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35 Cards in this Set

  • Front
  • Back

If you don't know toxicology status of patient, what cocktail should be given (4 items)?

dextrose, narcan, thiamine, and maybe flumazenil
Most drugs will resolve after 6 hours. What are 2 exceptions?
tylenol, ethylene glycol - more insidious
What drug classes cause miosis?
cholinergics
clonidine
nicotine
phenothiazines
narcotics
PCP
What are the signs and symptoms of cholinergic drugs?
Symptoms and Signs (Mnemonic: DUMBELLS)

1. Diarrhea (and Diaphoresis) and abdominal cramping
2. Urination
3. Miosis (pinpoint pupils)
4. Bradycardia (muscarinic) or Tachycardia (nicotinic)
5. Emesis (Nausea and Vomiting)
6. Lacrimation
7. Lethargy
8. Salivation

Symptoms and signs: Other (not covered by mnemonic)

1. Anxiety or agitation
2. Seizures
3. Coma
4. Muscle fasciculations
5. Flaccid paralysis (including respiratory muscles)
What are the signs and symptoms of anticholinergic drugs?
Symptoms: Mnemonic (antimuscarinic)

1. Hot as a hare (Hyperthermia)
2. Dry as a bone (Dry Skin)
3. Red as a beet (Flushed)
4. Blind as bat (Mydriasis)
5. Mad as a hatter (Delirium)
6. Tachy as a leisure suit
What severe presentation might be expected for a teen who has taken ecstacy?
hyponatremic seizure from overdrinking water to prevent hyperthermia
What is the complete MUDPILES mnemonic?
I love chocolate topped mudpiles
I: i ibuprofen
L: lithium
c: cyanide, carbon monoxide; caffeine
T: toluene
M: methanol
U: uremia
D: DKA
P: paracetamol (acetaminophen), phenformim
I: iron, INH
L: lactic acidosis
E: ethylene glycol, ethanol
S: salicylates; starvation; seizure; H. sulfide; strychnine; sympathomimetic amines
What is the EKG finding pathognomonic for TCA overdose?

What is the treatment for TCA overdose?
Rabbit ears in AVR

bicarb
Treatment for BB overdose
milrinone
insulin
dobutamine

GLUCAGON
Cause of death in cholinergic OD
bronchorrhea, muscle paralysis
Main goal of decontamination ingested overdose
prevent toxin absorptoin
"solution to pollution is dilution"
Gastric lavage removes what % of stomach content if within hour
1/3
only useful if 1/3 reduction is lifesaving
***What toxins ARE NOT removed by charcoal?

(general)
lead, iron, and other heavy metals
potassium, lithium and other small molecules

alcohols
hydrocarbons
***What toxins ARE NOT removed by charcoal?

(mnemonic)
C: caustics, corrosives
H: heavy metals (K, Fe, lithium)
A: alcohols and glycols
R: rapidly absorbed substances
C: cyanide
O: other INSOLUBLE drugs
A: aliphatic hydrocarbons
L: laxatives
Usual dose of charcoal for toxic ingestion
10x ingested substance or 1g/kg

50-100g usually
antidote for acetaminophen
N-acetylcysteine

140 mg/kg loading then 70 mg/kg
acetaminophen toxicity takes ? to show effects
24 h
low end of toxic range for acetaminophen
140 mg/kg

some centers treat only above 200 mg/kg
T/F A two hour rule out test is adequate for acetaminophen
Controversial, but 2 hour does predict 4 hour reliably
3 ways to kill patients with salicylates
1. setting low respiratory rate on vent
2. not anticipating concretion/ bezor -- plateau in decline (often at 50-60), then suddden jump in levels; don't expect steady state!
3. failure to get to dialysis soon enough
Three sx suggestive of salicylate poisoning
gastritis / hematemesis
acidosis + respiratory alkalosis
tinnitus

also: pulmonary edema, hepatic damage
tx for salicylate poisoning
bicarb to alkanalize
consider dialysis
What urine test is available for salicylate poisoning?
ferric chloride test, turns purple
Which NSAIDS can cause seizures?
piroxicam
mefenamic acid
oxyphenbutazone / phenylbutazone
To die from NSAIDs, you have to ?
"get hit by the truck taking them to the pharmacy"

400 tablets is lethal dose
"Four narcotics you should never use"
tylenol + codeine; codeine only add 5% efficacy, some don't feel effects at all, only adds sfx

propoxyphene/darvocet - Narcan won't reverse it, only adds 5% efficacy of pain control, addictive, withdrawal is atypical, banned in Europe
Demerol - toxic metabolite, addictive
Nubain - above 15 mg has antagonist effect, diminishing returns, addictive
What caution should you use in reversing narcotic OD with Narcan?
titrate only to wake; too much will remove analgesia as well, wake patient suddenly in panic
NEVER treat cocaine with ?
beta blockers

you can use with phentolamine, though some texts suggest it's not good even to do this
Tx for cocaine toxicity
Benzos to prevent/resolve seizures, HTN; NEVER use BB alone!!!!
if angina: nitro, CCBs, alpha blockers
if MI: thrombolytics vs cath
What drug OD will cause patients to protect their airway yet remain otherwise comatose, and to wake up explosively after about 6 hours
GHB
Coma, bradycardia, myoclonus, sudden spontaneous recovery

antidote?
GHB

respiratory monitoring
possibly physostigmine
antidote for dextromethorophan
supportive care
Narcan in some cases
Rubbing alcohol produces what kind of metabolic disorder?
produces an osmolar gap but no acidosis

produces ketosis (acetone)
[methanol, ethylene glycol] causes blindness
methanol
Antidote for methanol
ethanol
fomepizole ( 4- methylpyrazole)