Pharm Topic 25: General Approach To A Toxic Patient

Front 1

Whats a relatively safe drug to stop almost any seizure

Back 1

Lorazepam

Front 2

Coma differential diagnosis

Back 2

-Metabolic
-Infections
-Structural (tumor, hemorrhage, edema)
-Vascular
-Psychiatric

Front 3

Causes of Cyanosis

Back 3

Methemoglobinemia caused by:
-Nitrates
-Aniline dyes
-Phenazopyridine
-Benzocaine

Front 4

Causes of white transverse bands on nails (mee's lines)

Back 4

Poisoning with arsenic or thallium

Front 5

Causes of Toxic Alopecia

Back 5

-Thallium (takes 2 weeks and can lead to total body hair loss)
-Arsenic
-allopurinol
-Chemo
-Radiation
-Alopecia totalis

Front 6

Causes of miosis

Back 6

-Opiates
-Clonidine
-Nicotine
-Cholinergic excess (organophosphate
-Insecticides

Front 7

Causes of mydriasis

Back 7

-Sympathomimetics
-Cocaine
-Amphetamine
-Anticholinergic
-Antihistamines
-Antidepressents

Front 8

Causes of tachypnea

Back 8

-Toxins that produce acid metabolites (ethylene glycol, methanol)
-Toxins that uncouple oxphos (cyanide, carbon mono, hydrogen sulfide, salicylates
-Toxins that cause hypoxemia (CO, methemoglobin formers)
-Toxins that stim patient (sympathomimetics, cocaine, PCP)

Front 9

Causes of Bradypnea

Back 9

Opiates and drugs which suppress respiration

Front 10

Causes of Pulmonary edema

Back 10

Heroine and salicylates

Front 11

What are the 4 basic coma antidotes

Back 11

oxygen, naloxone, thiamine, dextrose

Front 12

Methylene Blue

Back 12

Antidote for methemoglobinemia. Is an oxidizing agent which is reduced and then can reduce Fe3+ back to 2+. Symptoms improve in 30 mins. Less effective in G6 deficient patients.

Front 13

Symptoms of digitoxin OD

Back 13

arrhythmias

Front 14

Symptoms of Tricyclic antidepressant OD

Back 14

wider QRS (via Na channel poisoning) or prolonged QTc (via K channel poisoning)

Front 15

Symptoms of levothyroxine OD

Back 15

tachycardia

Front 16

What OD causes brachycardia

Back 16

BBs and calcium channel blockers. Calcium channel blockers also cause bradycardia and heart block with hypotension.

Front 17

Calcium

Back 17

Used to treat hypocalcimia caused by poisoning from hydroflouric acid, ammonium bifluoride, and other fluoride salts. Is part of the multi-agent therapy for overdoses of calcium channel blockers

Front 18

Glucagon

Back 18

Antidote for BB poisoning. Switches on adenyl cyclase increasing cAMP causing calcium influx and increased rate and strength of myocardial contractions. Also treats hypoglycemia. SE are nausea and rash.

Front 19

Causes of Tachycardia

Back 19

-Amphetamines
-Antihistamines
-Anticholinergics
-Caffeine
-Cocaine
-Cyclic antidepresants
-Synthroid (levothyroxine)
-Withdrawl from sedative/hypnotics/alcohol

Front 20

Causes of Bradycardia

Back 20

-BB
-Propranolol
-calcium channel blockers
-clonidine
-cardiac glycosides (digoxin)
-opioids
-organophosphate insectisides

Front 21

What causes absence of bowel sounds

Back 21

Anticholinergic OD

Front 22

What causes NVD

Back 22

Cholinergic Excess (carbamate, organophosphate insecticide poisoning)

Front 23

Anticholinergic Toxideom

Back 23

Dry as a bone (dry mouth/skin)
Red as a beet (flushed skin)
Blind as a bat (dialated pupils and loss of site accommodation)
Mad as a Hatter (central anticholinergic mania)
Hot as Hades (Hot skin)
Full as a Flask (Urinary retention)

Front 24

Physostigmine

Back 24

Antidote to atropine/anticholinergic poisoning. Reversible Ach esterase inhibitor, Cx BBB. Very short duration. May cause arrhythmia. Dont use inpatients with trycyclic overdose b/c of increased risk of arrhythmia.

Front 25

Muscarinic Cholinergic Toxidrome

Back 25

Diarrhea
Urination
Miosis
Bradycardia
Bronchorrhea
Bronchoconstriction
Bradypnea
Emesis
Lacrimation

Front 26

Causes of anticholinergic tox

Back 26

Atropine, antihistimine, cyclic antidepressants, antipsychotics, jimson weed, belladonna alkaloids

Front 27

Atropine

Back 27

Cholinergic tox antidote. Muscarinic antagonist. Found in plants like nightshade and jimson weed. Treats symptomatic bradycardia due to any cause b/c of effect on SA node.

Front 28

Causes of muscarinic tox

Back 28

Organophosphates, carbamate, insectisides, mushrooms.

Front 29

nicotinic toxidrome

Back 29

Tachycardia, hypertension, muscle fasciculations, paralysis

Front 30

Causes of nicotinic tox

Back 30

Tobacco, nicotine, black widow spider venom

Front 31

Extrapyramidal Toxidrome

Back 31

Dystonia
torticollis
oculogyric crisis
gyric tongue movements
choreoathetosis

Front 32

Extrapyramidal tox causes and mech

Back 32

Antipsychotics (haloperidol, phenothiazines) These drugs selectively block D2 receptors allowing dopamine to stim D1 receptors which are excitatory.

Front 33

Benztropine mesylate and diphenhydramine

Back 33

Used to treat drug induced dystonic or extrapyramidal Rxs, or any involuntary contrctions. Acts as a centrally acting anticholinergic and antihistamine. Reduces central Ach activity diminishing imbalance between Ach and dopamine.

Front 34

Opiate Toxidrome

Back 34

Pinpoint pupils (mieosis)
Respiratory Depression
Coma

Front 35

Causes of Opiate tox

Back 35

Heroine
Codine
Diphenoxylate
Propoxyphene

Front 36

Naloxone

Back 36

Opiate tox antidote. Opiate antagonist. Effects Mu1,2 kappa, and sigma receptors.

Front 37

Ipecac

Back 37

Contains 2 main alkaloids, emetine and cephaeline. Causes emesis (vomiting). Not often used anymore.

Front 38

Ipecac OD

Back 38

dehydration, alkalosis, hypokalemia, myocarditis

Front 39

Gastric Lavage

Back 39

Putting tube in and pumping stomach. Rarely used.

Front 40

Activated charcoal

Back 40

Drinking a solution of charcoal to adsorb toxins. Used if a patient has ingested a toxic amount of poison which is known to be absorbed by charcoal up to one hour ago.

Front 41

Cathartics

Back 41

Super laxative. Not Used.

Front 42

Whole bowel Irrigation

Back 42

Considered a safe and effective way of limiting absorption of a toxic substance. Can be used for lead, iron tablets, illicit drug packets.