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Toxicology Week 1 Flashcards

(55 cards)

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1
Q

When should a hospital referral happen?

A
  • Moderate to severe exposure
  • Intentional ingestion
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2
Q

What are the ABCs of management?

A

Airway
Breathing
Circulation
Dextrose/Decontamination
EKG/Elimination

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3
Q

What are non-pharm options for toxic exposures?

A

Inhalational - remove from exposure area
Topical/dermal - irrigation with soap/water

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4
Q

T/F: We should utilize the gag reflex to remove toxic substances

A

FALSE

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5
Q

Which substances will not bind to activated charcoal?

A
  • Ionized metals (lithium)
  • Alcohols
  • Gasoline
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6
Q

What are some pearls of activated charcoal?

A
  • Sorbitol can improve palatability (only with one dose)
  • Must have protected airway
  • 1g/kg
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7
Q

What are some side effects of activated charcoal?

A

Vomiting, black tarry stools

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8
Q

Which decontamination strategy is useful for body packers or XR products?

A

Whole bowel irrigation

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9
Q

T/F: WBI is always best given by mouth

A

FALSE: an NG tube will eliminate the need for large volume consumption

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10
Q

When should you use orogastric lavage?

A
  • Potential to produce serious toxicity
  • No antidotes
  • Time window gives reason to believe agent may still be in the stomach
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11
Q

When should hemodialysis be used?

A
  • Other strategies unavailable/ineffective
  • Potential to produce serious toxicity
  • Agent dialyzable
    Basically last line
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12
Q

What does an anticholinergic toxidrome look like?

A
  • Dry mucous membranes
  • Flushed skin
  • Confused
  • Absent bowel sounds
  • Dilated pupils
  • Hyperthermia
  • Tachycardia
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13
Q

What is the antidote to anticholinergics?

A

Physostigmine (anticholinesterase inhibitor)
0.5 - 2 mg IV

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14
Q

What does a sedative-hypnotic toxidrome look like?

A
  • Normal vital signs
  • Very sleepy but can be woken up (painful stimuli)
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15
Q

What does an adrenergic/sympathomimetic toxidrome look like?

A
  • All vitals high
  • Agitated
  • Positive bowel sounds
  • Diaphoretic
  • Dilated pupils
  • Tremor
  • Agitated
  • Seizures
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16
Q

What does an opioid toxidrome look like?

A
  • Unresponsive to stimuli (even painful)
  • Respiratory rate very low
  • Pinpoint pupils
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17
Q

What does a cholinergic toxidrome look like?

A
  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • Gastric cramps
  • Emesis
  • Pinpoint pupils
  • Heavy oral secretions
  • Confusion
  • Bradycardia
  • Bronchorrhea
  • Bronchospasm
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18
Q

What are the most dangerous effects of the cholinergic toxidrome?

A

Killer Bs:
- Bradycardia
- Bronchorrhea
- Bronchospasm

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19
Q

How can we treat a cholinergic toxidrome?

A

Atropine 1 mg IV - titrate until bronchorrhea resolved

Pralidoxime - must administer before cholinesterase becomes inactivated

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20
Q

What are substances with unique toxidromes that we should always get a level for?

A

Acetaminophen (no toxidrome), salicylates

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21
Q

Which drugs will levels be important for treatment?

A
  • Digoxin
  • Vancomycin
  • Phenytoin
  • Lithium
  • Acetaminophen
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22
Q

Which 3 receptors do opioids act on?

A
  • Mu
  • Kappa
  • Delta
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23
Q

Which enzyme is important for codeine?

24
Q

How do you treat an opioid overdose?

