Toxicology

Question 1

Most poisonings involve children under what age?

Answer 1

6

Question 2

Most poisoning death occur in what age range?

Answer 2

40-49

Question 3

What poisonings will cause a patient to smell like rotten eggs?

Answer 3

Hydrogen sulfide, mercaptans, disulfiram

Question 4

What poisonings will cause a patient to smell like garlic?

Answer 4

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

Question 5

What poisoning will cause a patient to smell like wintergreen?

Answer 5

methylcalicylate

Question 6

Poisoning with what will cause the patient to smell like peanuts.

Answer 6

Rodenticides

Question 7

Poisoning with what will cause a patient to smell like mothballs?

Answer 7

camphor

Question 8

A patient will smell like disinfectants if they OD on what?

Answer 8

phenol

creosote

Question 9

A patient will smell like acrid (aldehyde like) if they have what type poisoning.

Answer 9

Carbon monoxide

Question 10

A patient will smell acrid (pear like) with what type poisoning?

Answer 10

Paraldehyde, chloral hydrate

Question 11

What type lab is an assessment of poison concentration in tissues and is useful for antidotes?

Answer 11

Quantitative labs

Question 12

What type lab tests for the presence of a toxin and is expressed as present or absent?

Answer 12

Qualitative

Question 13

For radiopaque compounds what should you do to assess toxicity?

Answer 13

Get a radiograph

Question 14

What does gastrointestinal decontamination reduce?

Answer 14

Poisons bioavailability

Question 15

Does GI decontamination have an improvement in morbidity or mortality?

Answer 15

No

Question 16

What are some contraindications of GI decontamination.

Answer 16

Rapid onset of seizures
Rapid onset of CNS depression
Alkaline corrosives (acid controversial)
loss of gag reflex

Question 17

Where is emesis usually used with toxicity?

Answer 17

Rurall settings where there will be a dealy of >1 hour before the patient gets to an ER

Question 18

How long is the onset for syrup of Ipecac

Answer 18

15-20 minutes

Question 19

What does a lavage do?

Answer 19

Orogastric retrieval of substance

Question 20

Where do you stop a lavage?

Answer 20

When there are clear returns

Question 21

When can you lavage a patient w/ CNS depression

Answer 21

If intubated and cuffed with endotracheal tray

Question 22

Should you lavage patient with underlying pathology of esophagus or stomach?

Answer 22

Nope

Question 23

What type compounds will activated charcoal not bind?

Answer 23

low molecular weight charged compounds

highly concentrated solutions

Question 24

What are some compounds activated charcoal won’t bind.

Answer 24

Cyanide
bromide
potassium
ethanol
methanol
iron
lithium
alkaline
corrosives
mineral acids 
gasoline
kerosenes, alcohols

Question 25

What should you use whole bowel irrigation on

Answer 25

``` Substances not absorbed to AC Very large ingestions Significant GI hemorrhage Obstruction Unprotected airway hemodynamic instability ```

Question 26

What solution is used for whole bowel irrigation

Answer 26

Golytely

Question 27

What is the endpoint of whole bowel irrigation

Answer 27

Clearing of rectal effluent

Question 28

What are ways to enhance eliminiation

Answer 28

``` Multiple dose activated charcoal ion trapping hemodialysis forced diuresis exchanged transfusions ```

Question 29

What does multiple dose activated charcoal interrupt

Answer 29

Enetro-enteric and entero-hepatic recirculation of poison or poison metabolite

Question 30

What are 3 OD indications for multiple dose activated charcoal.

Answer 30

Theophylline Carbamazepine Phenobarbital OD

Question 31

What are some ADRs of multiple dose activated charcoal.

Answer 31

Pulmonary aspiration, constipation, fluid and electrolyte imbalance

Question 32

What does ion trapping do?

Answer 32

change pH of urine to ionize poison preventing reabsorption

Question 33

For salicylate and phenobarbital (weak acids) what should you administer for ion trapping.

Answer 33

Sodium bicarb to achieve a urine pH > 7

Question 34

What is dimercaprol (BAL) used as a chelator for

Answer 34

AS Hg Pb Cd

Question 35

What is penicillamine used as a chelator for

Answer 35

Cu Pb Hg As

Question 36

What are 2 toxicities of dimercaprol (BAL)

Answer 36

HTN | tachycardia

Question 37

What is EDTA (edetate calcium disodium) used as a chelator for

Answer 37

Lead

Question 38

what is a toxicity of EDTA

Answer 38

Nephrotoxicity

Question 39

What is deferoxamine used as a chelator for

Answer 39

Fe

Question 40

What are some ADRs of deferoxamine

Answer 40

Hypotension anaphlyactoid rxn ARDS

Question 41

What antivenin is used for a rattlesnake bite

Answer 41

Crotalidae antivenin

Question 42

What is used for a black widow bite

Answer 42

lactrodectus antivenin

Question 43

What is used to treat eastern and texas coral snake bites

Answer 43

Elapidae antivenin

Question 44

What is used to treat botulism types A, B, and E

Answer 44

trivalent botulinum

Question 45

What is used to treat digoxin immune Fab

Answer 45

Digoxin and Digitoxin

Question 46

What is used to treat acetaminopehn poisoning.

Answer 46

N-acetylcysteine

Question 47

How does N-acetylcysteine work

Answer 47

Prevents NAPQI from binding at hepatocyte

Question 48

What do you use to treat opioid poisoning

Answer 48

Naloxone

Question 49

What is naloxone

Answer 49

Opioid receptor antagonist

Question 50

What is used to treat benzodiazepine OD

Answer 50

Flumazenil

Question 51

What is flumazenil

Answer 51

Benzodiazepine receptor antagonist

Question 52

What is used to treat organophosphate and pesticides poioning

Answer 52

Atropine

Question 53

What is atropine

Answer 53

Muscarinic receptor antagonist

Question 54

What is used to treat methanol and ethylene glycol poisoning

Answer 54

Fomepizole

Question 55

What does fomepizole block

Answer 55

Metabolite formation