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Toxicology Flashcards

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1
Q

Antidote for arsenic?

A

dimercaprol, succimer, d-penicillamine

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2
Q

Antidote for lead?

A

succimer, EDTA, dimercaprol, d-penicillamine

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3
Q

Antidote for mercury?

A

dimercaprol, succimer, d-penicillamine

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4
Q

Antidote for black widow spider bite?

A

Lactrodectus antivenin

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5
Q

Antidote for calcium channel blockers?

A

calcium, glucagon, insulin + glucose

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6
Q

Antidote for cyanide?

A

nitrite + thiosulfate, hydroxycobalamin

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7
Q

Antidote for hydroxyfluoric acid?

A

calcium gluconate

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8
Q

Antidote for methemoglobinemia?

A

methylene blue, ascorbic acid

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9
Q

Antidote for opioids?

A

nalmefene, naloxone

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10
Q

Antidote for rattlesnake bite?

A

CroFab

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11
Q

Antidote for sulfonylureas?

A

ocreotide

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12
Q

Antidote for valproic acid?

A

carnitine

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13
Q

Antidote for TCAs?

A

sodium bicarbonate

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14
Q

Pt has taken an enteric coated, extended release drug. It’s only been 30 min. What to do?

A

whole bowel irrigation w/ 1-2L isotonic PEG electrolyte soln

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15
Q

Hemodialysis is an option for poisoning with…

A

methanol, ethylene glycol, lithium, salicylates, sotalol

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16
Q

Hemoperfusion is an option for poisoning with…

A

carbamazepine, phenytoin, phenobarbital, theophylline

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17
Q

Drugs that need quantitative serial levels?

A

PADlock the TV and the PC

Phenytoin
Aspirin/salicylates
Digoxin
Theophylline
Valproic acid
Phenobarbital
Carbamazepine
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18
Q

Drugs that need a single quantitative level at a set point?

A 
MACE HIM
Methanol
Acetominophen
Carbon monoxide
Ethanol, ethylene glycol
Heavy metals (24 hr urine)
Iron
Methemoglobin
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19
Q

What antidote is c/i in sympathomimetic toxicity?

A

beta blocker w/o alpha blocking activity

this is b/c unopposed alpha blockade is bad

give a combo blocker like carvedilol

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20
Q

Most toxic beta blocker?

A

propranolol

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21
Q

Membrane-depressant effects (widened QRS) of beta blockers may respond to…

A

sodium bicarbonate (as for TCA toxicity)

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22
Q

How well does calcium administration aid in treatment of calcium channel blocker toxicity?

A

it is most useful for negative inotropic effects, less effective for AV nodal blockade and bradycardia

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23
Q

IV lipid emulsion may aid in treating…

A

Calcium channel blocker toxicity and propranolol toxicity (lipophilic)

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24
Q

How does INH cause metabolic acidosis?