Study These Flashcards
A
  • Administer antidote (naloxone)
  • Protect airway
25
T/F: Intranasal naloxone will protect a patient's airway immediately
FALSE: longer duration than IV but SLOWER onset
26
Which dose of naloxone would you use for a non-opioid dependent patient?
0.4 mg IV
27
Which dose of naloxone would you use for an opioid dependent patient?
0.04 mg IV, titrate to effect (we do not want to precipitate withdrawal)
28
What should we do if a patient is unconscious again after initial bolus of naloxone?
Give 1/2 of effective dose as bolus Give 2/3 of effective dose per hour
29
What is naloxone-induced pulmonary edema?
Catecholamine surge causing tachycardia, tachypnea, HTN Blood shunts to lungs and causes fluid leakage into lungs
30
How can we treat naloxone-induced pulmonary edema?
Nitroglycerin, diuretics, positive pressure ventilation (Support their breathing)
31
How can we prevent naloxone-induced pulmonary edema?
Smaller initial doses of naloxone (prevents surge)
32
What does loperamide overdose look like?
Opioid overdose with cardiac arrhythmias
33
Blockage of what transporter ehnances loperamide effects?
PGP (keeps it from crossing BBB)
34
How do we treat loperamide overdose?
Naloxone (respiratory depression) (for cardiac disturbances:) IV magnesium Sodium bicarbonate IV isoproterenol Transcutaneous pacing CPR, ACLS
35
How do we treat benzodiazepine overdose?
Monitoring, supportive care (High therapeutic index, rare death)
36
What are symptoms of benzodiazepine withdrawal?
- Severe sleep disturbance - Irritability - Increased tension and anxiety - Panic attacks - Sweating - Difficulty in concentration - Dry retching and nausea - Palpitations - Headache - Psychotic reaction - Seizures - Death
37
T/F: Benzodiazepine withdrawal is fatal but opioid withdrawal is not?
TRUE
38
What is the antidote for benzodiazepines?
Flumazenil
39
What is the dosing for flumazenil?
0.2 mg IV over 15 min 1-2 minute onset Re-dosing maybe needed
40
How can a benzodiazepine overdose possibly kill you?
Respiratory depression
41
When should you use flumazenil?
- Procedural sedation (known PMH) - Unintentional, pediatric exposure (with relative confidence of non-dependence)
42
What are some sources of salicylates?
- Pepto-Bismol - Alka-Seltzer - Icy hot - Bengay - Oil of wintergreen
43
What is an acute overdose of salicylates?
>150 mg/kg (>500 mg/kg life threatening)
44
How much methyl salicylate is in oil of wintergreen?
98g / 100mL
45
Why do we have concern with renally impaired patients?
Renal elimination plays a greater role in significant overdose and has an extended half-life
46
What are s/s of salicylate overdose?
- Fast/shallow breathing - N/V, volume depletion - Hypoglycemia in brain - Tinnitus - Non-cardiogenic pulmonary edema (chronic) - Renal/hepatic injury
47
What will help with CNS abnormalities in salicylate overdose?
Dextrose
48
What acid/base progression can be seen in salicylate overdose?
Respiratory alkalosis -> metabolic and respiratory acidosis (breathing cannot compensate)
49
What labs can be seen in salicylate overdose?
- Abnormal blood sugar (but HYPOglycemia in brain) - Fluid/electrolyte losses - Increased anion gap - Positive urine ketones (utilized for energy)
50
What does a chronic salicylate overdose look like?
More insidious onset - N/V, tinnitus, dyspnea, hyperthermia, neurologic problems - Increased PT/LFTs - Lower levels will produce toxic effects (higher Vd)
51
How could you treat salicylate overdose?
DO NOT INTUBATE - Take multiple salicylate levels - Multiple doses of activated charcoal - Urine alkalization (pH > 7.5) - Hemodialysis - Treat adverse effects (seizures, cerebral edema, hypoglycemia, dysrhythmias)
52
What supportive care should be given for salicylate overdose?
- Give dextrose (even with normal glucose 0.5-1 g/kg) - Fluid maintenance (serum pH 7.45-7.55) - Urine pH > 7.5 - Maintain potassium - Monitor (mental status, urine/blood pH, salicylate levels, fluid, electrolytes)
53
How often should monitoring be done in salicylate overdose?
Every 2-4 hours
54
When should hemodialysis be used in salicylate overdose?
- Serum level (acute >100mg/dL, chronic >60mg/dL) - Neurologic deterioration - Seizures - Intractable acidosis (pH < 7.20) - Renal failure - Pulmonary edema
55
When can you stop hemodialysis
- Clear improvement in patient - Salicylate <19 mg/dL - HD completed for 4-6 hours and levels not obtainable

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