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Flashcards in Toxidromes Deck (90):
1

Garlic odor

1. Dimethyl sulfoxide (DMSO) Arsenic
2. Organophosphates

2

Bitter almonds

Cyanide

3

Rotten eggs

Hydrogen sulfide
Sewer Gas

4

Acetone

Isopropyl Alcohol
Ethanol

5

Shoe polish

Nitrobenzene

6

Peanuts

Vacor (rat poison)

7

Fruity

DKA
Isopropanol

8

Mothballs

Naphthalene
If kids eat 2 of these=Hospital

9

Wintergreen

Methylsalicylate

10

List the causes for a decreased anion gap

1. Lithium
2. Bromide
3. Hypoalbuminemia
4. Multiple Myeloma

11

Define Kussmaul breathing

Acidemia causes Hyperventilation=
Respiratory compensation for metabolic acidosis

12

What is the normal osmolar gap?

< or equal to 10

13

When is gastric lavage effective?

If it's within 60 minutes of ingestion

14

Syrup of ipecac effects

-Plant derivative which works centrally and peripherally to induce vomiting
-Use in remote locations

15

When is IV lipid emulsion indicated?

OD of lipophilic agents (CCB, Beta-Blockers) with cardiac arrest OR
Significant hemodynamic instability failing conventional therapy

16

Complication of IV lipid emulsion

Post-infusion pancreatitis

17

What are the key sx's in anticholinergic toxidrome?

1. Dry armpits
2. Agitated
3. Hyperthermia

18

Anticholinergic toxidrome causes

1. Jimson weed
2. Antihistamines- Benadryl (Diphenhydramine)
3. Antidepressants, TCAs
4. Carbamazepine

19

Anticholinergic toxidrome treatment

1. ABC’s
2. Supportive care
3. Rapid cooling- water and fans
4. Benzodiazepines- Help with agitation
5. Paralytic Agents- Consider

20

When should you consider Physostigmine in Anticholinergic toxidrome? Major ADE's?

If have both central and peripheral effects
CI: Heart block, COPD, Bradycardia
ADE: ASYSTOLE

21

Cholinergic Toxidrome sx's in muscarinic

SLUDGE

22

Cholinergic Toxidrome sx's in Nicotinic

Monday – Miosis
Tuesday – Tachycardia
Wednesday – Weakness
Thursday – Tremors
Friday – Fasciculations
Saturday – Seizures
Sunday – Somnolent

23

Sympathaomimetics Toxidrome sx's

Anticholinergic sx's:
1. ↑BP and HR
2. Hyperthermia
3. Mydriasis
4. Delusions
+
5. Seizure
6. Piloerection (hair standing up)
7. Hyperreflexia

24

Sympathaomimetics Toxidrome causes

Stimulants:
1. Amphetamines
2. Cocaine
3. Pseudoephedrine
4. Caffeine
5. PCP

25

Medications that can cause Serotonin Syndrome

1. SSRI
2. Meperidine (Demerol) + Serotonin enhancing agent
3. Lithium
4. Monoamine oxidase inhibition= Rasagilline

26

What are the triad of sx's of Serotonin Syndrome?

1. Myoclonus
2. MS changes
3. Shivering
+ Agitation

27

Serotonin Syndrome treatment?

Supportive:
1. Remove offending agent
2. Reduce temperature
3. Benzodiazepines

28

Opiate Toxidrome sx's

Everything decreases!
1. Pinpoint pupils
2. Depressed respirations

29

Opiate Toxidrome treatment

1. ABC's
2. Naloxone= Narcan

30

What does a UDS NOT test for?

1. Meperidine
2. Hydrocodone
3. Oxycodone
4. Methadone*
5. Tramadol

31

Antidote for Cholinergic toxidrome

1. Atropine
2. Tupam

32

Sympathomimetics Toxidrome treatment

1. Benzodiazepine
2. Sodium Bicarb-Correct acidosis
3. DO NOT give beta blockers

33

What is the toxic dose of Acetaminophen?

140 mg/kg

34

Toxic effects of acetaminophen toxicity

1. Centrolobular necrosis (liver) = 40%
2. Renal failure
3 Vomiting – MCly seen in children

35

Acetaminophen toxicity antidote

N-acetylcysteine (NAC)

36

Salicyclate Toxicity sx's

1. Vomting, abd. pain
2. GI hemorrhage
3. Hypotension
4. Increased bleeding time
5. Agitation, confusion

37

Salicyclate Toxicity treatment

1. Gastric lavage if within 1 hour of ingestion
2. Activated charcoal
3. Sodium Bicarb
4. Normal saline

38

MCC of seizure in patients with seizure disorder

1. Subtherapeutic level of medication
2. Infection or hyperthermia
3. Alcohol use
4. Head trauma
5. Breakthrough seizure

39

What anticonvulsant can cause a false positive drug screen for amphetamines?

Phenytoin (Dilantin)

40

why can't you give Phenytoin (Dilantin) IM?

Can cause:
1. Thrombophlebitis
2. Sterile abscesses

41

Phenytoin (Dilantin) toxicity sx's

1. Slurred speech
2. Ataxia
3. Nystagmus (horizontal)
4. Visual changes
5. Decreased LOC

42

Phenytoin (Dilantin) toxicity Tx

Supportive
MDAC

43

What is the MCC of coma from overdose?

