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Therapeutics V > Toxicology > Flashcards

Toxicology Flashcards

(47 cards)

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1
Q

Anticholinergic toxidromes

A

-As blind as a bat
-Hot as Hades
-Red as a beet
-Dry as a bone
-Mad as a hatter

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2
Q

Anion gap equation

A

(Na + K) - (Cl + HCO3)

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3
Q

When is an anion gap present?

A

Greater than 14

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4
Q

Pros of activated charcoal

A

-Decreases time related problems
-Absorbs most toxins

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5
Q

Cons of activated charcoal

A

-Difficult administration
-Should not be administered if airway is unprotected

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6
Q

In what cases could whole bowel irrigation be used?

A

-Sustained-release product toxicity
-Body packers/stuffers
-Iron
-Lithium

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7
Q

When can you stop whole bowel irrigation?

A

Continue until presence of clear rectal effluent

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8
Q

In what medications is hemodialysis effective?

A

-Alcohol
-Lithium
-Salicylates
-Theophylline

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9
Q

Salicylate toxicity risk factors

A

-Mixed acid/base disorder
-Electrolyte disturbances
-Salicylate concentrations

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10
Q

What are signs of a mixed acid/base disorder in salicylate toxicity?

A

-Increased anion gap: metabolic acidosis
-Early respiratory alkalosis: hyperventilation

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11
Q

What is the most common electrolyte disturbance in salicylate toxicity?

A

Hypokalemia

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12
Q

Symptoms of salicylate toxicity

A

-Hyperventilation
-Tinnitus and diaphoresis
-Seizures
-Altered mental status
-Decreased GI motility
-N/V

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13
Q

What are possible treatments for salicylate toxicity?

A

-Fluids with KCl
-Sodium bicarbonate
-Activated charcoal (?)
-Hemodialysis (?)

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14
Q

Sodium bicarbonate mechanism of action when used for salicylate toxicity

A

Urine alkalinization

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15
Q

Sodium bicarbonate indications for salicylate toxicity

A

-Serum salicylate level over 30
-Anion gap metabolic acidosis
-Altered mental status

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16
Q

What should be monitored in patients taking sodium bicarbonate for salicylate toxicity?

A

-Serum pH
-Potassium and calcium levels

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17
Q

Signs and symptoms of sedative toxicity

A

-CNS depression
-Respiratory depression
-Hypotension
-Bradycardia

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18
Q

Potential treatments for sedative toxicity

A

-Activated charcoal (?)
-Flumazenil (?)

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19
Q

Flumazenil mechanism of action

Study These Flashcards
A

Competes with BZDs at BZD binding site of GABA complex

20
Q

Why is flumazenil not commonly used for BZD toxicity?

Study These Flashcards
A

It can induce seizure activity in patients who are at risk for seizures

21
Q

TCA pharmacokinetics

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A

-Rapidly absorbed from the GI tract
-Large Vd
-Acidemia increases the percentage of unbound TCA
-Highly lipophilic
-Half-life 4-93 hours

22
Q

TCA pharmacologic effects

Study These Flashcards
A

-Anticholinergic activity
-Alpha receptor blockade
-Serotonin, norepinephrine, and dopamine inhibition
-Sodium and potassium channel blockade
-CNS and respiratory depression

23
Q

TCA signs and symptoms

Study These Flashcards
A

-Anticholinergic symptoms
-Seizures
-Prolonged QRS

24
Q

Effects of QRS prolongation

Study These Flashcards
A

-QRS interval over 100 msec: increased risk of seizure activity
-QRS interval over 150 msec: increased risk of cardiac arrhythmias
-Metabolic acidosis: promotes unbinding of drug from proteins

25
TCA toxicity treatment
-Fluids -Vasopressors -Seizure management -Sodium bicarbonate
26
Sodium bicarbonate mechanism of action for the treatment of TCA toxicity
Increases sodium gradient of poisoned sodium channels
27
Sodium bicarbonate indications for the treatment of TCA toxicity
-QRS interval over 100 msec -TCA induced arrhythmias and hypotension -Metabolic acidosis
28
When should sodium bicarbonate be discontinued in TCA toxicity?
-QRS interval under 100 msec -Resolution of ECG abnormalities -Hemodynamically stable
29
What drugs should be used to treat TCA induced seizures?
-BZDs -Phenobarbital
30
Which antipsychotics are more likely to cause toxicity?
Typical (haloperidol and any that end in zine)
31
Signs and symptoms of antipsychotic toxicity
-Hypotension -Tachycardia -QT/QRS prolongation -Extrapyramidal symptoms -Neuroleptic malignant syndrome -Sedation
32
What drugs are used to treat EPS?
-Benztropine -Diphenhydramine
33
Symptoms of NMS
-Hyperpyrexia -Altered mental status -Muscular rigidity -Occurs later after initiating therapy
34
NMS complications
-Death -Rhabdomyolysis -Renal failure -Cardiovascular collapse -Respiratory failure -Arrhythmias -Thromboembolism
35
How to treat NMS
-D/C offending agent -Rapid external cooling -BZDs -Dantrolene or bromocriptine
36
Symptoms of serotonin syndrome
-Altered mental status -Autonomic instability -Neuromuscular abnormalities
37
Treatment of serotonin syndrome
-D/C offending agents -BZDs -Aggressive cooling -Cyproheptadine
38
Difference between serotonin syndrome vs NMS
-NMS has a higher fever -NMS lasts for more than 24 hours, and SS lasts for less than 24 hours -They both have lead pipe rigidity but lower limbs are more affected in SS
39
Common side effects in digoxin overdoses
-Seeing yellow halos over peoples heads -Hyperkalemia
40
Management of digoxin toxicity
-D/C digoxin -ABC management -Obtain serum digoxin concentration and BMP -Monitor vitals and ECG changes -Administer activated charcoal if presented within 2 hours of ingestion -Consider administering Digibind -Do NOT use hemodialysis
41
CCB toxicity symptoms
Hyperglycemia
42
BB toxicity symptoms
-Hypoglycemia -Bronchospasms
43
Should atropine be used for CCB and BB overdoses?
It is readily available but it is usually not effective
44
Which overdose should calcium be used in
CCB overdoses
45
When should norepinephrine be used in BB/CCB toxicity?
Vasodilatory shock
46
When should epinephrine be used in BB/CCB toxicity?
Cardiogenic shock
47
What may need to be used to pre-medicate with glucagon?
Ondansetron

Therapeutics V (52 decks)

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