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MRCEM INTERMEDIATE > Toxicology & Pharmacology > Flashcards

Toxicology & Pharmacology Flashcards

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1
Q

How to calculate dose of naloxone infusion needed

A

60% of dose needed to reverse respiratory depression, including total of divided doses

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2
Q

At what dose of paracetamol OD does NAC need to be started

A

> 75mg/kg

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3
Q

Cholinergic features

DUMBELS

A

DIRRHOEA
URINATION
MIOSIS
Bronchorrhea
EMESIS
LACRIMATION
SALIVATION

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4
Q

Pralidoxime antidote for

A

Antidote for toxic exposure to organophosphate anticholinesterase pesticides

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5
Q

Anticholinergic toxidrome

A

Tachycardia, hyperthermia, dilated pupils, warm and dry skin, urinary retention, agitation

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6
Q

Cholinergic toxidrome

A

Salivation, lacrimation, urination, diarrhoea, bronchorrhoea, bronchospasm, bradycardia, vomiting

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7
Q

Hallucinogenic toxidrome

A

Hallucinations, panic, seizures, hypertension, tachycardia, tachypnoea

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8
Q

Sympathomimetic toxidrome

A

Tachycardia, hypertension, dilated pupils, agitation, seizures, hyperthermia, sweating

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9
Q

Examples of Anticholinergic drugs

A

Antihistamines, tricyclic antidepressants, carbamazepine, phenothiazines

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10
Q

Examples of Cholinergic drugs

A

Carbamates, organophosphates insecticides, some mushrooms

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11
Q

Examples of Hallucinogenic drugs

A

LSD, Phencyclidine , Magic Mushrooms

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12
Q

Examples of Sympathomimetic drugs

A

Amphetamines, cocaine, MDMA

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13
Q

Calcium channel blockers antidote

A

Calcium chloride/gluconate

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14
Q

Lead antidote

A

Calcium disodium EDTA

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15
Q

Neuroleptic malignant syndrome antidote

A

Dantrolene

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16
Q

Serotonin syndrome antidote

A

Cyproheptadine (Periactin®)

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17
Q

Ethylene glycol & methanol antidote

A

Fomepizole

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17
Q

Benzodiazepines antidote

A

Flumazenil

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18
Q

Cyanide antidote

A

Hydroxocobalamin

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19
Q

Dabigatran antidote

A

Idarucizumab (Praxbind®)

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20
Q

Sulfonylureas antidote

A

Octreotide (Sandostatin®)

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21
Q

Anticholinergic syndrome antidote

A

Physostigmine

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22
Q

Heparin antidote

A

Protamine sulfate

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23
Q

Organophosphate insecticides, nerve gases antidote

A

Pralidoxime (2-PAM, Protopam®)

