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PHRM 865 > Toxicology > Flashcards

Toxicology Flashcards

(52 cards)

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1
Q

most common adult medication overdoses

A

analgesics

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2
Q

first steps to stabilize patients

A

airway, breathing, circulation
oxygenation
IV access

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3
Q

considerations for exposure

A

medication use/ illicit substances
doses
time of ingestion

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4
Q

assessment upon presentation

A

physical exam - looking for packers
labs - BMP
APAP salicylate concentrations
alcohol panel

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5
Q

anticholinergic symptoms

A

blind
hot
red
mad
dry

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6
Q

do we use urine tox screens?

A

not really, shows all recent use and might not be the overdose substance

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7
Q

anion gap equation and gap

A

(Na+K)-(CL+HCO3)
if 14 or greater there is gap

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8
Q

when is charcoal used

A

if patient presents within 1-2 hours
binds toxin before it gets into bloodstream

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9
Q

charcoal dose

A

1-2 g/kg
50-100 g

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10
Q

whole bowel irrigation dosing

A

1-2 L/hr

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11
Q

whole bowel irrigation used for what

A

sustained release products
packers/stuffers
iron
lithium

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12
Q

hemodialysis may be useful for which tox

A

alcohol
salicylates

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13
Q

toxicities seen with salicylates

A

increased anion gap - metabolic acidosis
hypoventilation - respiratory alkalosis
hypokalemia

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14
Q

symptoms of salcylate tox

A

hyperventilation
tinnitus

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15
Q

what could we give in salicylate tox

A

sodium bicarb
fluids with KCl

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16
Q

salicylate antitode

A

sodium bicarb

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17
Q

when would we give sodium bicarb in salicylate tox

A

serum >30
anion gap metabolic acidosis

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18
Q

dosing for sodium bicarb

A

1-2 mEq/kg
50-100 mEq

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19
Q

sedatives toxicity symptoms

A

CNS depression
bradycardia
hypotension
respiratory depression

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20
Q

sedatives antidote

A

flumazenil

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21
Q

fumazenil considerations

Study These Flashcards
A

do not give with seizure history

22
Q

flumazenil MOA

Study These Flashcards
A

competes with benzos at GABA

23
Q

TCAs symptoms of tox

Study These Flashcards
A

anticholinergic
seizures
prolonged QRS

24
Q

what QRS is increased risk of seizure activity

Study These Flashcards
A

> 100
150 for increase risk arrythmias

25
TCA antidote
sodium bicarb given when QRS >100 and stop when QRS <100
26
TCA seizure managemtn
benzos phenobarbital other meds might not work like keppra
27
antipsychotic tox symptoms
neuroleptic malignant syndrome (NMS) extrapyramidal sx (EPS) QT prolongation
28
EPS with antipsychotics tox treatment
benztropine 2 mg IM long half life diphenhydramine 1-2 mg/kg IV/IM can give oral for 3-4 days 50 mg TID
29
NMS symptoms
high fever >108 over 24 h diffuse lead pipe rigidity
30
NMS commonly caused by what
antipsychotics haloperidol, chlorpromazine, fluphenazine
31
NMS treatment
d/c offending agent rapid cooling benzos dantroline bromocriptine
32
dantroline used for what
NMS 2.5-10 mg/kg
33
serotonin syndrome treatment
cyproheptadine 4 mg PO q1h for max: 16 mg d/c offending agent benzos aggressive cooling
34
serotonin syndrome symptoms
lasts <24 h lower limbs more affected
35
digoxin symptoms
hyperkalemia vision changes bradycardia arrythmias
36
digoxin management of tox
Digibind get serum dig monitor ECG
37
when to give digibind
hyperkalemia serum dig >10 ng/mL at least 6 hours after ingestion ingestion >10 mg in adults, 4mg in kids
38
digibind dosing calculation
(serum x 0.8) /0.5 (dose x body weight) /100
39
when to redraw dig levels
do not redraw after giving digibind
40
symptoms of CCB tox
hyperglycemia metabolic acidossi pulmonary edema ileus
41
symptoms of BB tox
hypoglycemia bronchospasm
42
antidotes to CCBS and BBS
atropine calcium pressors high dose insulin glucagon
43
atropine use
CCB and BB overdose but not really useful
44
calcium used for what
BB and CCB tox, but CCB better
45
calcium chloride vs calcium gluconate
chloride has 3x more elemental calcium than gluconate
46
vasopressors used in CCB and BB
epinephrine - cardiogenic norepinephrine - vasodilatory
47
vasopressor considerations
requires higher doses to overcome receptor blockade
48
glucagon use
CCB and BB overdose
49
glucagon consideration
may need to premedicate with zofran to prevent N/V
50
high dose insulin therapy use
CCB and BB
51
dosing for insulin therapy
0.5-1 unit/kg/hr IV much higher than in DKA
52
high dose insulin given with what
dextrose titrate to SBP >90-100

PHRM 865 (33 decks)

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