Clinical Toxicology!

Front 1

If a patient is suspected of drug overdose and is unconscious, what therapies should be administered?

Back 1

1. Naloxone
2. Glucose (source of energy)
3. Thiamine

Front 2

What can you give a patient in shock (hypotension)?

Back 2

1. Ringer's lactate
2. Normal saline

(Addition of a vasopressor such as dopamine or norepinephrine might be necessary if a satisfactory response is not achieved w/ fluids alone).

Front 3

What can you give a patient experiencing seizures?

Back 3

Benzodiazepines = PREFERRED
(Barbiturates may be considered if benzodiazepines are not effective).

Front 4

If a patients breath smells like acetone, what type of intoxication does this indicate?
What should you do for this patient?

Back 4

Isopropanolol

1. Hemodialysis may be necessary to remove very high concentrations of the alcohol
2. Gastric lavage may be considered early after exposure

(*ADH inhibitors are NOT indicated)

Front 5

Urinary Ca2+ oxalate crystals were found in a patient whose blood work also showed low Ca2+ levels—what kind of intoxication does this indicate?

Back 5

Ethylene glycol

(metabolized to oxalic acid which increases acidosis and binds Ca2+ causing formation of urinary Ca2+ crystals, and dramatically lowers blood Ca2+ levels)

Front 6

What is the product of methanol metabolism?
What does this metabolite cause?

Back 6

Formic acid
Causes severe metabolic acidosis and can cause blindness!

Front 7

What should you do for a patient with acute ethanol intoxication?

Back 7

Manage this patient through supportive therapy:
1. Protect breathing and ventilation
2. Correct hypothermia
3. Provide adequate nutrition
4. Give glucose for hypoglycemia
5. Give thiamine as a precaution against Wernicke's encephalopathy.

(*do not need to consider lavage, dialysis, or activated charcoal)

Front 8

What are your treatment options for a patient who has ingested a toxin within the last hour?

Back 8

1. Emesis (syrup of ipecac)
2.Apomorphine
3. Lavage
4. *Activated charcoal
5. Dilution

Front 9

What sort of treatment must you use for "body packers?"

Back 9

Whole bowel irrigation

Front 10

How should you treat a patient who has ingested large quantities of a toxin and several hours have passed by?

Back 10

Whole bowel irrigation

Front 11

What sort of treatment should you use for a patient who has overdosed with a delayed release medication?

Back 11

Whole bowel irrigation
(these preparations become "sticky" when wet, and may form intestinal masses of tablet aggregates, called "concretions." Such masses can't be removed by emesis or lavage.

Front 12

How can you best correct electrolyte imbalances for a patient who has overdosed?

Back 12

Hemodialysis

Front 13

What is the best treatment for a patient whose blood contains chemical toxins that are lipid soluble or highly bound to plasma proteins?

Back 13

Hemoperfusion

Front 14

T or F.

Neither dialysis nor hemoperfusion significantly decrease blood levels of toxicants that have a high volume of distribution.

Back 14

TRUE

These toxicants have diffused out of the bloodstream, and are relatively unavailable for removal.

Front 15

How can you use diuresis to remove basic chemicals from the body?

Back 15

Acidify the urine by administering ascorbic acid or ammonium chloride

Front 16

How can you use diuresis to remove acidic chemicals from the body?

Back 16

Alkalinize the urine by administering sodium bicarbonate

Front 17

Metabolic acidosis with a high osmolar gap strongly suggests prior ingestion of which 2 alcohols?

Back 17

1. Methanol
2. Ethylene glycol

Front 18

What 2 enzymes are involved in alcohol metabolism?

Back 18

1. Alcohol dehydrogenase
2. Aldehyde dehydrogenase

Front 19

What toxin is found in windshield washing fluids, carburetor cleaners, camp stove fuels, and gasoline additives?

Back 19

Methanol

Front 20

What toxin is a common component of antifreeze, and is also used as a solvent for paints, lacquers, and other products?

Back 20

Ethylene glycol

Front 21

What 3 treatments are both utilized for the treatment of methanol and ethylene glycol intoxication?

Back 21

1. Fomepizole or ethanol --> inhibit ADH
2. Sodium bicarbonate ---> correct acidosis
3. Hemodialysis ---> remove alcohol and metabolites

Front 22

What unique treatment is required for treatment of methanol poisoning?

Back 22

Folic/folinic acid

Front 23

What unique treatment is required for treatment of ethylene glycol poisoning?

Back 23

Thiamine and pyridoxine

Front 24

Which toxin is associated with "gasping syndrome" seen in newborns?

Back 24

Benzyl alcohol

(should NOT be used for injectable drugs in neonates!)

Front 25

How can you treat carbon monoxide poisoning?

Back 25

1. Administration of 100% Oxygen
2. Hyperbaric oxygen chamber

Front 26

T or F.

