Toxicology Flashcards by Tom Bicknell

Calcium channel blockers

Amlodipine
Diltiazem
Verapamil
Felodipine
Nicardipine
Nifedipine

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Beta Blockers

Bisoprolol
Atenalol
Propanalol
Metoprolol
Carvedilol

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SSRI (Selective seretonin re-uptake inhibitors)

citalopram
dapoxetine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
vortioxetine

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Antidote for Beta Blocker overdose

Glucagon

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Antidote for Benzodiazepine OD

Flumazenil

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Antidotes for calcium channel blocker overdose

Calcium chloride
Calcium gluconate
Glucagon (if severe hypotension)

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Carbon monoxide poisoning treatment

Oxygen

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Cocaine OD treatment

Benzodiazepines
Diazepam
Lorazepam

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Cyanide poisoning antidote

Hydroxycobalamin
Sodium thiosulphate

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Opioid OD antidote

Naloxone

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Organophosphate poisoning antidote

Atropine
Pralidoxime

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DOAC

Direct oral anticoagulants

Dibigatran
Apixaban
Rivaroxaban
Edoxaban

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Digoxin effect on ECG

Downsloping ST depression with a characteristic “reverse tick” or “Salvador Dali sagging” appearance

Flattened, inverted, or biphasic T waves

Shortened QT interval

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5 main toxidromes

Symathomimmetic
Cholinergic
Anti-Cholinergic
Sedative/Hypnotic
Opioid

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Symathomimmetic presentation

HR - Increased
BP - Increased
RR - Normal to high
Temp - Normal to high
Eyes - Dilated
Skin - Normal, maybe diaphoretic
Secretions - Normal

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Symathomimmetic toxidrome causes

amphetamines
cocaine
theophylline
LSD
MDMA (Ecstacy)
other novel recreational drugs (e.g. Meow-Meow)
hypermetabolic syndromes (MH, NMS)

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Symathomimmetic toxidrome treatment

Supportive care
Benzodiazepines
Anti-adrenergics

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Opioid toxidrome presentation

Sedation
Miosis
Respiratory depression

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Opioid toxidrome causes

Opioid overdose

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Opioid toxidrome treatment

Study These Flashcards

Naloxone
Respiratory support

Cholinergic toxidrome presentation

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HR - Slow
BP - Normal to low
RR - Low
Temp - Normal - low
Eyes - Miosis (pinpoint)
Skin - Profusely diaphoretic
Secretions - Copious

S - Salivation
L - Lacrimation
U - Urination
D - Defecation
G - GI dismotility
E - Emesis

Cholinergic toxidrome causes

Study These Flashcards

Pesticides
Nerve agents

Cholinergic toxidrome treatment

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Remove the exposure if possible - DECON

Atropine
Pralidoxime

Anti-Cholinergic toxidrome presentation

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HR - Fast
BP - High
RR - Fast
Temp - Normal - high
Eyes - Dilated
Skin - Dry
Secretions - Dry

Mad as a hatter
Blind as a bat
Red as a beet
Hot as a hare
Dry as a bone

Anti-Cholinergic toxidrome causes

Antihistamines Antiemetics Anti-psychotics Muscle relaxants Tricyclic antidepressants

Anti-Cholinergic toxidrome treatment

Sedation Supportive care Antidote if available for specific drug injestion

Sedative/Hypnotic toxidrome presentation

Sedation! Loss of airway protection Respiratory depression

Sedative/Hypnotic toxidrome causes

benzodiazepines barbiturates GHB

Sedative/Hypnotic toxidrome treatment

Supportive care

Seretonin syndrome presentation

1) Autonomic hyperactivity - Hypertension - Tachycardia - Hyperthermia - Dilated pupils - Diaphoresis 2) Neuromuscular abnormality - Tremor. - Clonus. - Nystagmus - Hypertonicity 3) Mental status changes - Anxiety. - Agitation. - Confusion. - Coma.

Seretonin syndrome causes

monoamine-oxidase inhibitors (MAOIs) serotonin-norepinephrine reuptake inhibitors (SNRIs) selective serotonin reuptake inhibitors (SSRIs) Sympathomimmetic drugs (cocaine, MDMA, amfetamine, LSD)

SLUDGE

Cholinergic toxidrome S - Salivation L - Lacrimation U - Urination D - Defecation G - GI dismotility E - Emesis

Barbituates

Anxiolytics / sleeping pills / anti-epileptics

Excitatory neurotransmitters

Acetylcholine, Nor-adrenaline Glutamate

Inhibitory neurotransmitters

GABA Seretonin

Accidental poisoning occurs most in which age group

Under 5yo

Anticholinergic features may include

Tachycardia Fever Flushed skin Dilated/ blurred pupils/ vision Hyperthermia Seizures Arrythmia

Cholinergic toxidromes

Constricted pupils Bradycardia Vomiting Sweating Bronchospasm Increased salivation Hypotension Seizures

Clinical features of a toxic substance are called?

Toxidromes

For patients who have intensionally ingested poison, what also needs to be undertaken?

Mental health assessment

For the ingestion of poision, vomiting should...

Never be induced.

Irregation of the eyes should include

Removal of contact lenses and checking of conjiunctival PH with indicator paper (aim for pH of 7-8 but irregate regardless)

Neuroleptic Malignant syndrome toxidromes

Hyperthermia muscle rigidity altered mental state tachycardia tachyponea

Opoid toxidromes

Constricted pupils Nausea and vomiting Reduced respiratory rate Hypotension

Routes of toxin ingestion include

Dermal Occular Ingestion Inhalation

Serotonin syndrome toxidromes

CNS - confusion, agitation, ataxia Autonomic instability - Hyperthermia, labile BP & HR Neuromuscular - hypertonia, hyperflexia, tremor, clonus

The nine considerations when assessing a toxic agent are

Toxicity Concentration Duration of exposure Dose Route Toxicokinetics Toxicodynamics Chemical interactions Comorbidities

Toxicity is classed as

Highly toxic Toxic Low Toxicity This is calculated from the lethal dose (LD50) or lethal concentration (LC50), e.g. the amount required to kill 50% of exposed individuals

Toxicology Flashcards

(48 cards)