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Flashcards in Toxicology Deck (47):
1

Describe the ABCDs of the acute management and stabilization of the poisoned patient.

Airway
Breathing
Circulation
Dextrose/decontamination

2

List drugs/substances that induce hypotension due to vomiting and diarrhea.

Iron
Arsenic
Food poisoning
Organophosphates and carbamates
Mushroom poisoning
Thallium

3

List drugs/substances that induce hypotension due to sweating and venodilation.

Organophosphates and carbamates
Barbiturates
Other sedative-hypnotics

4

List drugs/substances that induce hypotension due to depressed cardiac contractility.

TCAs
Beta-blockers
Calcium antagonists
Sympathetic agents (clonidine, sedative-hypnotics, etc.)

5

List drugs/substances that induce hypotension due to reduced peripheral vascular resistance.

Beta2-adrenergic stimulations
Phenothiazines
TCAs
Hydralazine
Nitrates
Trazadone

6

List the common causes of drug-induced seizures.

TCAs/antidepressants
Cocaine/amphetamines
Theophylline
Diphenhydramine
Isoniazid

7

What are some causes of sympathomimetic autonomic syndrome?

Cocaine
Amphetamines
Pseudoephedrine
Yohimbine

8

What are some empirical interventions for sympathomimetic autonomic syndromes? ie...
(How would you treat the HTN?)
(How would you treat the tachycardia?)

Sedation
Treat HTN w/phentolamine or other vasodilator
Treat tachycardia w/beta-blocker

9

What are some causes of sympatholytic autonomic syndromes?

Clonidine
Oxymetazoline
Tetrahydrozoline
Bromonidine
Tizanidine
Barbiturates
Opioids
Benzodiazepines

10

What are some empirical interventions for sympatholytic autonomic syndromes...
1. For opioid OD?
2. For benzo OD?

Naloxone for opioid OD
Flumazenil for benzo OD

11

What are some causes of cholinergic autonomic syndrome?

Organophosphate and carbamate insectacides
Chemical warfare nerve agents

12

What are some empirical interventions for cholinergic autonomic syndrome?

Give atropine and pralidoxime; obtain measurements of serum and RBC cholinesterase activity

13

What are some causes of anticholinergic autonomic syndrome?

Atropine and related drugs
Antihistamines
Carbamezapine
Phenothiazines
TCAs

14

What are some empirical interventions for anticholinergic autonomic syndrome...
1. If TCAs are involved (what test should you order?)
2. If TCAs are not involved (what drug?)

1. Get EKG if TCA poisoning
2. Consider physostigmine only if TCAs are not involved

15

List the sx of sympathomimetic autonomic syndrome.

Agitation
Dilated pupils
Elevated BP and HR
Sweaty skin
Hyperthermia

16

List the sx of sympatholytic autonomic syndrome.

Lethargy/coma
Small pupils
Normal/low BP and HR
Low temp

17

List the sx of cholinergic autonomic syndrome.

Pinpoint pupils
Variable HR
Sweaty skin
Abdominal cramps and diarrhea

18

List the sx of anticholinergic autonomic syndrome.

Agitation
Delirium
Dilated pupils
Tachycardia
Decreased peristalsis
Dry, flushed skin

19

List methods of acute gastrointestinal decontamination.

Emesis
Gastric lavage
Activated charcoal
Whole bowel irrigation

20

In what situations would emesis be a useful method of GI decontamination?

Possible benefit in rare circumstances after a potentially lethal ingestion when medical care is > 60 min away but only under guidance of a poison-control center.

21

In what situations would gastric lavage be a useful method of GI decontamination?

Useful in obtunded or comatose patients, in recent ingestions (< 1 hr), or in ingestion of anticholinergic agents or salicylates (delayed gut emptying)

22

In what situations would activated charcoal be a useful method of GI decontamination?

*When is it NOT affective? (5)

Often useful because adsorbs most drugs and poisons; may be equally effective when given alone as when given after emesis or lavage.

(Not effective for ingestion of Fe, Li, K+, Na+, or alcohols.)

23

In what situations would whole bowel irrigation (colyte/golytely) be a useful method of GI decontamination?

Useful in ingestion of Fe, Li, sustained-release or enteric-coated pills, and drug packets or other foreign bodies.

24

How do you treat OD/poisoning with acetaminophen?

Charcoal
*Acetylcysteine

25

How do you treat OD/poisoning with anticholinergic agents?

Charcoal
*Physostigmine
Supportive
Mg2+ for v-tac

26

How do you treat OD/poisoning with antihistamines?

Charcoal
Supportive
Mg2+ for v-tac

27

How do you treat OD/poisoning with anticoagulants?

Charcoal
*Vitamin K
FFP or whole blood

28

How do you treat OD/poisoning with beta-blockers?

Gastric lavage
Charcoal
*Glucagon

29

How do you treat OD/poisoning with CO?

O2

30

How do you treat OD/poisoning with cocaine, amphetamines, or other stimulants?

Benzos
Phentolamine
Nitroprusside
Beta or alpha/beta blocker

31

How do you treat OD/poisoning with Cu?

*Penicillamine (1st choice) or dimercaprol for chelation

32

How do you treat OD/poisoning with cyanide?

Charcoal
*B12
Nitrites
Thiosulfates

33

How do you treat OD/poisoning with digitalis glycosides?

Charcoal
Atropine
*Digibind (antibody)

34

How do you treat OD/poisoning with ethanol?

Supportive

35

How do you treat OD/poisoning with methanol or ethylene glycol?

Gastric aspiration
*Fomepizole or EtOH
Hemodialysis

36

How do you treat OD/poisoning with gold?

*Dimercaprol for chelation

37

How do you treat OD/poisoning with Fe?

Gastric decontamination
IV fluids
*Deferoxamine for chelation

38

How do you treat OD/poisoning with Pb?

Removal of Pb source from stomach
EDTA for chelation

39

How do you treat OD/poisoning with Li?

Gut decontamination
IV fluids

40

How do you treat OD/poisoning with methemoglobinemia-inducing agents?

Methylene blue

41

How do you treat OD/poisoning with opioids?

Ventilation
O2
*Naloxone

42

How do you treat OD/poisoning with organophosphate agents?

Charcoal
Gastric lavage
*Atropin, then 2-PAM (pralidoxime)

43

How do you treat OD/poisoning with salicylates?

Charcoal
Gastric lavage
NaHCO3 to alkalinize urine
Hemodialysis

44

How do you treat OD/poisoning with sedative/hypnotics?

Airway
Pressors
*Flumazenil

45

How do you treat OD/poisoning with TCAs?

Charcoal
Gastric lavage
Benzos/barbs for seizures
IV fluids
NaHCO3

46

For what drug class OD/poisoning would you add Mg2+ to the regimen to treat v-tac? (2)

Anticholinergic agents
Antihistamines

47

How do you treat OD/poisoning with CCBs?

Gastric lavage
Charcoal
Fluids, pressors, Ca+, Epi or Glucagon for hypotension