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UCPEX > Toxicology > Flashcards

Toxicology Flashcards

(39 cards)

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1
Q

Indications and contraindications to activated charcoal

A

Ingestion within 1 hour of potentially toxic substance

Contraindications:
- low binding affinity for charcoal (iron, lithium)
- Decreased LOC
- Risk of GI bleed

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2
Q

Drugs causing anticholinergic toxidrome

A

Anticholinergics - benztropine, atropine
TCAs
Antipsychotics - chlorpromazine, quetiapine
Antihistamines - chlorpheniramine, promethazine
Antispasmodics - oxybutynin

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3
Q

Anticholinergic toxidrome presentation

A

Mad as a hatter - Confusion, delirium
Blind as a bat - Mydriasis
Dry as a bone - Dry skin, urinary retention
Red as a beet - Flushed skin
Hot as a hare - fever

Palpitations
Seizures

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4
Q

Drugs causing cholinergic toxidrome

A

Organophosphates
Carbamates - insecticide
Pilocarpine - treatment dry eyes and mouth
Neostigmine - reverses neuromuscular blockade
Donepezil
Mushrooms
Sarin nerve gas

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5
Q

Types of opioid overdose

A

Intentional
Unintentional recreational or prescribed
Unintentional iatrogenic

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6
Q

Presentation for opioid overdose

A

Miosis
Hypopnoea <12 breaths/min
Stupor

With suggestive history

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7
Q

Management of opioid overdose

A

Airway management
Naloxone
Beware rebound sedation as naloxone wears off

Check for transdermal patches
Check signs of IVDU
Check for compartment syndrome

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8
Q

Causes of sympathomimetic overdoses

A

Amphetamines
Ritalin
Cocaine
Pseudoephedrine
Caffeine

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9
Q

Symptoms of sympathomimetic overdose

A

Symptom onset within 2 hours, life-threatening complications 2-6 hours

Agitation, hyperalert, paranoia, mania, psychosis
Mydriasis
Tachycardia, tachypnoea, hypertension, arrhythmia
Tremor, hyperreflexia, seizure, diaphoresis

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10
Q

Management of sympathomimetic overdose

A

Asymptomatic - observe at home for 4 hours
Symptomatic - medical observation, cardiac monitoring, bloods, and cooling
Benzos for agitation, psychosis, seizure

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11
Q

Triad of symptoms in serotonin syndrome

A
  1. CNS - agitation, confusion, altered mental state, seizures
  2. Neuromuscular - clonus, myoclonus, hyperreflexia, rigidity, tremor
  3. Autonomic disturbance - hyper/hypotension, tachy/bradycardia, hyperthermia, dysrhythmia, flushing, sweating, mydriasis
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12
Q

Hunter Serotonin toxicity criteria

A

Use of serotonergic agent in last 5 weeks AND
- Spontaneous clonus
- Inducible clonus + agitation or diaphoresis
- Ocular clonus + agitation or diaphoresis
- Tremor + hyperreflexia
- Ocular clonus OR inducible clonus + rigidity OR hypotonia + hyperthermia

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13
Q

Drugs causing serotonin syndrome

A

SSRIs, SNRIs
Opiates + fentanyl, tramadol, pethidine
TCAs
MAOis
Mood stabilisers: Lithium, sodium valproate
Linezolid (abx)
Ondansetron, metoclopramide
Rec drugs - amphetamines, LSD, ecstasy
Herbal - St John’s wort, ginseng

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14
Q

Cardinal features of neuroleptic malignant syndrome

Other symptoms

A

Use of neuroleptic or withdrawal of anti-Parkinsonian medications within last 4 weeks
Temp >38
Muscle rigidity

Tachycardia, labile BP, dehydration, SOB, altered mental state, pseudo-Parkinsonism, incontinence, dysphagia, diaphoresis, salivation

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15
Q

Rate of ETOH metabolism

A

One standard drink, 10g ETOH, per 1 hour

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16
Q

Driving limit for ETOH

Study These Flashcards
A

Under 20 - zero

Over 20
- 50mg/100mL blood
250mcg/1000mL breath

17
Q

Lethal dose of ETOH

Study These Flashcards
A

5-8g/kg adult
3g/kg child

18
Q

Intoxicated patient with altered mental state, other conditions to rule out

Study These Flashcards
A

Head trauma
Hypothermia
Hypoglycaemia
Hypoxia
Hepatic encephalopathy
Metabolic derangement
Other substances

19
Q

Definition of ETOH abuse

Study These Flashcards
A
  • Maladaptive pattern of ETOH use causing clinical distress, impairment of social/occupational function.
  • High daily consumption, weekend heavy drinking, binge
  • In last 12 months at least one of:
    Failed to fulfil obligation
    Physical hazards
    Legal problems
    Social/interpersonal problems
20
Q

