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Toxidromes/Substances Flashcards

1
Q

Symptoms of marijuana intoxication?

A

conjunctival injection, cough/phlegm/wheeze, decreased short term memory, decreased coordination, loss of critical judgment, time perception distortion

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2
Q

effects of LT marijuana use?

A

decreased testosterone, decreased sperm making, decreased glucose tolerance, decreased IOP, antiemetic

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3
Q

symptoms of tobacco use?

A

chronic cough, phlegm, wheeze, increased Hb/Hct, increased platelet aggregation

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4
Q

effects of toluene use?

A

perioral eczema, pleasant hallucinations

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5
Q

what test for toluene use?

A

urine for hippuric acid; rapid excretion

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6
Q

effects of gasoline use?

A

perioral eczema, euphoria > violence > coma; pulmonary HTN, RLD, hematuria, rhabdo, peripheral neuropathy

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7
Q

effects of amyl nitrites / butyl nitrites?

A

euphoria, enhanced music appreciation, h/a, sexual enhancement, syncope, hypoxemia, decreased BP, transient T inversion and depressed ST segments, Met-Hb, increased IOP

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8
Q

effects of LSD?

A

potent hallucinogen; somatic sx (dizzy, dilated pupils, flushing, fever, tachycardia), perceptual (vision, sensory changes), psychic (psychosis, delusions); can get flashbacks years late; no withdrawal sx

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9
Q

effects of alcohol?

A

euphoria, groggy, talkative, impaired short term memory, coma/depression; increased GGT and AST, increased amylase and lipase

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10
Q

effects of inhalants?

A

perioral eczema, euphoria, slurred speech, decreased coordination, dizzy, hypoTN

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11
Q

effects of dextremethorphan?

A

out-of-body experience, increased HR, increased BP, lethargy, mydriasis, agitation, vomiting; sx last for 3-6 hr

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12
Q

effects of psilocybin / mushrooms are the same as which other drug?

A

LSD

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13
Q

effects of MDMA / ecstasy?

A

euphoria, heightened senses, increased emotions, nausea, bruxism, blurred vision, anxiety, psychotic episodes, tachycardia, HTN, high temp, mydriasis, apnea, low sodium, rhabdo, seizures

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14
Q

effects of PCP?

A

cramps, diarrhea, hematemesis, euphoria, nystagmus, ataxia, hallucinations; higher doses cause psychosis, verbal abuse; even higher doses cause arrhythmias and seizures; coma does not include respiratory depression; nystagmus, increased reflexes, muscle rigidity, clonus; can have temp instability and seizures; + on UDS for 8 days

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15
Q

effects of cocaine?

A

euphoria, decreased fatiguability, paranoid ideation, possible seizures, stroke, cerebral hemorrhage, pupil dilation, tachycardia, HTN, perforated nasal septum; think about this in young person with MI

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16
Q

effects of amphetamines?

A

HTN, hyperpyrexia, seizures, agitation, tachycardia, arrhythmias, rhabdo, seizures

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17
Q

effects of opiates?

A

euphoria, decreased pain, pinpoint pupils, respiratory depression, pulm edema, decreased libido, constipation, delayed gastric empyting, decreased HR and BP

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18
Q

effects of anabolic steroids?

A

acne, keloids, striae, hirsutism, gynecomastia, testicular atrophy, azoospermia, rage, depression, mania, libido change, hepatitis, increased risk HCC, fluid retention, growth retardation, cholestasic jaundice, ventricular wall mass, increased RBCs, tendon rupture, decreased HDL and increased LDL, breast atrophy, menstrual change, increased muscle mass and strength, arrhythmias; if take orally, urine + for weeks; if take IV, urine + for mo

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19
Q

effects of benzos?

A

relaxation, drowsy, flu-like sx, paradoxical aggression, anxiety; decreased BP, low tone, nystagmus, ataxia, respiratory depression

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20
Q

sx of opiate withdrawal?

A

start by 8 hr (yawning seen first > lacrimation, mydriasis, insomnia, goose pimples, diarrhea, HTN); gone by 36 hr

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21
Q

sx of benzo withdrawal?

