{ "@context": "https://schema.org", "@type": "Organization", "name": "Brainscape", "url": "https://www.brainscape.com/", "logo": "https://www.brainscape.com/pks/images/cms/public-views/shared/Brainscape-logo-c4e172b280b4616f7fda.svg", "sameAs": [ "https://www.facebook.com/Brainscape", "https://x.com/brainscape", "https://www.linkedin.com/company/brainscape", "https://www.instagram.com/brainscape/", "https://www.tiktok.com/@brainscapeu", "https://www.pinterest.com/brainscape/", "https://www.youtube.com/@BrainscapeNY" ], "contactPoint": { "@type": "ContactPoint", "telephone": "(929) 334-4005", "contactType": "customer service", "availableLanguage": ["English"] }, "founder": { "@type": "Person", "name": "Andrew Cohen" }, "description": "Brainscape’s spaced repetition system is proven to DOUBLE learning results! Find, make, and study flashcards online or in our mobile app. Serious learners only.", "address": { "@type": "PostalAddress", "streetAddress": "159 W 25th St, Ste 517", "addressLocality": "New York", "addressRegion": "NY", "postalCode": "10001", "addressCountry": "USA" } }

Toxicology Flashcards

(28 cards)

1
Q

Toxins causing Bradycardia

A

PACED: Propranolol (BetaBs), Poppies (Opioids), Physostigmine, Propoxyphene, Anticholinesterase drugs, Antiarrhythmics, Clonidine, CCBs, Ethanol/Alcohols, Digoxin, Digitalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Toxins causing Tachycardia

A

FAST: Free base cocaine, Freon, Anticholinergics, Antihistamines, Antipsychotic amphetamines, Alcohol WITHDRAWAL, Sympathomimetics, Solvents, Strychnine, Theophylline, TCAs, Thyroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Toxins causing Hypothermia

A

COOLS: Carbon monoxide, Opioids, Oral hypoglycemics, Insulin, Liquor, Sedative-hypnotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Toxins causing Hyperthermia

A

NASA: Neuroleptic malignant syndrome, Nicotine, Antihistamines, Alcohol withdrawal, Salicylates, Sympathomimetics, Serotonin Syndrome, Anticholinergics, Antidepressants, Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Toxins causing Hypotension

A

CRASH: Clonidine, CCBs, Rodenticides (Arsenic, Cyanide), Antidepressants, Amiophylline, Antihypertensives, Sedative-hypnotics, Heroin (Opioids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Toxins causing Hypertension

A

CT SCAN: Cocaine, Thyroid supplements, Sympathomimetics, Caffeine, Anticholinergics, Amphetamines, Nicotine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Toxins causing Tachypnea

A

PANT: Phencyclidine (PCP), Pneumonitis, Phosgene, Paraquat, ASA, Nerve Agents, Noncardiogenic pulmonary edema, Toxin-induced metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Toxins causing Bradypnea

A

SLOW: Sedative-hypnotics, Liquor, Opioids, Weed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In salicylate overdose, what does acidemia signify?

A

Loss of respiratory compensation (first sign is tachypnea), and acceleration of the toxicity (acid to the CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sources of salicylate

A

Aspirin (acetylsalicylic acid), Topical salicylates, Analgesic balms, Oil of wintergreen, Willow bark, Alka Seltzer, Bismuth subsalicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Progression of Acid-Base Disturbance and Toxicity in Acute ASA OD.

A

Early (0-4 hours): 20-60mg/dL, Respiratory alkalosis with alkalemia, GI distress, Mild-mod hyperpnea, Tinnitus, Lethargy.

Moderate (2-12 hours): 50-90mg/dL, Respiratory alkalosis + Metabolic acidosis with alkalemia or neutral pH, Severe hyperpnea, Lethargy or Agitation, Hyperthermia.

Severe (6-24 hours): >80mg/dL, Respiratory alkalosis or acidosis + Metabolic acidosis with acidemia, Severe hyperpnea, Coma or Acute Delirium, Hyperthermia, Pulmonary or Cerebral edema, Seizure, Cardiovascular collapse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Salicylate toxicity causes what metabolic issues?

A

Interferes with aerobic metabolism, Uncoupling of mitochondrial oxidative phosphorylation, Inhibition of Krebs cycle = increased pyruvic acid -> lactic acid, Increased lipid metabolism -> ketone bodies, Increased metabolic rate, temperature, tissue CO2 and O2 consumption, Tissue glycolysis = hypoglycemia, Ineffective anaerobic metabolism = decreased ATP production, Energy lost as heat = hyperthermia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does ASA toxicity lead to hypokalemia?