Audit-C questionnaire

Study These Flashcards
A

How often drink of ETOH?
Never, </=monthly, 2-3/month, 2-3/week, 4+/week

How many drinks on a typical session?
1-2, 3-4, 5-6, 7-9, 10+

How often 6 or more drinks?
Never, <monthly, monthly, weekly, daily

Score >5 - Full Audit questionnaire

21
Q

ETOH guidelines

Study These Flashcards
A

Men:
3/day, 15/week
5 in one session

Women:
2/day, 10/week
4 in one session

At least 2 ETOH free days/week

22
Q

Most common overdose

Study These Flashcards
A

Paracetamol
Suspect in all deliberate self-poisonings

23
Q

Symptoms of paracetamol overdose

Study These Flashcards
A

nausea, vomiting
Pallor, diaphoresis
RUQ pain

Hepatotoxicity within 48-72 hours

24
Q

Management of paracetamol OD with known time of ingestion

Study These Flashcards
A

<2 hours - consider activated charcoal

2-8 hours
Paracetamol levels at 4 hours
Treat according to nomogram

> 8 hours
Paracetamol level and LFTs
Start NAC
Below nomogram and ALT <50 - stop NAC
Otherwise finish NAC and repeat LFTs

25
Threshold for dangerous level of paracetamol ingestion
Single ingestion (within 8 hours): >200mg/kg child <6 >10g adult Repeated supra therapeutic: >10g or 200mg/kg over 24 hours >6g or 150mg/kg daily over 48 hours >4g or 100mg/kg daily >48 hours PLUS symptoms of liver damage
26
Etiology of carbon monoxide poisoning
CO binds Hb with 200x affinity of O2 Carboxyhaemoglobin Reduces O2 binding Hypoxia
27
Carbon monoxide poisoning pertinent history
COMA Cohabitants and companions - similar symptoms? Outside and away - feel better? Maintenance - appliances well serviced? Alarm - CO alarm in the house?
28
Symptoms of carbon monoxide poisoning
Acute: Headache, lethargy Nausea, vomiting Abdo pain Chest pain, SOB Neuro symptoms Chronic: Memory impairment Fatigue Mood changes Hearing loss Ataxia, tremor, incoordination, slow movement Cherry red lips Normal sats reading
29
Management of CO poisoning
High flow O2/hyperbaric chamber Treatment for 6 hours Notifiable to MOH Psych review if intentional poisoning
30
Symptoms of organophosphate exposure
Nicotinic then muscarinic Nicotinic: Monday - Mydriasis Tuesday - Tachycardia Wednesday - Weakness Thursday - Hypertension Friday - Fasiculations Muscarinic: Diarrhoea Urination Miosis Bradycardia Bronchorrhoea, bronchospasm Emesis Lacrimation Salivation Neuro: Anxiety, confusion, drowsiness, seizures, hallucinations, insomnia, memory loss Intermediate: Neck flexion, proximal muscle weakness, resp insufficiency, decreased deep tendon reflexes, cranial nerve abnormality Late: glove and stocking neuropathy, flaccid paralysis LL=>UL
31
Management of organophosphate exposure
Refer to gen med PPE Decontaminate - burn clothing, irrigate Do not induce vomiting IV fluids Atropine 0.05mg/kg or 2-5mg IV benzos for seizure/agitation
32
Symptoms of salicylate toxicity
May come on 6-12 hours post ingestion Mild <150mg/kg Nausea, abdo pain, headache, dizziness, tinnitus, tachypnoea Mild-moderate 150-300mg/kg Confusion, slurred speech, hallucination Tachycardia, worse tachypnoea Orthostatic hypotension Severe >300mg/kg Reduced GCS, seizures Hypoventilation Dysrhythmia - usually sinus tachy Cardiac arrest Hyperthermia/fever
33
Blood gas progression in salicylate poisoning
1. Respiratory alkalosis, alkaluria 2. Respiratory alkalosis, paradoxical acuduria <6 3. Repiratory alkalosis, metabolic acidosis, hypokalaemia
34
Management of salicylate poisoning
Decontamination: - Activated charcoal - Urine alkalisation +- haemodialysis - Flushing, wash with soap + water ABCs Correct hypoglycaemia
35
Toxic level of oil of wintergreen
98% salicylate - 1 tsp = 7000mg <6 - more than lick/taste >6 - more than 4mL
36
Symptoms of TCA poisoning
Anticholinergic Fever, flushing, dry skin, mydriasis, palpitations, urinary retention Cardiovascular - tachycardia, hypertension > hypotension Sodium channel blockade: ECG - long QRS, terminal R wave >3mm in aVR CNS - drowsy, confusion, delirium, seizure, coma, resp depression
37
Symptoms of lithium toxicity
Altered mental state Nausea, vomiting, diarrhoea Tremor, weakness, ataxia Renal toxicity Hypotension, dysrhythmia, seizure, coma Background condition resulting in volume or sodium loss
38
Level of lithium toxicity
>40mg/kg No clear correlation between serum levels and symptoms
39
ECG changes in lithium toxicity
Sinus node dysfunction Long QT Intraventricular conduction defects T wave flattening U wave

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