Toxicology

Question 1

Cholinergic Symtpoms

Answer 1

SLUDGE + bronchorrhea, bradycardia, fasiculations, confusions

Question 2

Anticholinergic Symptoms

Answer 2

Dry as a bone, hot as a hare, mad as a hatter, full as a flask, blind as a bat

Question 3

Not absorbed by charcoal

Answer 3

Fe, lithium, cyanide, strong acid, alcohol, hydrocarbon

Question 4

when to use alkalinzation– urine pH >7

Answer 4

salicylates, barbiturates, primidone

Question 5

Removed by HD

Answer 5

Alcohol, amphetamine, phenobarbital, lithium, salicylates, theophylline, thiocyanate

Question 6

Not removed by HD

Answer 6

TCA, betablocker, benzo, sulfonylurea, digoxin

Question 7

Goal serum, urine pH in salicylate toxicity

Answer 7

serum 7.5, urine 6.5-8

Question 8

Antedote for TCA

Answer 8

Bicarb to alkalinze serum and sodium load for prolonged QRS

• reduce active unbound drug in serum
• HD NOT WORK
• activated charcoal more useful because sig enterohepatic circ

Question 9

Clues to SSRI overdose

Answer 9

Hyperthermia, myoclonus

Question 10

For CO poisoning, use hyperbaric if:

Answer 10

CO level >25% (20% if pregnant)
LOC
Severe acidosis
End organ ischemia

Question 11

Antedote for Cyanide

Answer 11

1. Direct cyanide binding- hydroxycobalamin
2. INduce MetHg- amyl nitrate (reduce Fe2+ to Fe 3+, less toxic
3. Sulfur donor- sodium thiosulfate, form thiocyanate, excreted in urine

Question 12

OK to give which beta-blocker with cocaine toxicity

Answer 12

Labetalol (alpha and Beta)

Question 13

Use of glucagon in beta blocker and CCB overdose:

Answer 13

Improve BP and perfusion, not HR

-Insulin helps with verapamil overdose

Question 14

Extra thing to treat CCB but not beta blocker OD

Answer 14

Insulin, and Ca obviously

Question 15

Antedote for malig hyperthermia and mech

Answer 15

Dantrolene

Reduce Ca reslease from ER (not affect reuptake)

Question 16

Antedote NMS

Answer 16

Bromocriptine

Amantadine

Question 17

Rasburicase major side effect

Answer 17

Met-Hg

Question 18

Ascorbic acid can affect: testing

Answer 18

POCG- makes it falsely elevated

Question 19

Isopropyl alcohol causes:

Answer 19

Osm gap

NOT Anion gap

Question 20

Treatment of sulfonylurea overdose

Answer 20

Octreotide is specific antedote

• sulfonylurea causes endogenous insulin secretion
• dextrose and glucagon increase glucose but this can actually cause resultant rebound hypoglycemia due to glucose
• octreotide will decrease insulin production, c-peptie and improve glucose

Question 21

Drugs with zero order kinetics

Answer 21

• set amount (not proportion) of drug eliminated per unit time due to saturation of enzymes. Narrow therapeutic window. With 2 concentrations and time measurement can estimate when it will be therapeutic.
• Drugs: peas and WHEATS (phenytoin, warfarin, heparin, Ethanol, APAP, Aspirin, Theophyline, Salicylates)