A
  1. Vomiting 2/2 stimulation of medullary chemoreceptor trigger zone.
  2. Increased renal excretion of K, Na, HCO3 2/2 compensation to resp alkalosis + ASA-induced increased permeability of renal tubules losing more K.
  3. Inhibition of active transport system 2/2 uncoupling of oxidation phosphorylation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for salicylate-induced pulmonary edema

A

Age > 30, Chronic smoking, Chronic ASA ingestion, Metabolic acidosis, Neurologic symptoms, ASA > 80mg/dL, Large AGMA, Hypokalemia, Low pCO2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two salicylate effects on CNS

A
  1. Cerebral Edema = increased energy requirements, acidemia, direct cellular toxicity.
  2. Neuroglycopenia = consumption of glucose in brain may be faster than supply (even with normal serum glucose). One or both of above can cause AMS, seizure, coma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does ASA toxicity affect bleeding?

A

Therapeutic dose = increased bleed risk via irreversible inhibition of PLT COX. Overdose = vitamin K epoxide reductase is inhibited (similar to warfarin). Acquired coagulopathy prolongs prothrombin time, associated with increased risk of clinically significant bleeding.

17
Q

How are the elderly predisposed to salicylate toxicity from chronic therapeutic ingestions?

A

Decreased liver blood flow limits biotransformation of salicylate, Decreased renal function reduces salicylate clearance, Decreased albumin binding = increased free salicylate entering cells and passing through blood-brain barrier.

18
Q

Clinical features of salicylate toxicity?

A

GI upset, Tachypnea and respiratory alkalosis, Tinnitus & hearing disturbances (concentration-dependent reversible ototoxicity), Diaphoresis, AGMA, Hyperthermia, Coagulopathy, Cerebral edema, Pulmonary edema, Cardiovascular collapse, Death.

19
Q

DDx for Salicylism

A

Salicylism, Sepsis, CNS infection, Withdrawal syndromes, Alcoholic ketoacidosis, Diabetic ketoacidosis.

20
Q

Toxins causing AGMA

A

ASA, Colchicine, Iron, Isoniazid, Methanol, Ethylene glycol, Metformin, Cyanide.

21
Q

Toxins causing tinnitus

A

ASA, Aminoglycosides, Loop diuretics, Opioids, Methotrexate, Cisplatin, Quinine.

22
Q

Is activated charcoal useful for ASA overdose?

A

Yes. Can use MDAC as well. 25-50g NG q2-4h x 2-4 doses. For acute ingestions. NOT chronic.

23
Q

Main treatment objectives in ASA toxicity?

A
  1. Correct fluid deficits and acid-base abnormalities.
  2. Increase excretion.
24
Q

Treatment of Acute Salicylate Toxicity

A

Consider MD activated charcoal, 25g q2-4h x2-4 doses, Treat dehydration, urine output 2-3ml/kg/hr, Correct K depletion with goal serum 4.5-5.0, Alkalinize urine, goal pH 7.5-8.0, serum goal pH 7.55, NaHCO3 150mEq = 3amps, in D5W 1L, with KCl 40mEq @ 2-3ml/kg/hr, Dextrose 0.5-1.0g/kg IV for any CNS abnormalities, Hemodialysis if criteria met = AMS, coma, seizure, respiratory failure, pulmonary edema, serum pH <7.2, renal failure, hepatic failure, rapidly rising salicylate level, failure of urine alkalinization, ASA >100mg/dL in acute OD, ASA >40mg/dL in chronic OD.

25
Indications to dialyze in ASA toxicity?
Deterioration in condition, Altered mental status, seizure, coma, Respiratory failure, pulmonary edema, need to intubate, Serum pH <7.2, Rapid rise in ASA level, ASA > 100mg/dL after acute OD, ASA > 40mg/dL after chronic OD, Renal failure, failure to alkalinize urine, Hepatic failure.
26
Considerations in maternal ASA poisoning?
Greater [ASA] on fetal side of placenta, Relative fetal acidemia contributes to fetal distress, Associated with fetal demise, Treat expeditiously, Consult OB for delivery of distressed fetus in 3rd trimester if fetus viable.
27
Differential for bilateral putamen hypodensity changes?
Methanol toxicity, CO toxic encephalopathy, Cyanide toxic encephalopathy, Hydrogen sulfide toxic encephalopathy, Hemolytic-uremic syndrome, Hypoxic-ischemic injury, Wilson disease, Leigh disease, Kearns-Sayre syndrome.
28
What are causes of a double OG and AG?
Methanol, Ethylene glycol, Alcoholic ketoacidosis, Diabetic ketoacidosis, Uremia, Septic Shock, Multiorgan failure