Toxicology

Question 1

what is a toxidrome

Answer 1

constellation of physical findings that supports the clinical dgx of poisoning

Question 2

Cholinergic toxidrome acronyms

Answer 2

Dumbbels, MTWRF, or SLUDGE
Diarrhea
Urination
Miosis
Bronchorrhea
Bradycardia
Emesis
Lacrimation
Salivation

Mydriasis
Tachycardia
Weakness
HTN
Fasiculation

Salivation
Lacrimation
Urination
Defecation/Diarrhea
GI complaint 
Emesis

Question 3

What system cholinergics affect and some agents

Answer 3

increases PNS (overactivity of rest and digest)
Ex. organophosphates, carbamates, some mushrooms, nerve agents

Question 4

Anticholinergic toxidrome sx

Answer 4

Hot as a Hare (hyperthermia)
Blind as a Bat (blurred vision, mydriasis)
Dry as a bone (impaired sweating)
Red as a Beet ( flushing)
Mad as a Hatter ( agitation, psychosis, delirium, coma)
Bloated as a Bladded (urinary retention)

Question 5

What system do anticholinergics affect and some agents

Answer 5

decreases PNS (underactivity of rest and digest)
anti-cholinergics (atropine, scopolamine)
anti-histamines (benadryl)
anti-psychotics (Haldol)
anti-emetics (compazine, phenergan)
antidepressants (TCAs, SSRIs)
plants (Jimson weed, deadly nightshade)

Question 6

Opiate/Sedative Toxidrome sx

Answer 6

Everything DOWN
miosis
bradycardia
HOTN
decreased LOC, coma
decrease RR/Effort
hypotonia, hyporeflexia
decrease bowel sounds

Question 7

Opiate/Sedative affect and agents

Answer 7

decreases SNS (decrease in fight or flight)
Morphine, Heroin, Oxycodone, Codeine, Methadone
Barbituates
Benzos
Ethanol

Question 8

Sympathomemtic Toxidrome sx

Answer 8

Hyperthermia
HTN
tachycardia
mydriasis
urinary retention
psychosis
sz
*diaphoresis*
*hyperactive bowel sounds*

Question 9

Sympathomemtic Toxidrome sx

Answer 9

Hyperthermia
HTN
tachycardia
mydriasis
urinary retention
psychosis
sz
*diaphoresis*
*hyperactive bowel sounds*

Question 10

Sympathomemetic affect and agents

Answer 10

increases SNS (overactivity of fight or flight)
Cocaine
amphetamine
MDMA
phencyclidine
Ephedrine, Pseudoephedrine
Theophylline
Caffeine
Withdrawal from alcohol or benzos

Question 11

What is serotonin syndrome and how to dgx

Answer 11

it is a change in the SNS and PNS usually from stacking agents
Pt has to have 1-2 sx from each category:
Cognitive/Behavioral
Autonomic Nervous System
Neurmuscular

Question 12

Drugs that cause Serotonin syndrome

Answer 12

drugs that inhibit serotonin breakdown (MAOIs, Linezolid)
drugs that prevent synaptic reuptake of serotonin (SSRIs, cocaine, dextromethorphan, TCAs, etc)
drugs that agonize serotonin receptors (LSD, buspirone)
drugs that increase serotonin release (lithium, amphetamines, MDMA)

Question 13

Drugs that cause Serotonin syndrome

Answer 13

drugs that inhibit serotonin breakdown (MAOIs, Linezolid)
drugs that prevent synaptic reuptake of serotonin (SSRIs, cocaine, dextromethorphan, TCAs, etc)
drugs that agonize serotonin receptors (LSD, buspirone)
drugs that increase serotonin release (lithium, amphetamines, MDMA)

Question 14

Cholinergic OD tx

Answer 14

Atropine 0.05-0.1 mg/kg in children
1-5mg in adults IV/IM
repeat every 5 min until secretions clear
competitive inhibition of ACh at active sites

Pralidoxime (2-PAM)
may repeat hourly
breaks covalent bond with active site on AChase

Question 15

Anticholinergic AND sympathomimetic OD tx

Answer 15

DIazepam
5-10mg IV/IM for adults, repeat PRN
manage anxiety and sz

Also use cooling agents to prevent hyperthermia

Question 16

Opiate/Sedative OD tx

Answer 16

Naloxone
2-4mg IV/IM/IN in adults
competitive inhibition of opiate

Flumazenil
usually reserved for pts we OD on benzos

Question 17

Serotonin syndrome tx

Answer 17

diazepam
cooling
antipyretics
Cyproheptadine (antihistamine)

Question 18

How to tx APAP toxicity

Answer 18

ABCs
supportive care
if in first hour, can do activated charcoal
if at least 4 hours out, can do N acetyl cysteine (NAC) which is a reactive sulfur source the NAPQI can bind to

Question 19

Anticholinesterase Insecticides agents and antidotes

Answer 19

Agents:
Carbamate
Organophosphate-bond to active site of Ach-ase becomes irreversible over time

Antidotes:
Atropine
Pralidoxime

Question 20

CCB OD effects and management

Answer 20

vasodilation, decreased cardiac contractility, and decreased conduction velocity, impair insulin release leading to hyperglycemia

IV calcium chloride
infusion of insulin and dextrose
consider GI decontamination (WBI)
Glucagon bolus
Intralipid

Question 21

Iron toxicity sx and managment

Answer 21

N/V/D followed by 6-48 hours of absence of sx the progression of sx

Tx
ABCs, supportive care
*fluid resusitation
IV deferoxamine (highly selective iron chelator)

Question 22

TCA toxicity sx and management

Answer 22

change in LOC, EKG in first hour
lethargy, coma, sz
depressed resp drive
if nothing occurs in first 6h probably unlikely to happen

Tx
ABCs, supportive care, ALS
BICARB