Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

81 Cards in this Set

  • Front
  • Back
Describe Acute Toxicity
1-2 days with a single or multiple exposures
Describe Subacute Toxicity
repeated exposure of less than 3 months
Describe Chronic Toxicity
repeated exposure of greater than 3 months
What is the Therapeutic Index?
What is the Margin of Safety?
Define "Risk"
the probability that injury will result from exposure to a substance under SPECIFIED CONDITIONS of DOSE & ROUTE of administration
Define "Threshold Limit Values"
Safe ambient air concentrations in the work place
Drugs whose toxic mechanism of thru Receptor-ligand interactions

Most drugs
Drugs whose toxic mechanism of thru membrane function (2)
General anesthetics

Drugs whose toxic mechanism is via cellular energy

Drugs whose general mechanism of toxicity is via Covalent binding to biomolecules

Alkylating agents

Reactive intermediates
Drugs whose general mechanism of toxicity is via Calcium Homeostasis
Drugs whose general mechanism of toxicity is via non-lethal alterations in somatic cells
Drugs whose general mechanism of toxicity is via Ligand-activated transcription factors

Drugs whose general mechanism of toxicity is via Programmed cell death (apoptosis)

List the 4 primary determinants of toxicity
1. dose & dose rate

2. duration of exposure

3. route of exposure

List the "ABCD's" in the management of a poisoned patient
Airway = should be cleared of vomitus or any other obstruction & an airway or endotracheal tube inserted

Breathing = assessed by observation & by measurements of arterial gases = pulse-oximetry; intubate & mechanically ventilage if needed

-monitor pulse rate, blood pressure, & urinary output
-start IV & draw blood for glucose & other laboratory determinants

-every patient with altered mental status
-100 mg of Thiamine to alcoholic & malnourished patients to prevent Wernicke-Korsakoff syndrome
What group of people are most frequently poisoned?
What drugs cause CNS depression as their route of death to the patient?

*lose airway protective reflexex & respiratory drive
*likely to die as a result of airway obstruction, aspiration, or respiratory arrest
What drugs can cause Hypotension as their mode of mortality?
1. TCA's = alpha blockade
2. Phenothiazines (Chlorpromazine) = alpha blockade
3. Beta-blockers
4. CCA's
5. Theophylline = increases cAMP
6. Barbiturates
What drugs can cause Cardiac Arrhythmias as their mode of mortality? (5)
1. Amphetamines = releases stored catecholamines
2. Cocaine = uptake inhibitor
3. TCA's = anticholinergic effects = tachycardia
4. Digitalis
5. Theophylline
What drugs may cause Cellular Hypoxia and result in death?
1. Cyanide

2. Hydrogen Sulfide

3. Carbon Monoxide

*evident by: tachycardia, hypotension, acidosis, & cardiac ischemia
What drugs may cause a combination of HYPERTENSION & TACHYCARDIA as vital signs?
1. Amphetamines = releases of Catecholamines

2. Cocaine

3. Antimuscarinics
What drugs may cause a combination of HYPOTENSION & BRADYCARDIA as vital signs?
1. Beta blockers
2. CCA's
3. Clonidine
4. Sedative-hypnotics
What drugs may cause a combination of HYPOTENSION & TACHYCARDIA? (4)
1. TCA's
2. Phenothiazines (Chlorpromazine)
3. Theophylline (Acute)
4. Beta-agonists = Beta-1 on heart; Beta-2 on venous smooth muscle
What drugs may cause rapid respiration as a vital sign?
1. Salicylates

2. Carbon Monoxide

3. Chemical producing Metabolic Acidosis or Cellular Asphyxia
What drugs can cause Hyperthermia?
1. Sympathomimetics
2. Anticholinergics = atropine
3. Salicylates
4. Pentachlorophenol = uncoupler of oxidative phosphorylation
5. chemicals producing seizures or muscular rigidity
What drugs can cause Hypothermia or Poikilothermy? (2)
1. Phenothiazines (Typical Antipsychotics)

2. Ethanol & other sedatives
What drugs can cause Pupil constriction (miosis)? (4)
1. Opioids
2. Phenothiazines (alpha-blockade)
3. Cholinesterase inhbitors
4. Alpha-blockers

*Miosis is caused by Parasympathetic activation or Sympathetic inactivation
What drugs can cause Pupil Dilation (Mydriasis)?
1. Amphetamines
2. Cocaine
3. LSD
4. Anticholinergics
5. Phencyclidine

*Mydriasis = caused by sympathetic activation or parasympathetic blockade
What drugs can cause HORIZONTAL NYSTAGMUS?
2. Alcohol
3. Barbiturates
What drug do Vertical & Horizontal nystagmus strongly suggest?
Phenyclidine (PCP)
What drugs can cause Flushed, hot & dry skin?