Barbiturates

44

Barbiturates toxicity sx's

1. CNS depression
2. Hypothermia
3. Urinary retention
4. Hypoglycemia
5. Decreased motor activity
6. Aspiration pneumonia

45

Barbiturates toxicity treatment

1. Supportive
2. Glucose
3. Narcan
4. Charcoal

46

Lithium toxicity treatment

Benzodiazepines

47

What is the MCly used and abused intoxication in the US?

Ethanol

48

List Isopropanol products

1. Rubbing alcohol
2. Jewelry cleaners
3. Paint thinners

49

List Methanol products

1. Wood varnishes
2. Windshield washing fluid

50

Metanol toxicity sx's

1. CNS depression
2. Vision changes**
3. Abdominal pain
4. Hypotension=bad

51

Methanol treatment

1. Supportive
2. IV fluids
3. Ethanol
4. Fomepizole

52

List Ethylene Glycol product

Antifreeze

53

What may you see in 50% of cases of Ethylene Glycol toxicity?

Calcium oxalate crystalluria

54

Ethylene Glycol toxicity sx's

1. CNS depression
2. Tachycardia, tachypnea
3. Hypertension
4. Flank pain, renal failure
5. Hypocalcemia with tetany and QT prolongation
6. Metabolic Acidosis

55

What is the MC dysrhythmia in calcium channel blockers?

1. AV dissociation
2. Bradycardia
3. Increased PR interval

56

Calcium channel blocker treatment

1.CaCl
2. Insulin + Glucose
3. Epinephrine
4. Pacemaker

57

Beta Blocker treatment

1. Glucagon
2. Epinephrine
3. Pacemaker

58

Digoxin treatment

1. Vasopressors
2. Atropine
3. External pacing

59

TCA treatment

1. Fluids, Bicarb, alpha agonists- Tx hypotension
2. Benzo + Barbiturates-Tx seizure
3. Charcoal

60

What other drug combo with TCA will cause death?

TCA + Procainamide

61

What is the MCC of unintentional poisoning death in the US?

Carbon Monoxide

62

Whipples Triad

1. Hypoglycemia: glucose < 60
2. Symptoms of hypoglycemia: Diaphoresis, nausea, AMS
3. Resolution of symptoms with administration of glucose

63

Define Dystonic Reaction

1. Idiosyncratic reaction
2. Sudden onset of abnormal or exaggerated posturing of head, neck, jaw

64

Medications that can cause dystonic reactions

1. Phenothiazines-Phenergan, compazine
2. Butyrophenones-Haldol
3. Reglan

65

Risk Factors for development of dystonic reactions

1. Male sex
2. Young age
3. Cocaine use
4. Hypocalcemia
5. Neurodegenerative disorders

66

Dystonic Reactions clinical presentation

1. Spastic contractures of lips, tongue, face, throat
2. Trismus, tongue protrusions
3. Laryngeal and pharyngeal spasms
4. Fear, anxiety
5. Oculogyric crisis

67

Dystonic Reaction Tx

1. Benadryl x 3-4 days
2. Benzotropine IV or IM

68

What is the MCC of pediatric mortality secondary to poisoning?

Iron poisoning

69

Stage 1 iron poisoning

GI injury: 6-12 hrs
1. V/D, abdominal pain
2. Hypotension, pallor
3. Lethargy
4. Metabolic acidosis

70

Stage 2 iron poisoning

6-24 hrs
Hypovolemia

71

Stage 3 iron poisoning

Multisystem organ failure

72

Lab findings in iron poisoning

1. Increased WBC- Basophilic stippling
2. Increased glucose

73

Iron poisoning treatment

1. Asx after 6 hrs= Discharge
2. Whole Bowel irrigation (WBI)
3. IV Deferoxamine (DFO)

74

What products contain hydrofluoric acid?

1. Glass etching
2. Metal cleaning
3. Electronics manufacturing
4. Rust remover

75

Clinical presentation of hydrofluoric acid toxidrome?

1. Pain out proportion to exam
2. Hypocalcemia
3. Hypomagnesemia

76

hydrofluoric acid toxidrome EKG findings

1. Arrhythmias
2. QT prolongation

77

hydrofluoric acid toxidrome CXR findings

Pulmonary Edema

78

hydrofluoric acid toxidrome treatment

1. Double gloves for providers
2. Copious water irrigation
3. Calcium gluconate

79

What does cocaine show up on a UDS?

benzoylecgomine

80

Cocaine toxidrome treatment

Benzodiazepines

81

Phenycyclidine (PCP) effects

1. Psychosis: Euphoria, agitation, hallucination, "super human strength"
2. CV: Tachycardia, HTN
3. Nystagmus
4. MIOSIS-Pupul constricted
5. Salivation

82

Phenycyclidine (PCP) TX

1. IV fluids
2. Benzodiazepines

83

What is the only opiate associated with seizure?

Propoxyphene

84

Are the eye constricted or dilated with opiates?

Constricted=Miosis

85

Opiate Treatment

Narcan

86

MDMA treatment

Benzodiazepines

87

What does Amphetamines increase the the activity/release of?

1. Dopamine
2. Norepinephrine

88

Increased dopamine activity results in what effects?

1. Restlessness, hyperactivity
2. Decreased sleep
3. Repetitive behavior

89

Increased norepinephrine results in what effects?

1. Mydriasis=Dilation
2. Bronchodilation
3. Vasoconstriction
4. Hypertension
5. Increased HR

90

Amphetamine treatment

1. Benzodiazepine
2. Haldol
3. Cooling