toxicology

Question 1

what toxic agent?

decreased BP, decreased RR, pinpoint pupils, decreased bowel soudns

Answer 1

opiods

altered mental status, decreased HR, decreased temp can also be seen

Question 2

which of the opiods are synthetic? why is this significant

Answer 2

fentayl
meperidine
buprinophine

important because these can require more of the antedotes than the natural opioids (like mohprine and codeine)

Question 3

what is the opioid receptor antagonist that is used medically

Answer 3

naloxone

Question 4

flu like symptoms (N/V, diarrhea), piloerection, yawning, irritability. normal mental status

whats going on with this patient

Answer 4

opioid withdrawal

Question 5

depressed mental status, NORMAL vital signs

what did the patient overdose on?

Answer 5

benzodiazepine

Question 6

what is the competitive non selective benzo receptor antagonist that can be used?

who is a good patient for this

Answer 6

flumazenil

a young child that you suspect overdosed on a benzo. dont want to give to someone that you suspect benzo tolerance

Question 7

what is the one drug you should test for in anyone that tried committing suicide with pills

Answer 7

acetaminophen

Question 8

with a acetaminophen toxicity, what symptoms do you see first

Answer 8

can be asymptomatic or GI irritation for the first day

Question 9

what is the predominant organ that is affected by acetaminophen in day 1-4

Answer 9

liver!

Question 10

what metabolite is the “bad” guy that causes the damage in acetaminophen toxicity

Answer 10

N-acetyl-benzoquinonemine

Question 11

what is the antidote for acetaminophen toxicity?

Answer 11

N acetylcysteine (NAC)

Question 12

NAC is 100% successful in acetaminophen poisoning if given within…

Answer 12

first 8 hours

Question 13

if NAC is given past the 8 hour window, there are still some benefits, how does NAC do this?

Answer 13

	supplies sulfhydryl groups
	antioxidant
	improves microcirculation
	supplies glutathione
	anti inflammatory properties

Question 14

dry mucous membranes, dry flushed skin, no bowel movements
dilated pupils
dysrhythmia

Answer 14

so you see some anticholinergic effects plus a dysrhythmia

think tricyclic antidepressant

Question 15

what kills you in a TCA overdose

Answer 15

the Na channel blockade!!

ventricular depolarization gets blocked, widened QRS complex

Question 16

whats the antidote for TCA poisoning

Answer 16

Na bicarbonate

to overcome the Na channel blockade

Question 17

what are some symptoms of an anticholinergic toxidrome

Answer 17

mydriasis, dry flushed skin, decreased bowel sounds, urinary retention, increased temp, altered mental status (confusion, hallucinations, seizures)

Question 18

what are some anticholinergic agents

Answer 18

atropine, benadryl (diphenhydramine), scopalamine, TCA antidepressants

Question 19

what is the antidote for a toxicity of anticholinergics

Answer 19

phyostigmine

anticholinesterase inhibitor

Question 20

which drug with anticholinergic properties can you NOT give phyostigmine too in the case of an overdose

Answer 20

TCA antidepressants

Question 21

not oriented
sweating, vomiting, diarrhea, miosis

plus CNS bronchorrhea/spasm and fasiculations

Answer 21

Cholinergic! plus the muscle symptoms are due to a nicotinic agent

Question 22

what is the antidote for a cholinergic toxidrome

Answer 22

atropine

Question 23

what is the antidote for a nicotinic toxidrome

Answer 23

pralidoxime

Question 24

what is the metabolite that kills in methanol poisoning

Answer 24

formac acid

Question 25

what is the metabolite that kills in ethylene glycol poisoning

Answer 25

glycolic acid

Question 26

how can you treat a toxidrome with methanol or ethylene glycol

Answer 26

you want to competitively inhibit ADH (can do this with ethanol or more preferably fomepizole)

Question 27

what are some indications for dialysis in a methanol or ethylene glycol poisoning

Answer 27

- methanol or ethylene glycol level greater than 25-50 - metabolic acidosis - coma - hemodynamic instability

Question 28

if patient took some BP medications and presents with hypotension AND bradycardia (4)

Answer 28

BBB CCB a2 agonist digoxin

Question 29

what can you do for a toxidrome with a CCB

Answer 29

calcium salts, glucagon (acts like a beta agonist) and high dose insulin, amrinone (phosphodiesterase inhibitor), vasopressors

Question 30

what BBB causes the "most trouble" because of its stabilizing effect

Answer 30

propranolol

Question 31

how does digoxin work

Answer 31

• Blocking Na/K ATPase.. Enhances intracellular Na… ultimately increase intracellular Ca

Question 32

what are the effects of a digoxin toxicity seen before the drug distributes

Answer 32

N/V | hyperkalemia

Question 33

what are effects of digoxin toxicity after the drug distributes

Answer 33

hypotension bradycardia dysrhythmias death

Question 34

what can you give in a digoxin toxicity

Answer 34

digibind (digoxin specific FAB fragment)

Question 35

what "upper" can you see seizures with

Answer 35

cocaine