A

inhibits hepatic conversion of lactate -> pyruvate

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25
What is a Rumack-Matthew nomogram?
computer program: give it a blood level of acetominophen and how long after overdose you are and it tells you the likelihood of hepatic toxicity
26
Administer N-acetylcysteine in Tylenol overdose if levels are...
> 150 mcg/mL @ 4 hours
27
When to discontinue N-acetylcysteine administration in acetominophen overdose?
DO NOT d/c once started. must give q4h x17
28
What concentration of ASA after acute poisoning indicates possibility of severe overdose?
100 mg / dL
29
Acute Rx of salicylate poisoning?
glucose-containing fluids to reduce risk of cerebral hypoglycemia sodium bicarb to treat acidosis and acidify urine add in some potassium to maintain lytes hemodialysis for severe acidosis or severe neurological sx
30
Tx for inhalation of chlorine gas?
humidified O2, bronchodilators
31
Tx for inhalation of ammonia gas?
humidified O2, bronchodilators
32
Tx for inhalation of sulfur dioxide gas?
humidified O2, bronchodilators
33
How does cyanide cause damage?
blocks binding of O2 to cytochrome c | inhibts complex IV in ETC
34
How does hydrogen sulfide cause damage?
similar to cyanide: blocks binding of O2 to cytochrome c but there is no specific antidote smells like rotten eggs
35
What gas causes damage in a manner similar to cyanide but has no specific antidote?
hydrogen sulfide (smells like rotten eggs)
36
How does nitrogen oxide gas cause damage?
causes methemoglobinemia... tx w/ methylene blue, ascorbic acid
37
How does the cyanide kit work?
contains sodium nitrite, sodium thiosulfate, amyl nitrite the inhaled amyl nitrite + IV sodium nitrite cause formation of methemoglobin. cyanide likes methemoglobin more than cytochrome c, so it binds here. thiosulfate + cyanomethemoglobin = thiocyanate, regular hemoglobin. the thiocyanate is eliminated renally
38
Charcoal/gastric lavage for hydrocarbon toxicity?
nope... not usually. charcoal isn't used; gastric lavage may be indicated for some rare situations w/ a few select hydrocarbons that have severe toxicity
39
Tx for hydrocarbon toxicity?
no specific antidote intubation for resp failure Mg, K for arrhythmias lidocaine or beta blockers for vfib KEEP CALM since they're sensitive to catecholamine release
40
Rx for organophosphate poisoning?
atropine + pralixodime [ProtoPam]
41
Rx for carbofuran poisoning?
it's a carbamate that causes cholinergic tox give atropine + pralixodime [ProtoPam]
42
What botanical insecticide can cause seizures and neurotoxicity?
pyrethrum (via inhalation or ingestion) (and nicotine) acts at voltage-sensitive Na, Ca, and Cl channels can also cause contact dermatitis tx: symptomatic support and control of seizures
43
What are the toxic botanical insecticides?
nicotine pyrethrum rotenone (GI irritation, rhinitis, pharyngitis, dermatitis) all of these are treated w/ symptomatic support
44
Toxic herbicides? How to treat?
2,4-D and Paraquat GI symptoms + bizarre or aggessive behavior (2,4-D) MOF, lung scarring, CNS effects (Paraquat) treat w/ fluids, sodium bicarbonate (2,4-D) and maintenance of lytes
45
Lab values in 2,4-D poisoning?
(herbicide) metabolic acidosis, elevated creatine phosphokinase, possibly myoglobinuria
46
Difference in effects of caustic acids vs. alkalis?
acids -> coagulative necrosis. stomach is most common involved site. esophagus and oropharynx relatively resisitant alkalis -> liquefactive necrosis. oropharynx, hypopharynx, esophagus most likely involved
47
Caustic acids cause (coagulative / liquefactive) necrosis.
coagulative | stomach most common involved site
48
Caustic alkalis cause (coagulative / liquefactive) necrosis.
liquefactive | esophagus, pharynx most common involved site
49
Treatment for acute caustic acid or alkali ingestion?
intubation NO EMETICS: it'll burn on the way up gastric lavage dilute alkalis if w/in 30 min (don't dilute acids: too hot) don't try and neutralize: too hot
50
Lead inhibits which enzymes of heme synthesis?
delta-ALA dehydratase and ferrochelatase
51
What levels of lead impact brain development in a child?
10 mcg/mL
52
Which lead chelator may actually increase CNS lead levels?
EDTA | therefore only use with dimercaprol, which is typically used for lead encephalopathy
53
You're treating someone with lead poisoning. You give them a chelating agent and after a short dip, their serum lead levels rise again. What did you do wrong?
serum levels may rise after chelation due to tissue redistribution. repeat the chelation
54
Heavy metal poisoning that can be measured in hair?
arsenic
55
Chronic exposure to this heavy metal causes dermatologic issues like palmar and solar keratoses.
arsenic
56
What drug is formulated in peanut oil?
dimercaprol (IM injection q4h) problem: hypersensitivity, G6PD deficiency, nephrotoxicity, sterile abscess at injection site, etc. etc.
57
Mercury toxicity causes what?
interstitial pneumonitis, intention tremor, inflammation of gums w/ excessive salivation desquamative rash in small children dose-related nephrotic syndrome
58
Which antivenin is made in horses and therefore may result in hypersensitivity reaction when administered?
lactrodectus antivenin
59
What happens if you take syrup of ipecac chronically?
cardiotoxicity
60
Why is glucagon a good antidote for beta blocker toxicity?
acts on cardiac muscle cells to increase intracellular cAMP | but does so independent of beta receptors
61
How does insulin help in beta blocker toxicity?
switches cardiac metabolism to glucose which improves heart muscle function.... also, since beta blockers and calcium channel blockers reduce insulin secretion (beta2 pancreatic receptors and L-type calcium channels), toxicity results in hyperglycemia, hypoinsulinemia, and acidosis. insulin helps correct this
62
Use metaclopramide for N/V associated w/ _______________ overdose.
acetominophen
63
This drug is an antihistamine with antiserotonin effects.
cyproheptadine

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