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Toxicology Flashcards

(65 cards)

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1
Q

What does toxicology involve?

A

ODs of medications and drugs

(Because your lips are venom you’re POISON)

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2
Q

Who may be able to give a good collateral history from a patient who just had an OD

A

Friends & family

Paramedics

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3
Q

What key bit of info would you try and get form paramedics regarding patients who had an OD?

A

If any drugs or medication packets were found nearby the poor bugger

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4
Q

What are the key bits of info you need to find out when taking a history of an OD

A

What was taken

How much

When

Was it taken all at once or staggered

Was alcohol involved

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5
Q

When someone presents to the ED with an OD, what do you need to consider?

A

If they have capacity

If their gonna leg it

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6
Q

What tool is used for assessing ODs

A

Toxbase tool

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7
Q

What does ‘Toxidrome’ mean?

A

The signs and symtpoms that indicate a specific class of poisoning

Just pattern recognition ehhhh

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8
Q

What is the very first thing you do for all patients who present with an OD

A

ABCDE assessment

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9
Q

So what do you look for in the ABCDE assessment for patient’s who have had an OD

A

A -> patency

B -> resp rate

C -> pulse & BP

D -> mental status, pupils, reflexes, seizures

E -> temperature, skin changes, musous membranes

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10
Q

When checking out the E in ABCDE for a patient whos had an OD, what do you look for with regards to skin?

A

If it’s sweaty or dry

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11
Q

What are the 4 main types of toxidromes

A

Adrenergic (sympathomimetic) drugs

Sedative-hypnotic drugs

Opioids

Anti-cholinergics

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12
Q

What is another term for adrenergic drugs

A

Sympathomimetics

(they mimic the effects of the sympathetic system ehhhh)

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13
Q

How do sympathemimetic (adrenergic) drugs work?

A

Stimulate a & B adrenergic receptors

Prevent noradrenaline reuptake

Release noradrenaline

(keeps noradrenaline going strong)

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14
Q

How do adrenergic drugs affect noradrenaline?

A

They keep it presennt and active

(let’s it go a bit maaad ehhh)

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15
Q

How do anticholinergic drugs work?

A

Block Na channels

Block a-adrenergic receptors

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16
Q

What are the 3 consitent features for pretty much all toxidromes?

(symtpoms to always guess ehh)

A

Altered mental state

Hallucinations

Delirium

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17
Q

What are the ECG signs for anti-cholinergic toxidromes?

A

Wide QRS

Prolonged PR and QT interval

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18
Q

What is the difference between anti-cholinergic and opioid toxidromes regarding what happens to the pupils?

A

Anti-cholingeric -> dilated & non-reactive

Opioid -> pin-point

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19
Q

What is the difference regarding what happens to reflexes for:

A. Adrenergic toxidromes

B. Sedative-hypoxic toxidromes

C. Anti-cholinergic toxidromes

A

A. Brisk

B. Reduced

C. Brish -> absent

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20
Q

What toxidromes casue hypertension and hypotension

A

Hypertension

Adrenergic

Anti-cholingeric

Hypotension

Sedative-hypoxic

Opioids

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21
Q

What toxidrome is being described here:

“Hot as a hare, dry as a bone, mad as a hatter”

A

Anti-cholinergic

Hot as a hare -> pyrexia

Dry as a bone -> dry skin

Mad as a hatter -> confusion ehhh

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22
Q

For anti-cholingeric toxidromes, what are the indications to give 50ml of Sodium bicarbonate?

A

Metabolic acidosis

Prolonged QRS

Arrythmias

Still hypotensive after fluids

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23
Q

What are the key questions you need to think about regarding how an OD will be managed?

A

Do they need resus

What have they taken, how much and when

Have the paramedics brought anything

Do they need charcoal

What tests need to be done

Is there a specific antidotoe

What is the predictive clinical course

Is a psych assessment needed

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24
Q

How would manage resp. depression that can occur in opioid ODs?

