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tox and environmental Flashcards

1
Q

GHB overdose sx

A

slow: CNS depression, hypoventilation, bradycardia
fast: myoclonus, seizures

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2
Q

GHB withdrawal sx

A

agitation, delirium, seizures

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3
Q

beta-blocker overdose tx

A

fluids and pressors
insulin 1u/kg bolus
glucagon 5q10 x 3 doses
intralipid

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4
Q

CCB overdose tx

A

insulin 1u/kg bolus
calcium gluconate 3g
intralipid

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5
Q

dig overdose tx

A

Digibind 10-20 vials

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6
Q

heroin overdose tx (and when to use it)

A

opioid-naive: 0.4 mg IV
opioid-dependent: 0.04-0.1 mg (to prevent inducing withdrawal)

when to use it: obtunded, miotic, RR < 12, and O2 sat < 90% (all others can be observed)

*in all cases: may uptitrate to max 10 mg

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7
Q

organophosphate overdose tx

A

atropine 2 mg, double q5-30m until secretions controlled –> pralidoxime 1-2g over 15-30m

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8
Q

dig: 2 pathognomonic EKG findings

A

PAT w/block (rare)

bidirectional VT

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9
Q

dig: most common dysrhythmia

A

PVCs

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10
Q

dig: most common EKG change

A

Salvador Dali STs

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11
Q

regularized afib

A

dig toxicity

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12
Q

naloxone: onset of action

A

1-6 mins depending on route

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13
Q

naloxone: duration of effect

A

20-90 mins depending on route

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14
Q

naloxone gtt dose

A

2/3 wake-up dose

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15
Q

check this before giving physostigmine

A

EKG (for blocks, TCA)

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16
Q

Librium taper

A

6 50 mg tabs

  • day 1: 1 tab TID
  • day 2: 1 tab BID
  • day 3: 1 tab
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17
Q

naloxone: full dose

A

2 mg

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18
Q

black widow vs brown recluse

A

black widow: neurotoxins (ACh and NE) > fake appy, neuroexcitation opioids and benzos, antivenin if severe
brown recluse: cytotoxic enzymes > local tissue necrosis (no antivenin)

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19
Q

cholinergic toxidrome

A

SLUDGE and killer Bs (bradycardia, bronchorrhea, bronchospasm)

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20
Q

dextromethorphan toxidrome

A

like PCP: CNS sx like visual hallucinations, rotary nystagmus, tachycardia (reliable), mydriasis, hyperthermia

21
Q

APAP overdose mechanism

A

overdose overwhelms normal metabolic pathways (sulfation and glucuronidation), shunting the rest of of the APAP to the CYP450 pathway which generates NAPQI, which requires glutathione to detox it
rapid depletion of glutathione stores leads to NAPQI accumulation and hepatotoxicity

22
Q

acute mountain sickness: tx

A

halt ascent, Diamox (except in sulfa allergy)

23
Q

decompression sickness

A

gas bubbles go free > obstruct/inflame tissues/vasculature mins/hours after surfacing

  • type 1: joints (“bends”), skin (mottling), extremity lymphatic obstruction
  • type 2: cardiopulmonary (“chokes”), neuro (“staggers”), upper lumbar/lower thoracic spine pain

tx is like arterial air embolism: supine position, O2, increase tissue perfusion (IVF), recompression (hyperbaric)

24
Q

When does pulmonary barotrauma occur?

A

ascent

25
Q

When do sinus squeeze and inner ear barotrauma occur?

A

descent

26
Q

VPA toxicity

A

N/V, encephalopathy, hyperammonemia

tx: charcoal, L-carnitine, HD

27
Q

how to dose bicarb in TCA toxicity

A

50 mEq IV at a time until QRS narrows

then gtt @150 mEq in 1L D5W at 2-3xM

28
Q

When do you stop cooling a hyperthermic pt?

A

39 degrees, to avoid overshoot

29
Q

cyclosporine can cause

A

hyperK, hyperuricemia, HTN, nephrotoxicity

30
Q

azathioprine can cause

A

marrow suppression, pancreatitis, hepatitis, jaundice

31
Q

oil of wintergreen toxicity and blood gas

A

highly-concentrated ASA (deadly to a kid)

early resp alkalosis, later gap metabolic acidosis

32
Q

myasthenia pathophysiology

A

autoantibody binds nicotinic ACh receptors > prevents ACh binding > neuromuscular weakness

33
Q

tetanus toxin pathophysiology

A

prevention of presynaptic release of inhibitory neurotransmitters (GABA and glycine)

34
Q

botulinum toxin pathophysiology

A

inhibition of presynaptic release of ACh > flaccid paralysis

35
Q

NAC mechanism

A

restores glutathione

36
Q

What dose of acetaminophen is typically required to cause significant liver damage?

A

150 mg/kg or greater

37
Q

sudden sniffing death syndrome

A

hydrocarbon ingestion > catecholamine surge > ventricular dysrhythmia

avoid procainamide, sotalol, amio (classes IA and III)

38
Q

calcium channel blocker toxicity tx

A

glucagon (although this works more w/beta-blocker toxicity)
calcium chloride
high-dose insulin
epinephrine

39
Q

when to avoid rewarming in frostbite

A

if there’s a risk of refreezing

40
Q

trench foot

A

prolonged wet/cold (but nonfreezing) exposure causing reversible neurovascular injury

just the toes = chilblains

41
Q

symptom of early radiation exposure

A

vomiting

42
Q

when to antibiose animal bites

A

cat bite
wound requiring closure
immunocompromised pt
hand/genitalia

43
Q

danger of physostigmine

A

asystole

44
Q

drugs associated with noncardiogenic pulmonary edema

A

meprobamate, opioids, Narcan, PCP, aspirin

45
Q

isopropyl EtOH tx

A

supportive, sometimes HD

46
Q

methanol tx

A

fomepizole

47
Q

ethylene glycol tx

A

fomepizole

48
Q

methylene chloride toxicity mimics

A

CO poisoning

49
Q

electrolyte abnormality that worsens dig toxicity

A

HYPOkalemia

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