A

diaphoresis, confusion, agitation, psychosis, protracted seizures if abrupt

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22
Q

effects of synthetic bath salts? (aka cathinones)

A

stimulation, hallucinogenic effects, diaphoresis, increased HR, HTN, high temp, psychosis, paranoia, scary hallucinations, rhabdo, nosebleeds, ATN, intracerebral hemorrhage, low Na and K, high Mag

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23
Q

sx of discontinuation of synthetic bath salts?

A

depression, tremor, paranoia, anxiety

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24
Q

effects of barbiturates?

A

nystagmus, range of sedation, high doses cause miosis

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25
false + on UDS from what drugs?
NSAIDs can give false + for PCP, cannabinoids, barbs, and benzos; PPIs for cannabis; antidepressants for amphetamines
26
sx of anabolic steroid withdrawal?
insomnia, suicidal ideation with mood disorders, anorexia, muscle and joint pain
27
effects of GH when taken by athletes?
increased muscle mass, lower body fat, peripheral edema, insulin resistance so increased glucose, cardiomegaly, HTN, joint pain, muscle weakness
28
effects of EPO when taken by athletes?
increases RBS and O2 carrying capacity; increased risk stroke, MI, PE
29
effects of Creatine when taken by athletes?
increased muscle strength, cramps, weight gain, renal/liver damage
30
2 ingestions that cause most hospitalizations in kids?
clonidine and buprenorphine
31
causes of miosis?
COPS = cholingergics/clonidine, opiates/organophosphamides, PCP/pilocarpine/phenothiazine, sedatives
32
causes of mydriasis?
AAS = anticholingergics (atropine), antihistamines, sympathomimetics (LSD, cocaine, amphetamines)
33
intoxication causes of skin discoloration?
cherry red in CO, cyanosis in Met-Hb, hypoxemia
34
contraindications for activated charcoal use?
CHEMICAL CamP = caustics, hydrocarbons, electrolytes/endoscopy, metals, iron, CN, alcohol, Li, camphor, phos
35
blood gas in salicylate ingestion?
respiratory alkalosis (usually), metabolic acidosis
36
treatment for salicylate ingestion?
supportive care, activated charcoal if within 1 hr, sodium bicarb for alkalinization
37
anticholinergic toxidrome?
dry as a bone, red as a beet, hot as a hare, mad as a hatter, blind as a bat = dilated pupils (sluggish), tachycardia, HTN, urinary retention, hot, delirium, hallucinations, flushed, dry skin
38
anticholinergics that cause the toxidrome?
atropine, antihistamines, TCAs (but no pupil dilation and low BP instead), jimson weed, deadly nightshade
39
cholinergic toxidrome for muscarinic effects?
DUMBBELS - diarrhea, urination, miosis, bronchorrhea/bronchospasm/bradycardia, emesis, lacrimation, salivation; increased RR, lethargy, sweating, emesis
40
nicotinic effects of cholinergics?
weakness, fasciculations, paralysis, respiratory depression, coma, seizure, lethargy
41
cholinergics that cause the toxidrome?
insecticides, nicotine
42
clonidine has effects similar to which drug class?
opioids
43
sympathomimetic toxidrome?
agitation, tremor, hallucinations, seizure, tachycardia, HTN, mydriasis (reactive!), diaphoresis, nystagmus, feelings of grandeur, paranoia, hot
44
sympathomimetics that cause the toxidrome?
decongestants, cocaine, amphetamines, psychostimulants
45
toxic metabolite of acteminophen?
NAPQI
46
tx of anticholinergic toxicity?
physostigmine except if TCA poisoning
47
effects of CCBs? which 2 are most severe?
diltiazem and verapamil; low BP, low HR, high glucose; may need IV Ca-gluconate, or Ca-Cl; glucagon not very helpful
48
tx of iron toxicity?
chelation with IV deferoxime if mod-severe or >500
49
effects of TCA toxicity?
drowsy, lethargy, seizures, coma, tachycardia, low BP, long QRS, R deflection of end of QRS, prolonged QTc, intraventricular conduction delay, convulsions, arrhythmias, acidosis, anticholinergic effects