A

Fire in a nasopharyngeal airway

Give 15L of O2

Montitor CO2

Do an ABG

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25
Why is it important to monitor CO2 and do an ABG for opioid ODs?
To check for acidosis
26
Opioid ODs can cause hypoglycemia. How can you treat hypoglycemia?
IV dextrose (if you can't give IV -\> do IM glucagon)
27
What can happen to BG levels for opioid ODs?
Hypoglycemia
28
Why is charcoal often used for ODs?
As charcoal binds to the drug, limiting it's effect
29
What is a sign of warfarin OD, and how would you treat it?
Sign -\> Haemorrhage Treatment -\> Vit. K
30
Give examples of adrenergic drugs
Cocaine Ampthetamines Noval psychoactive substances Decongestants
31
Noval psychoactive agents are examples of adrenegric drugs, what are they also known as?
Legal highs
32
Cocaine and amphetamines are examples of what type of drug?
Adrenergic
33
Give examples of sedative-hypoxic drugs
Benzodiazipeines Barbituates Ethanol Zopidone (sleepign tablets)
34
Give an exmaple of a benzodiazpine, which is a type of hypoxic-sedative drug?
Diazepam
35
Baribituates are an example of sedative hypoxic drugs, what are they used to treat?
Epilepsy
36
Give examples of opioids
Codeine Heroin Methadone MST
37
Heroin and methodone are what type of drug
Opioid
38
What are opioids used to treat?
Chronic pain
39
Give examples of anti-cholinergic drugs
TCAs (e.g. amitriptyline) Antihistamine Oxybutynin Diphenhydramine
40
If someone presents with an OD of one of their anti-depressants or medicine for their urinary incontinence, what is the likley toxidrome?
Anti-cholinergic (anti-depressant -\> TCA) (urinary incontience drug -\> oxybutynin)
41
If someone presents with an OD after taking too much pain meds, what is the likely toxidrome?
Opioid
42
If someone presents with an OD of hayfever and allergy tablets, what is the toxidrome that will occur?
Anti-cholinergic
43
What are the clinical features for adrenergic (sympathomimetic) toxidromes?
Chest pain Agitation Tachycardia & tachypnoea Sweating Dilated pupils Brisk refelexes Arrythmias Hypertension
44
What are the clinical features of sedative-hypoix toxidromes?
Brachycardia & bradypnoea Slurred speach Nystagmus & blurred vision Reduced reflexes Hallucinations Coma
45
What are clinical features of opioid toxidromes?
Resp. depression Bradycardia Pinpoint pupils Hypothermia Seziures
46
What are the clinical features of an anti-cholinergic toxidrome?
Pyrexia (hot as a hare) Dry skin (dry as a bone) Confusion (mad as a hater) Tachycardia Brisk (then absent) reflexes Dilated & non-reactive pupils Urine retention
47
What types of toxidromes cause tachycardia and bradycardia?
**Tachycardia** Adrenergic Anti-cholinergic **Bradycardia** Sedative-hypoxic Opioid
48
How is an OD of an adrenergic drug managed?
**Measure** CK levels ECG Temperature **Give** Diazepan GTN infusion Sodium bicarbonate
49
What is sodium bicarbonate used to treat
Metabolic acidosis
50
Levels of what should you always check in adrenergic drug ODs?
CK
51
If CK levels are high in a adrenergic OD, what do you give?
IV fluids
52
How is an OD of a sedative-hypnotic drug managed?
Intubate & protect airway Ventilation support Correct hypotension Give flumazenil (if OD' on benzo)
53
How can you correct hypotension? (need to do in sedative-hypoxic and opoiod ODs)
Give IV fluids Lift legs Vasopressors
54
What is the main management goal for sedative-hypoxic toxidroems?
Protect the airway
55
What is the 'antidote' for benzodiazpenie OD?
Flumazenil
56
How is an OD of an opioid drug managed?
Give Naloxone Give 15L oxygen Set up a nasopharyngeal airway Do a GCS assessment Montiro CO2 and ABGs
57
What is the 'antidote' for... A. Adrenergic ODs B. Sedative-hypoxic (benzo) ODs C. Opioids
A. Diazepam B. Flumazenil C. Naloxone
58
What are the 2 ways that you give naloxone?
IV or IM
59
How long does naloxone last one given?
40mins approx (so it's long acting)
60
How are anti-cholingeric ODs managed?
Give charcoal Give glucahon (if hypotensive or in shock) Give sodium bicarbonate ( Check CK and ECG
61
What does diazpeam treat
Agitation Arrythmias
62
When would you give sodium bicarbonate in an anti-cholinergic OD?
If metabolic acidosis occurs (same for adregenric OD)
63
Alcohol OD would cause what type of toxidrome?
Sedative-hypoxic (As alcohol is ethanol ehhhhh)
64
What is the antidote for a benzo OD?
Flumanazil
65
An OD of what is treated with alcohol?
Anti-freeze

Systems- Acute stuff (2 decks)

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