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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
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Most drugs will resolve after 6 hours. What are 2 exceptions?
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tylenol, ethylene glycol - more insidious
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What drug classes cause miosis?
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cholinergics
clonidine nicotine phenothiazines narcotics PCP |
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What are the signs and symptoms of cholinergic drugs?
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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) |
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What are the signs and symptoms of anticholinergic drugs?
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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 |
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What severe presentation might be expected for a teen who has taken ecstacy?
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hyponatremic seizure from overdrinking water to prevent hyperthermia
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What is the complete MUDPILES mnemonic?
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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 |
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What is the EKG finding pathognomonic for TCA overdose?
What is the treatment for TCA overdose? |
Rabbit ears in AVR
bicarb |
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Treatment for BB overdose
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milrinone
insulin dobutamine GLUCAGON |
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Cause of death in cholinergic OD
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bronchorrhea, muscle paralysis
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Main goal of decontamination ingested overdose
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prevent toxin absorptoin
"solution to pollution is dilution" |
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Gastric lavage removes what % of stomach content if within hour
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1/3
only useful if 1/3 reduction is lifesaving |
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***What toxins ARE NOT removed by charcoal?
(general) |
lead, iron, and other heavy metals
potassium, lithium and other small molecules alcohols hydrocarbons |
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***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 |
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Usual dose of charcoal for toxic ingestion
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10x ingested substance or 1g/kg
50-100g usually |
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antidote for acetaminophen
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N-acetylcysteine
140 mg/kg loading then 70 mg/kg |
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acetaminophen toxicity takes ? to show effects
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24 h
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low end of toxic range for acetaminophen
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140 mg/kg
some centers treat only above 200 mg/kg |
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T/F A two hour rule out test is adequate for acetaminophen
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Controversial, but 2 hour does predict 4 hour reliably
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3 ways to kill patients with salicylates
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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 |
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Three sx suggestive of salicylate poisoning
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gastritis / hematemesis
acidosis + respiratory alkalosis tinnitus also: pulmonary edema, hepatic damage |
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tx for salicylate poisoning
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bicarb to alkanalize
consider dialysis |
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What urine test is available for salicylate poisoning?
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ferric chloride test, turns purple
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Which NSAIDS can cause seizures?
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piroxicam
mefenamic acid oxyphenbutazone / phenylbutazone |
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To die from NSAIDs, you have to ?
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"get hit by the truck taking them to the pharmacy"
400 tablets is lethal dose |
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"Four narcotics you should never use"
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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 |
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What caution should you use in reversing narcotic OD with Narcan?
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titrate only to wake; too much will remove analgesia as well, wake patient suddenly in panic
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NEVER treat cocaine with ?
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beta blockers
you can use with phentolamine, though some texts suggest it's not good even to do this |
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Tx for cocaine toxicity
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Benzos to prevent/resolve seizures, HTN; NEVER use BB alone!!!!
if angina: nitro, CCBs, alpha blockers if MI: thrombolytics vs cath |
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What drug OD will cause patients to protect their airway yet remain otherwise comatose, and to wake up explosively after about 6 hours
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GHB
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Coma, bradycardia, myoclonus, sudden spontaneous recovery
antidote? |
GHB
respiratory monitoring possibly physostigmine |
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antidote for dextromethorophan
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supportive care
Narcan in some cases |
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Rubbing alcohol produces what kind of metabolic disorder?
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produces an osmolar gap but no acidosis
produces ketosis (acetone) |
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[methanol, ethylene glycol] causes blindness
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methanol
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Antidote for methanol
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ethanol
fomepizole ( 4- methylpyrazole) |