What drugs can cause Excessive sweating?
1. Cholinesterase inhibitors

2. Sympathomimetics

3. Nicotine
What drugs can cause Cyanosis?
1. Hypoxemia

2. Methemglobinemia
What drugs can cause Jaundice (liver toxicity)?
1. Acetaminophen
2. Erythromycin estolate (cholestatic)
3. Carbon Tetrachloride
What drugs can cause Ileus? (3)
1. Antimuscarinics
2. Opioids
3. Sedatives
What drugs can cause Hyperactive bowel sounds, cramping, & diarrhea?
1. Organophosphates
2. Iron
3. Arsenic
4. Theophylline
5. Mushrooms
What drugs can cause twitching & muscular hyperactivity? (3)
1. Anticholinergics
2. Sympathomimetics
3. Cocaine
What drugs can cause Muscular Rigidity? (2)
1. Antipsychotics (esp. Haloperidol)

2. Strychnine
What drugs can cause Seizures? (7)

What do you usually treat with?
Tx = Diazepam or Lorazepam

1. Theophylline
2. Isoniazid (treat with Pyridoxine = B6)
3. Cocaine
4. Amphetamines
5. TCA's
6. Diphenhydramine
7. Lidocaine (treat with Thiopental)
How do you treat seizures caused by Isoniazid? Lidocaine?
Isoniazid = Pyridoxine (B6)

Lidocaine = Thiopental
What drugs can cause Flaccid coma?
1. Opioids

2. Sedative-hypnotics

3. CNS depressants
pO2 may appear normal in this poisoning b/c Arterial blood gases only measures dissolved oxygen & not oxyhemoglobin saturation
Carbon Monoxide
How do you calculate the Anion Gap? What is the normal range?
Anion Gap = (Na + K) - (HCO3 + Cl)

Normal = 12 +/- 4
What conditions can cause an elevated Anion Gap?
1. Renal failure
2. Diabetic Ketoacidosis
3. Shock-induced lactic acidosis
4. Drug-induced Metabolic Acidosis
-Methanol -> formic acid
-Ethylene glycol -> Oxalic acid
-Metformin -> lactic acidosis
What 2 drugs cause both an Anion Gap & Osmolar Gap?
1. Methanol

2. Ethylene glycol
What drugs cause an Osmolar Gap?
1. Ethanol
2. Methanol (also Anion gap)
3. Ethylene glycol (also Anion gap)
How does one calculate the Osmolar Gap?
Calc. OG = 2(Na+) + (Glucose/18) + (BUN/2.8)

Osmolar Gap = Measured - Calculated
Widening of the QRS complex

TCA's = Amytriptyline

Antidote = IV Sodium Bicarbonate
What is seen here? What drugs can cause this? What is the Antidote?
Torsades de Pointes

Caused by:
1. Quinidine
2. TCA's
3. Phenothiazines
4. "Non-sedating" Antihistamines
5. Cisapride = 5-HT4 agonist used for GERD

Prolonged QT caused by:
1. Beta-1 stimulationm (Epi, NE, Isoproterenol, Dobutamine, etc)
2. Intense sympathetic activation
What is seen here?
What drugs can cause it? (5)
What are 5 factors that can contribute to Torsades de Pointes?
1. Hypokalemia
2. Hypomagnesemia
3. Hypocalcemia
4. Ischemia
5. Tissue hypoxia

**low everything
What is the treatment for Torsades de Pointes?
Magnesium Sulfate
When is Gastric Lavage not recommended?
after 30 minutes to 4 hours
What are the Contraindications for Gastric Lavage & Induced Emesis?
1. More than 30 minutes have elapsed since ingestion of a CORROSIVE material
2. Hydrocarbon solvents have been ingested (ethanol, methanol)
3. Coma, stupor, delerium, or convulsions
What is sometimes used to induce emesis?
Ipecac syrup

*often not recommended today
This substance will absorb many toxins if given in slurry immediately before or after lavage
Activated Charcoal
What drugs are used as cathartics (laxatives) to enhance elimination of toxic drugs?
1. MgSO4

2. Sorbitol
What drugs are given to get rid of Weak Acids in the urine?
Bases = HA -> A-

1. NaHCO3 = Sodium Bicarb
2. Acetazolamide
This is used to Acidify the urine and increase the excretion of Weak Organis Bases
Ammonium Chloride
What is the rule of thumb in Hemodialysis & trying to remove a toxic drug?
the smaller the Vd = the more effective is Hemodialysis
Osmotic diuretic used to enhance the elimination of toxic drugs
Drug used as a chelator for Iron Poisoning
Deferoxamine mesylate
Drug used for Arsenic, gold, mercury, & acute lead poisoning
Metal chelator used for Lead poisoning
Edetate, Calcium Disodium = CaNa2(EDTA)
Chelating agent used for Wilson's disease (copper), cystinuria, & resistant cases of Rheumatoid Arthritis

Chelates copper; also used for lead
Oral chelator used for lead
Drug that inactivates toxins & is used in Acetaminophen poisoning
Inactivating-toxin drug that is used for Cardiac Glycoside toxicity
Digoxin-specific FAB antibodies
Antidote to Cholinesterase Inhibitor poisons
Atropine = antimuscarinic
Cholinesterase reactivator given only for Organophosphates
Pralidoxime chloride = 2-PAM
Antidote for Benzodiazepine overdoses
Opioid antidote
Cyanide antidote package = ?
Sodium nitrite
Sodium Thiosulfate
Amyl Nitrite
Antidote for Beta-blocker poisoning
Antidote for Methanol or Ethylene glycol poisoning
Alcohol Dehydrogenase inhibitor used for treatment of Methanol & Ethylene glycol poisoning
Antidote for poisoning with Cardiac Depressants:
Sodium Bicarbonate
Antidote for chemical-induced convulsions
Diazepam or Lorazepam
Antidote for Isoniazid poisoning
Antidote for Anticholinergic poisoning