hepatic encephalopathy, heavy metals, hydrogen sulphide, hypoglycaemia arsenic, antidepressants, anticonvulsants, antipsychotics, antihistamines rohypnol, risperidone GHB isoniazid, insulin CO, CN, clonidine ```
55
agents causing seizures
``` OTIS CAMPBELL organophosphates, oral hypoglycemias TCAs isoniazid, insulin sympathomimetics, strychnine, salicylates ``` camphor, cocaine, CO, CN, chlorinated hydrocarbons amphetamines, anticholinergics methylxanthines (theophylline, caffeine), methanol PCP, propranolol benzo withdrawal, botanicals (water hemlock, nicotine), bupropion, GHB EtOH withdrawal, ethylene glycol lithium, lidocaine lead, lindane
56
agents causing diaphoretic skin
``` SOAP sympathomimetics organophosphates asa, other salicylates PCP ```
57
agents causing dry skin
antihistamines | anticholinergics
58
agents causing bullies lesions or blisers
barbiturates and other sedative-hypnotics mustard gas snakes and spiders
59
agents causing flushed or red skin
anticholinergics, nicchia boric acid CO CN
60
agents causing cyanosis
``` ergotamine nitrates nitrites aniline dyes phenazopyridine dapsone agent causing hypoxemia, hypotension or methemoglobinemia ```
61
agents causing acneiform rash
bromides | chlorinated aromatic hydrocarbons
62
tox source associated with odor of bitter almonds
cyanide
63
tox source associated with odor of carrots
cicutoxin
64
tox source associated with odor of fruity
DKA, isopropanol
65
tox source associated with odor of garlic
organophosphates, arsenic, DMSO, selenium
66
tox source associated with odor of gasoline
petroleum distillates
67
tox source associated with odor of mothballs
naphthalene, camphor
68
tox source associated with odor of pears
chloral hydrate
69
tox source associated with odor of pungent aromatic
ethchlorvynol
70
tox source associated with odor of oil of wintergreen
methylsalicylate
71
tox source associated with odor of rotten eggs
SO2, hydrogen sulfide
72
tox source associated with odor of freshly mowed hay
phosgene
73
cholinergic toxidrome - muscarinic symptoms
DUMBELLS - diarrhea, diaphoresis - urination - miosis - bradycardia - bronchorrhea - emesis - lacrimation - lethargic - salivation
74
cholinergic toxidrome - nicotinic symptoms
MTWTFSS - mydriasis - tachycardia - weakness - tremors - fasciculations - seizures - somnolent
75
anticholinergic toxidrome
- dry skin - hyperthermia - flushed - mydriasis - psychosis - urinary retention - tachycardia - hot as a hare (hyperthermia) - dry as a bone (dry skin, urinary retention) - blind as a bat (mydriasis) - mad as a hatter
76
opioid toxidrome
miosis hypoventilation depressed mental status/coma
77
opioid withdrawal
``` diarrhea mydriasis goose flesh tachycardia lacrimination hypertension yawning cramps hallucinations seizures (with EtOH and benzo withdrawal) ```
78
sympathomimetic toxidrome
``` hyperthermia mydriasis tachycardia hypertension diaphoresis flushed agitated seizures ```
79
serotonin syndrome
``` AMS hyperthermia agitation hyperreflexia clonus diaphoresis ```
80
NMS
``` AMS hyperthermia agitation muscle rigidity decreased reflexes ```
81
DDX for altered mental status
``` AEIOU TIPS alcohol, acidosis electrolytes - hyponatremia, etc infectious/sepsis opioids, overdose uremia ``` trauma insulin (hypoglycaemia, hyperglycaemia) psychosis seizure/stroke structural: - bleed: SDH, SAH, ICH, etc. - pus: meningitis, encephalitis - water: hydrocephalus - mass effect: tumor - bullet/fb
82
tox causes of bradycardia
PACED propranolol, poppies (opioids), propoxyphene, physostigmine anti-cholinesterase drugs, antiarrhythmics clonidine, CCBs ethanol, other alcohols digoxin, digitalis
83
tox causes of tachycardia
FAST free base cocaine, freon amphetamines, anticholinergics, antihistamines, antipsychotics sympathomimetics, solvent abuse, strychnine theophylline, TCAs, thyroid hormone
84
tox causes of hypothermia
``` COOLS CO opioids oral hypoglycemics, insulin liquor (EtOH) sedative/hypnotic ```
85
tox causes of hyperthermia
NASA NMS antihistamines, alcohol withdrawal salicylates, sympathomimetics, serotonin syndome anticholinergics, antidepressants, antipsychotics
86
tox causes of hypotension
CRASH clonidine, CCBs rodenticides (containing arsenic, cyanide) antihypertensives, aminophylline, antidepressants sedative-hypnotics heroin, other opioids
87
tox causes of hypertension
``` CT SCAN cocaine thyroid supplements sympathomimetics caffeine anticholinergics, amphetamines nicotine ```
88
tox causes of rapid respiration