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24
Seen on a VBG early with salicyclate OD
Low CO2, respiratory acidosis
25
Hallmark for TCA poisoning on ECG
+ve R wave in aVR
26
Precipitants of methaemoglobinaemia
Local anaesthetics Chloroquinine Metoclopramide Nitrates Phenytoin
27
ECG findings in patients on digoxin (non toxic)
Down sloping ST depression Flattened or inverted T waves Shortened QT interval
28
Digoxin toxicity ECG findings
Bradycardia PR and QR prolongation
29
Fomepizole treats what?
Used to treat methanol and ethylene glycol poisoning. Should be used when suspected and patient has a metabolic acidosis with raised osmolar gap
30
Ways to reduce risk of local anaesthetic toxicity
Calculate doses Reduce dose in frail patients Use USS Combine with adrenaline Diluting doesn't reduce this risk
31
Electrolyte imbalances causing digoxin toxicity
Hypercalcaemia Hypokalaemia Hypomagnesia
32
Most concerning ECG finding in serotonin OD and why?
QT prolongation Leads to torsades
33
Most common ECG finding in TCA OD
QRS prolongation
34
Arterial blood gas in carbon monoxide poisoning
Metabolic acidosis Raised lactate Normal pO2
35
Antidote for salicylate overdose
Sodium bicarb
36
When to give sodium bicarbonate in a TCA OD
QRS > 120 msecs / hypotensive unresponsive to fluids
37
Salicylate initial ABG findings
Respiratory alkalosis (increased resp rate)
38
Biochemistry results caused by loop diuretics
Hyponatraemia Hypokalaemia Hypocalcaemia Hypomagnesaemia Hypochloraemic alkalosis
39
The only anticonvulsant therapy thought to be associated with the development of Dupuytren’s contracture is ...
Phenytoin
40
Which electrolyte disturbance is most dangerous for a patient taking digoxin?
HypoK
41
How much adrenaline in an adult / child autoinjector
0.3mg 0.15mg
42
BP medication which actually lowers your risk of gout
Calcium channel blockers
43
If given in 3rd trimester SSRIs are associated with
(antidepressant) discontinuation syndrome and persistent pulmonary hypertension of the newborn.
44
Methionine is an alternative antidote to
NAC (paracetamol)
45
fetal warfarin syndrome
nasal hypoplasia, bone stippling, bilateral optic atrophy and intellectual disability
46
Calcium channel OD, IV calcium dose options (2)
10% calcium gluconate 60 mL IV (0.6-1.0 mL/kg in children), or; 10% calcium chloride 20 mL IV (0.2 mL/kg in children) via central venous access
47
Salicylate OD, common clinical features include
Nausea and vomiting Tinnitus Deafness Sweating and dehydration Hyperventilation Cutaneous flushing
48
The indications for DigiFab in acute toxicity
Cardiac arrest Life-threatening arrhythmia Potassium level >6.5 mmol/l >10 mg digoxin ingested (adult) >4 mg digoxin ingested (child) Digoxin level >12 ng/ml
49
When furosemide and macrolide antibiotics are prescribed together, what is the risk?
Hypokalaemia, potentially increasing the risk of torsades de pointes
50
Non drug factors that increase the half-life of theophylline include:
Heart failure Cirrhosis Viral infection
51
Non drug factors that decrease the half-life of theophylline include:
Smoking Heavy drinking
52
What dose of activated charcoal should be administered in children?
1g/kg
53
The two drugs that are associated with the highest risk of developing drug-induced lupus
Procainamide and hydralazine
54
Above what digoxin level is toxicity usually seen?
2 nmol/L
55
Theophylline toxicity metabolic results
Mild metabolic acidosis Hypokalaemia Hypomagnesaemia Hypophosphataemia Hypo- or hypercalcaemia Hyperglycaemia
56
Over what threshold level are toxic effects generally seen with Lithium?
1.5 mmol/l
57
What do calcium channel blocker ODs do to BGL?
Hyperglycaemia
58
Arthus reaction
In-situ formation of antigen/antibody complexes following the intradermal injection of an antigen. Type III hypersensitivity
59
Benzodiazepines antidote
Flumazenil
60
Beta blockers antidotes
Atropine Glucagon Insulin
61
Ethylene glycol / methanol antidotes
Ethanol Fomepizole
62
Heparin antidote
Protamine sulphate
63
Isoniazid antidote
Pyridoxine
64
Organophosphates antidotes
Atropine Pralidoxime
65
Sulphonylureas antidotes
Glucose Octreotide
66
Thallium antidote
Prussian blue
67
The most common ECG change seen in TCA overdose
Sinus tachycardia
68
Normal serum osmolality
between 275 and 295 milliosmoles per kilogram (mOsm/kg)
69
Foxglove causes what type of toxicity?
Digoxin
70
MOA of TCAs (5)
Anticholinergic effects Direct alpha-adrenergic blockade Blockade of noradrenaline reuptake at the preganglionic synapse Blockade of sodium channels Blockade of potassium channels
71
Normal anion gap
8-16
72
Causes of type A lactic acidosis
All to do with resp / cardiac Shock (including septic shock) Left ventricular failure Severe anaemia Asphyxia Cardiac arrest CO poisoning Respiratory failure Severe asthma and COPD Regional hypoperfusion
73
Causes of type B lactic acidosis
Renal failure Liver failure Sepsis (non-hypoxic sepsis) Thiamine deficiency Alcoholic ketoacidosis Diabetic ketoacidosis Cyanide poisoning Methanol poisoning Biguanide poisoning
74
Which supplement should people taking warfarin avoid? (2)
Omega 3 St. John’s wort
75
Flumazenil dosing
The dose is 200 μg every 1-2 minutes (max dose 3mg/hour)
76
Arthus reaction
In-situ formation of antigen/antibody complexes following the intradermal injection of an antigen. They are rarely reported following vaccination and can occur after tetanus toxoid-containing ort diphtheria toxoid-containing vaccines. They are an example of a type III hypersensitivity reaction.
77
Examples of enzyme-inducing anticonvulsants include:
Carbamazepine Phenytoin Phenobarbitol Topiramate
78
Anti epileptic associated with gum hypertrophy
Phenytoin
79
Drugs that cause gynaecomastia include:
Cimetidine Omeprazole Spironolactone Digoxin Furosemide Finasteride Some anti-psychotics.

MRCEM INTERMEDIATE (19 decks)

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