Toxicology

Question 1

When assessing poisoned patients, which drugs cause Mydriasis (Dilated)

Answer 1

Adrenergic agonists

Anticholinergics

Question 2

When assessing poisoned patients, which drugs cause Miosis (Constricted)

Answer 2

Sympatholytics

Cholinergics

Question 3

Acetone odor

Answer 3

Ketosis, ethanol, isopropyl alcohol, salicylates

Question 4

Acrid (pear like) odor

Answer 4

Paraldehyde, chloral hydrate

Question 5

Acrid (aldehyde like) odor

Answer 5

Carbon monoxide

Question 6

Almond odor

Answer 6

Cyanide, amygdalin, apricot pits

Question 7

Carrots odor

Answer 7

Cicutoxin (water hemlock)

Question 8

Disinfectant odor

Answer 8

Phenol, creosote

Question 9

Rotten eggs odor

Answer 9

Hydrogen sulfide, mercaptans, disulfiram

Question 10

Rotten fish odor

Answer 10

Zinc/aluminum phosphide

Question 11

fruit-like odor

Answer 11

Amyl nitrite, alcohol, isopropyl alcohol

Question 12

Garlic odor

Answer 12

DMSO, organophosphates, phosphorous, arsenic, arsine gas, thallium

Question 13

Mothballs odor

Answer 13

Camphor

Question 14

Peanuts odor

Answer 14

Rodenticides

Question 15

Wintergreen odor

Answer 15

Methylsalicylate

Question 16

Syrup of Ipecac

Answer 16

Onset 15-20 min
95% vomit in 20 min, 30% reduction in bioavailablity at 1 hour
Side effects:
Acute: Diarrhea, Drowsiness
Chronic: Cardiac arrhythmias, neuropathy, muscle weakness

Question 17

Lavage

Answer 17

Orogastric retrieval of substance
30% reduction in bioavailability at 1 hour
Lavage fluid- saline
End point- clear returns
Indications-same as general

Question 18

Lavage:contraindications and ADRs

Answer 18

Contraindications same EXCEPT
Can lavage patients with CNS Depression if intubated and cuffed with endotracheal tray.
If seizures are controlled and patient is intubated (but don’t lavage if seizure uncontrolled)
DO NOT lavage patients with underlying pathology of esophagus or stomach (ulceration, Chrons)
ADRS
Aspiration (that’s why you provide airway), esophageal/gastric bruising, fluid/electrolyte imbalance (can worsen the situiation. Monitor this), EKG changes, hypoxia, esophageal rupture

Question 19

Activated charcoal

Answer 19

Will NOT bind: Low molecular weight, charged compounds; cyanide, bromide, potassium, ethanol, methanol, iron, lithium, alkaline corrosives, mineral acids
Highly concentrated solutions; gasoline, kerosene, alcohols
Efficacy 40% reduction in bioavailability at 1 hour
Cathartics: Promote movement of AC bound drug through GI tract
May cause hypovolemia and electrolyte imbalance
ADR: Vomiting, constipation, aspiration, GI obstruction, charcoal empyema, GI perforation

Question 20

Whole Bowel Irrigation

Answer 20

Reserved for: 
Substances not adsorbed to AC
Very large ingestions
Significant GI hemorrhage
Intestinal obstruction
Unprotected airway
Hemodynamic instability
Endpoint: clearing of rectal effluent
Solutions used: Golytely

Question 21

Multiple Dose Activated Charcoal

Answer 21

Interrupts entero-enteric and entero-hepatic recirculation of poison and or poison metabolite
1gm/kg initially followed by ½ g / kg every 2-6 hours
Indications
Theophylline (used to be used for asthma, not anymore, crazy kinetics), carbamazepine, phenobarbital overdose
Contraindications
Ileus, intestinal obstruction, unprotected airway
ADR
Pulmonary aspiration, constipation, fluid and electrolyte imbalance

Question 22

Ion Trapping

Answer 22

Change pH of urine to ionize poison preventing reabsorption
Weak acids (salicylate, phenobarbital) admin sodium bicarb to achieve a urine pH of > 7

Question 23

Chelator: Dimercaprol (BAL)

Answer 23

Uses:As, Hg, Pb, Cd
Toxicity: Hypertension, tachycardia

Question 24

Chelator: Penicillamine

Answer 24

Uses: Cu, Pb, Hg, As
Toxicity: Allergic reactions

Question 25

Chelator: DMSA (succimer) Uses: Toxicity:

Answer 25

Uses: Pb, As, Hg Toxicity: gas, ab pain

Question 26

Chelator: Edetate Calcium Disodium (EDTA)

Answer 26

Uses: Pb Toxicity: Nephrotoxicity

Question 27

Chelator: Deferoxamine | :

Answer 27

Uses: Fe Toxicity: Hypotension, anaphlyactoid reaction, ARDS

Question 28

Antivenins/Biologic Agent: Crotalidae Antivenin

Answer 28

Rattlesnake envenomation

Question 29

Lactrodectus antivenin

Answer 29

black widow spider envenomation

Question 30

Elapidae Antivenin

Answer 30

Eastern and Texas coral snake envenomation

Question 31

Trivalent botulinum

Answer 31

Botulism types A, B and E

Question 32

Digoxin Immune Fab

Answer 32

Digoxin and Digitoxin

Question 33

Pharmacologic antagonist agents: (List)

Answer 33

``` N-acetylcysteine Naloxone Flumazenil Atropine Fomepizole ```

Question 34

Antivenin/biologic agents (list)

Answer 34

``` Crotalidae Antivenin Lactrodectus antivenin elapidae antivenin trivalent botulinum digoxin immune fab ```

Question 35

Chelators (list)

Answer 35

``` dimercaprol (BAL) penicillamine DMSA (Succimer) Edetate calcium disodium (EDTA) Deferoxamine ```

Question 36

N-acetylcysteine

Answer 36

Used for acetaminophen poisoning. | Prevents NAPQI binding at hepatocyte

Question 37

Naloxone

Answer 37

For opioid poisoning. Opioid receptor antagonist

Question 38

Flumazenil

Answer 38

For benzodiazepine poisoning. Benzodiazepine receptor antagonist.

Question 39

Atropine

Answer 39

For organophosphate and pesticide poisoning. Muscarinic receptor antagonist

Question 40

Fomepizole

Answer 40

For methanol and ethylene glycol poisoning. Blocks metabolite formation