``` PANT PCP, parquet, pneumonitis, phosgene asa, other salicyaltes noncardiogenic pulmonary edema, nerve agents toxin induced metabolic acidosis ```
89
tox causes of slow respiration
``` SLOW sedative hypnotics liquor (ETOH) opioids weed ```
90
substances causing wide anion gap metabolic acidosis
general KULT (ketoacidosis, uremia, lactate, tox) ``` MUDPILESCAT methanol, metformin, massive ingestions uremia DKA paraldehyde, phenformin iron, INH, ibuprofen lactate ethylene glycol salicylates cyanide, CO, colchicine alcoholic ketoacidosis, acetaminophen toluene ```
91
tox ECG finding of absent P wave
digoxin cholinergics hyperkalemia
92
tox ECG finding of notched P wave
quinidine
93
tox ECG finding of prolonged PR interval
BBs CCBs Mg
94
tox ECG finding of prolonged QRS interval
Type 1 antidysrhythmics cocaine diphenhydramine TCAs
95
tox ECG finding of scooped ST segment
digoxin
96
tox ECG finding of prolonged QT
``` TCA antipsychotics citalopram HF ondansetron HF methadone ethylene glycol ```
97
tox finding peaked T wave
HF (hyperkalemia)
98
tox finding ECG flattened T wave
lithium
99
tox finding ECG of U wave
``` barium beta agonists (ventolin) lithium methylxanthines (Caffeine, theophylline) toluene ```
100
potentially lethal toxins which may need early charcoal administration
``` the killer C's cyanide colchicine CCBs cyclic antidepressants cardioglycosides cyclopeptide mushrooms (amanita phalloides) cocaine cicutoxin (water hemlock) salicylates ```
101
substances that do not bind to activated charcoal
``` pesticides heavy metals acids/alkalis iron lithium solvents ```
102
toxins that are dialyzable
``` STUMBLED salicylates theophylline uremia metformin/methanol barbituates lithium ethylene glycol depakote (valproic acid) ```
103
substances amenable to MDAC
``` ABCDQ aminophylline/theophylline barbituates carbamazepine/concretion forming drugs( eg. salicylates) -dapsone -quinine ```
104
how to dose MDAC
activated charcoal to xenobiotic ratio of 10:1, subsequent doses of 50% initial dose q4-6h for up to 24 hours -can D/C when serum levels no longer in toxic range
105
how to order meds for serum alkalinization
- goal of serum pH 7.5, urine pH 8.0 - check K before alkalization because will increase K reabsorption - 150mEq (3amps) of NaHCo3 into 1L D5W plus 20-40mEq of K, with rate below 250cc/hour
106
how to order intralipid
-dose: initial bolus of 1.5mL/kg of 20% lipid solution given over 2-3 minutes followied by an infusion of 0.25mL/kg/min
107
complications of intralipid
extreme lipemia interfering with lab tests, acute pancreatitis, ARDS
108
antidote for acetaminophen
N-acetylcysteine
109
antidote for methanol/ethylene glycol
fomepizole/ EtOH
110
antidote for CO
oxygen, hyperbarics | hydroxocobalamin
111
antidote for opioids
naloxone
112
antidote for anticholinergics
physostigmine
113
antidote for organophosphates
atropine | 2-PAM
114
antidote for methemoglobinemia
methylene blue
115
antidote for cyanide
nitrites | hydroxycobalamin
116
antidote for iron
deferoxamine
117
antidote for arsenic, lead
dimercaprol (BAL)
118
antidote for lead, mercury
succimer (DMSA)
119
antidote for lead
Ca-EDTA
120
antidote for digoxin, crotalids
Fab fragments
121
antidote for BBs
glucagon
122
antidote for CCBs
calcium | insulin/ glucose
123
antidote for salicylates, TCAs
bicarbonate
124
antidote for oral hypoglycemias
glucagon, octreotide, pyridoxine (B6)
125
antidote for local anesthetic systemic toxicity
intralipid
126
false positive screen for amphetamines on urine tox
``` amantadine bupropion labetalol promethazine ranitidine trazodone ```
127
false negative for amphetamines for urine tox
designer amphetamines
128
false positive for benzos for urine tox screen
sertraline | oxaprozin
129
false negative for benzos for urine tox screen
alprazolam flurazepam midazolam Z drugs (zoo-idem, zap,lon, zoplicone, eszoplicaone)
130
false positive for opioids on urine tox
dextromethorphan | diphenhydramine
131
false negative for opioids for urine tox
synthetic opioids: demerol, fentanyl, methadone, propoxyphene semisynthetic opioids: hydromorphone ,hydrocodone, oxycodone - may have some cross-reactivity
132
false positive for cannibinoids for urine tox
dronabinol efavirenz PPI
133
false negative for canninbinoids for urine tox
synthetic marijuna: K2/Spice
134
false positive for PCP for urine tox
``` quinolones dextromethorphan diphenhydramine ibuprofen tramadol ```
135
false positive for cocaine for urine tox
coca leaf tea

Emergency (3 decks)

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