50
tx of TCA and when?
Na bicarb if arrhythmias
51
drugs that can cause serotonin syndrome?
SSRIs, MAOIs, ecstasy, linezolid, mepridine, fentanyl, tramadol, demerol, LSD, triptans, St John wort
52
clinical features of serotonin syndrome?
fever, confusion, sweating, myoclonus (most specific)
53
tx of serotonin syndrome?
supportive; if give benzo and no change, can try cyproheptadine
54
what is NMS?
idiosyncratic drug reaction to antipsychotics and related drugs; associated with antimetics
55
clinical features of NMS?
hyperthermia, muscle rigidity, confusion, autonomic instability
56
treatment of NMS?
supportive; consider bromocriptine, dantrolene, or amantadine - controversial
57
what is a dystonic reaction? how do you treat it?
get 2/2 phnothiazines; usually only in 1 major muscle group; give anticholinergic like benztropine or benadryl
58
1 pill can kill insulin secretagogues?
glipizide, glyburide
59
sx of metformin ingestion?
GI upset, lactic acidosis
60
causes of methemoglobinemia?
nitrates, nitrites, cardiac meds, fertilizers, foods, amyl nitrates, aniline dyes, topical anesthetics
61
features of methemoglobinemia?
skin discoloration, h/a, syncope, dyspnea, confusion, chest pain, sz, dysrhythmias, coma, acidosis, death
62
when do you suspect CN poisoning? sx? tx?
smoke inhalation, nitroprusside; shock, lactic acidosis; give O2 and hydroxycobalamin or Na-thiosulfate
63
alkaline substances?
industrial bleach, ammonia, oven and drain cleaners, dish detergents, hair relaxers, lye, laundry detergents
64
acidic substances?
toilet cleaner, grout cleaner, rust remover, battery liquid, muriatic acid for pools, metal cleaners
65
types of necrosis in alkaline vs acidic ingestion?
alkaline = severe deep liquefaction necrosis; acidic = coagulation necrosis (more superior)
66
hydrocarbon substances with low risk unless inhaled?
mineral oil, motor oil, baby oil, suntan oils
67
hydrocarbons with high aspiration risk?
mineral spirits, lamp oil, gasoline, kerosene, furniture polish, lighter fluid, turpentine
68
highly toxic hydrocarbons?
CHAMP - camphor, halogenated, aromatic, metals (arsenic and mercury), pesticides
69
which ethanol type does not cause HAGMA?
isopropyl alcohol
70
sx of methanol ingestion?
nonspecific; h/a, malaise, GI discomfort, N/V, snowstorm/blurred vision, photophobia (optic n damage), CNS depression; HAGMA without ketones or lactic acidosis, bicarb <8, high osmolal gap
71
tx of methanol and ethylene glycol intoxication?
Na bicarb to decreased end organ penetration of toxic metabolites; preferred antidote is IV fomepizole; give folate to enhance metabolism; add thiamine and pyridoxine and monitor Ca level for EG
72
sx of ethylene glycol ingestion?
vomiting, lethargy, slurred speech, AKI, coma, tachypnea, metabolic acidosis, renal failure, hematuria, flank pain; HAGMA without lactic acid or ketones, high osmolal gap
73
how do you confirm dx of organophosphate poisoning?
decreased RBC cholinesterase activity
74
antidotes for organophosphates? how do they work?
atropine for temporary blocking of muscarinic effects of Ach until bronchospasm resolves/secretions are dry, pralidoxime for hydrolyzing bonds with cholinesterase if given before permanent damage (does not cross BBB)
75
plants that act like digitalis?
foxglove, lily of the valley, oleander
76
plants that act like atropine?
jimson weed, deadly nightshade
77
plants like CN?
pear and apple seeds, peach pits, bitter almonds
78
plants that cause liver toxicity?
mushrooms with anatoxin
79
plants that cause mild GI sx?
poinsetta, mistletoe, holly
80
benzo antidote?
flumazenil
81
Beta block antidote?
glucagon
82
Cyanide antidote?
amyl nitrite
83
warfarin antidote?
vitamin K

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