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UCPEX > Toxicology > Flashcards

Toxicology Flashcards

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

A

Under 20 - zero

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

17
Q

Lethal dose of ETOH

A

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

18
Q

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

A

Head trauma
Hypothermia
Hypoglycaemia
Hypoxia
Hepatic encephalopathy
Metabolic derangement
Other substances

19
Q

Definition of ETOH abuse

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

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

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

A

Paracetamol
Suspect in all deliberate self-poisonings

23
Q

Symptoms of paracetamol overdose

A

nausea, vomiting
Pallor, diaphoresis
RUQ pain

Hepatotoxicity within 48-72 hours

24
Q

Management of paracetamol OD with known time of ingestion

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
Q

Threshold for dangerous level of paracetamol ingestion

A

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
Q

Etiology of carbon monoxide poisoning

A

CO binds Hb with 200x affinity of O2
Carboxyhaemoglobin
Reduces O2 binding
Hypoxia

27
Q

Carbon monoxide poisoning pertinent history

A

COMA

Cohabitants and companions - similar symptoms?
Outside and away - feel better?
Maintenance - appliances well serviced?
Alarm - CO alarm in the house?

28
Q

Symptoms of carbon monoxide poisoning

A

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
Q

Management of CO poisoning

A

High flow O2/hyperbaric chamber
Treatment for 6 hours
Notifiable to MOH
Psych review if intentional poisoning

30
Q

Symptoms of organophosphate exposure

A

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
Q

Management of organophosphate exposure

A

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
Q

Symptoms of salicylate toxicity

A

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
Q

Blood gas progression in salicylate poisoning

A
  1. Respiratory alkalosis, alkaluria
  2. Respiratory alkalosis, paradoxical acuduria <6
  3. Repiratory alkalosis, metabolic acidosis, hypokalaemia
34
Q

Management of salicylate poisoning

A

Decontamination:
- Activated charcoal
- Urine alkalisation +- haemodialysis
- Flushing, wash with soap + water
ABCs
Correct hypoglycaemia

35
Q

Toxic level of oil of wintergreen

A

98% salicylate - 1 tsp = 7000mg
<6 - more than lick/taste
>6 - more than 4mL

36
Q

Symptoms of TCA poisoning

A

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
Q

Symptoms of lithium toxicity

A

Altered mental state
Nausea, vomiting, diarrhoea
Tremor, weakness, ataxia

Renal toxicity
Hypotension, dysrhythmia, seizure, coma

Background condition resulting in volume or sodium loss

38
Q

Level of lithium toxicity

A

> 40mg/kg
No clear correlation between serum levels and symptoms

39
Q

ECG changes in lithium toxicity

A

Sinus node dysfunction
Long QT
Intraventricular conduction defects
T wave flattening
U wave

UCPEX (13 decks)

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