There are no pharmacological treatments for CO overdose.

Back 26

TRUE!

(just use oxygen!)

Front 27

In an emergency situation, how would you treat a patient with cyanide poisoning?

(3 treatment options)

Back 27

1. First administer amyl nitrate (inhaled), and then set up a sodium nitrate IV
2. Sodium thiosulfate
3. *Hydroxocobalamin-->PREFERRED

Front 28

A patient comes into the ER who has had prolonged exposure to sewer gas. What sort of toxin has this patient inhaled?

Back 28

Hydrogen sulfide

Manage this patient with supportive therapy.

Front 29

What type of side effects would you expect from ingestion of aliphatic hydrocarbons?

Back 29

Primarily GI effects

Front 30

What type of toxin is found in gasoline, kerosene, and lighter fluid?

Back 30

Aliphatic hydrocarbons

Front 31

What type of toxin is found in benzene, toluene, napthalene?

If a person ingests one of these, what type of damage would you expect?

Back 31

Aromatic hydrocarbons.

Liver, kidney, and other organ damage.

Front 32

What type of toxin is found in chloroform, freon, trichloroethylen, and many aerosol propellants?

If a patient is exposed to one of these, what are the major risks?

Back 32

Halogenated hydrocarbons

These are toxic to major organs, but have the additional risk of sensitizing the heart to catecholamines => risk of cardiac arrhythmias and death if frightened or stressed.

Front 33

What type of insecticides are "irreversible" inhibitors of acteylcholinesterase?

Back 33

Organophosphates

Front 34

A patient comes into the ER with constricted pupis, bradycardia, hypotension, excessive GI and respiratory secretions, uncontrolled urination, a headache, anxiety, and convulsions.

What type of toxin do you suspect this person has been exposed to?

Back 34

Organophosphates

Front 35

Death from organophosphate poisoning is usually due to __________.

Back 35

Respiratory failure

Front 36

What can be used to treat organophosphate poisoning?

Back 36

1. Atropine
2. Pralidoxime (2-PAM)

Front 37

What type of drug is an ADH inhibitor?

Back 37

Fomepizole

Front 38

What toxins are "reversible" inhibitors of acetylcholinesterase?

How can you treat exposure to these agents?

Back 38

Carbamates.

Emergency therapy:
Maintain adequate respiration and decrease absorption by emesis or activated charcoal.
Atropine can be given to antagonize actions at muscarinic receptors.
(*do NOT use pralidoxime)

Front 39

What should you use to treat a patient experiencing convulsions?

Back 39

Benzodiazepines

Front 40

DDT is the prototype of what type of insecticides?

If a patient was exposed to too much DDT, what symptoms would you expect?

Back 40

Organochloride

Excitation resulting in convulsions

Front 41

What type of corrosive (acid or base) causes tissue necrosis by denaturing proteins, but tends to form a protective coagulum ("eschar") that limits further penetration of the agent?

Back 41

Acidic corrosive.

Front 42

What type of corrosive (acid or base) soponifies fats and causes liquefaction necrosis?

Back 42

Basic corrosive.

Front 43

Which type of corrosive is more damaging to tissues--an acidic or basic corrosive?

Back 43

Basic

Front 44

How should you treat tissue damage caused by acidic or basic corrosives?

Back 44

Extensive flushing with water.

Front 45

How should you treat a patient who has ingested an acidic corrosive?

Back 45

Give this patient a small volume of water to dilute the caustic

Front 46

In general, how do you treat heavy metal toxicity?

Back 46

Chelation therapy

Front 47

What would you use to treat a patient with iron poisoning?

Back 47

Deferoxamine (IV)

Front 48

After absorption, where is lead distributed in the body?

Back 48

First soft tissue, and then it is deposited in the bone

Front 49

What sort of symptoms are present with lead poisoning?

Back 49

1. Hypochromic microcytic anemia (due to inhibition of 2 enzymes required for heme biosynthesis)
2. "Lead palsy" (Neuromuscular condition due to demyelination of the nerve sheath)
3. GI effects (constipation, anorexia, abdominal pain)
4. Renal toxicity

Front 50

T or F

Adequate dietary levels of iron will circumvent many of the toxic effects of lead, because these metals compete for several key metabolic functions.

Back 50

TRUE!

Front 51

What drugs could you use to treat a patient with lead poisoning?

Back 51

Combination of:
1. Dimercaprol
2. Edetate
3. Penicillamine (or succimer if the patient is a child)

Front 52

An intoxicated patient comes into the ER displaying neurological and psychiatric symptoms. It is found that this patient is also experiencing renal toxicity.

What type of toxin has this person been chronically exposed to?

How can you treat this patient?

Back 52

Mercury

Treatment:
1. Dimercaprol = PREFERRED
2. Penicillamine