Tox Stuff

Question 1

Toxins that indicate dialysis

Answer 1

carbamazepine, lithium, potassium, metformin, salicylate, theophylline, valproate, toxic alcohols

Question 2

Toxins eliminated by multidose AC

Answer 2

carbamazepine, dapsone, phenobarbitone, quinine, theophylline, amanita phalloides

Question 3

Toxins eliminated by urinary alkalinisation

Answer 3

salicylates, phenobarbitone

Question 4

Features of brown snake

Answer 4

VICC present, neuro rare, myotox not presentm ealry collapse/cardiac arrest

Question 5

Tiger snake venom features

Answer 5

VICC present, neur rare, myotox rare

Question 6

Death adder

Answer 6

VICC not present, neurotox common, myotox not present

Question 7

Black snake venom

Answer 7

VICC not present, neurotox not present, myotoxicity common, common pain at bite site

Question 8

Taipan

Answer 8

VICC present, neurotox common, myotox rare

Question 9

Sea snake

Answer 9

VICC not present, neuro tox uncomon, myotox common

Question 10

Sodium Channel Blockers

Answer 10

TCAs
Type 1a Antiarrhythmics Quinidie/Procainamide
Type 1c Antiarryhthmic flecainide, encainide
Local Anaesthetics: Bupivacaine/ropivacaine
Anti-Malarials: Quinine, hydroxychloroquine, chloroquine
Dextropropoxyphne
Propranolol
Carbamazepine

Question 11

Indications for whole bowel irrigation

Answer 11

Lead, iron >60mg/kg, slow release potassium, arsenic, slow release calcium channel, body packing

Question 12

Drugs causing QT prolongation

Answer 12

IA Anti-arrh: quinidine/procainamide
IC Anti-Arrh: Flecainide/Encainide
III Anti-Arrhy: Sotalol/Amiodarone
Anti Psychotics: Quetiapine, Haloperidol, amisulpride, chlorpromazine
TCAs: Amitryptiline, imipramine, doxepin
Miscellaneous Anti-Deps: Mianserin, citalopram, venlafaxine, moclobemide
Anti-Histamiines: Loratadine, Terfenadine, Diphenhydramine
Anti Malarials: Chlorogquine, hydroxychloroquine, quinine
Antibiotics: Eryhtromycin/Clarithromycin

Question 13

Indications for AC in paracetamol OD

Answer 13

IR Paracetamol: Give if presents within 2hours and 200mg/kg or 10g
or 30g in a 4 hour period

SR Paracetamol: >10g or >200mg/kg within 4 hours

Question 14

Expected blood abnormalities in VICC

Answer 14

INR> 3 or unrecordable, APTT markedly abnormal, Fibrinogen undetectable, D0Dimer markedly elevated 100x-1000x

Question 15

Features of neuroleptic syndrome

Answer 15

CNS Dysfunction: Confusion, delirium, stupor, coma

Autonomic Instability: Hypertension, tachycardia, hyperthermia, respiratory irregulaities, arrhythmias

Neuromuscular: Lead pike rigidity, akinesia/bradykinesia, mutism/staring, dysarthria, dystonia, abnormal posture, involuntary movements, incontinence

Question 16

Features of serotonin syndrome

Answer 16

Mental Status Changes: Apprehension, anxiety, agitation, psychomotor acceleration, confusion, delirium

Autonomic Stimulation: diarrhea, flushing, hypertension, hyperthermia, mydriasis, sweating, tachycardia

Neuromuscular Excitation: Clonus, hyperreflexia, increased tone, myoclonus, rigidity, tremor

Question 17

Risk factors for neuroleptic malignant syndrome

Answer 17

high dose neuroleptic
young
male
dose increase in last 5 days
presence of organic brain disorder
parenteral
haloperidol/depot fluphenazine

Question 18

Treatment options for neuroleptic malignant syndrome

Answer 18

bromocriptine - antidote
dantrolene - muscle relaxant
ECT - if refractory
Benzos - for agitation

Question 19

Features of quetiapine OD by dose

Answer 19

Less than 3g: mild to moderate sedation, sinus tachycardia

More than 3g: CNS depression, coma, hypotension, seizures, delirium

Question 20

Serotonin syndrome algorithm

Answer 20

Serotenergic Agent

Spontaneous Clonus = Serotonin syndrome

Inducible Clonus + (agitation or diaphoresis or hypertonia and pyrexia) = Serontonin syndrome

Tremor + Hyper-reflexia = Serotonin syndrome

Else not serotonin syndrome

Question 21

Phases of paracetamol toxicity

Answer 21

Phase 1 (1st 24 hrs): Assymtpomatic. May have nausea/vomting. AST and ALT start to rise. Paracetamol levels elevated

Phase 2 (1-3 days): RUQ tenderness,. ALT/AST peak at 2-3 days 15000 to 20000. PT/INR elevated. Renail impairment and increased bilirubin

Phase 3 )3-4 days) : Fulminant liver failure with coagulopathy, jaundice, encephalopathy, multi organ failure.

Predictors of death: Elevated lactate despite resus, creatinin3 >300, worsening coagulopathy PT >100s and encepalopathy

Phase 4: Recovery of hepatic structure and function

Question 22

Venlafaxine and seizure

Answer 22

<1.5g = 5% risk of seizure
<3g = 10% risk of seizures
3-4.5g = 30% seizures
>4.5g = 100% risk of seizures. Expect hypotension, QRS and QT prolongation
>7g = severe hypotension and LV dysfunction

Question 23

Enhanced Elimination drugs and methods

Answer 23

MultiDoseAC: Carbamazepine, theophylline, phenobarbitone, quinine, dapson, amanita mushroom

Urine Alkalisation: Salicylates, Phenobarbitone

Haemodialysis: Toxic alcohols, salicylate, theophylline, valproic acid, carbamazepine, metformin, potassium, lithium

Question 24

NAC Dosing in Paracetamol Toxicity

Answer 24

200mg/kg first 4 hours

100mg/kg over 16 hours

Question 25

Toxins where AC is not useful

Answer 25

Pesticides
Hydrocarbons
Acids/Alkalis
Iron
Lithium
Solvents
Toxic Alcohols