Toxicology

Front 1

Define toxidrome

Back 1

a specific cluster of symptoms that occurs after patients are exposed to a poisonous agent; a toxic syndrome

Front 2

Define Poison

Back 2

any substance taken into the body by ingestion, inhalation, injection or absorption that interferes with normal physiological functions; term implies an excessive degree of dosage as almost any substance can be poisonous in sufficient doses

Front 3

Define cathartic agent

Back 3

an active purgative, producing bowel movements

Front 4

List five routes of exposure to poisons, identify the most common one:

Back 4

1. Inhalation 2. insufflation 3. ingestion (tast or swalling most common) 4. Cutaneous and mucous membrane exposure 5. injuection

Front 5

List the basic elements of an exposure Hx

Back 5

# of persons exposed, type of ex, amount/dose, route, intent, obtain corroborating info, how pt found, empty bottles, etc., smells, occupation or hobbies of pt., notes

Front 6

Identify the four emperic antidotes that should be administered within the first few minutes of a tixic pt's arrival

Back 6

1. O2 2. Naloxone 3. D50W - 50ml for adults, 1g/kg glucose for kids 4. 100 mg thiamine in adults

Front 7

List the poisons that may result in the following abnormal physical findings: Hypertension

Back 7

alcohol withdrawl, Amphetamines, Anticholinergic, Caffeine, Cocaine, Methaqualine, Serotonin syndrome, Theophylline, Tricylic antidepressants, Monoamine oxidase inhibitor overdose (MAOI), Phencyclidine, Sedative hypnotic withdrawl, Phenylpropanolamine, Nicotine

Front 8

List the poisons that may result in the following abnormal physical findings: Hypotension

Back 8

Baclofen, B blockers, Calcium-channel blockers, Clonidine, Ethanol, Phenothiazines, Opioids, Organophosphates, Meprobamate, Barbiturates, Ethchlorvynol, Glutethamide, Salicylates, Hydrocarbons, Toxic alcohols, Iron

Front 9

List the poisons that may result in the following abnormal physical findings: Tachycardia

Back 9

Alcohol withdrawl, Amphetamines, Anticholinergic, Baclofen, Caffeine, Cocaine, Methaqualine, Serotonin syndrome, Theophylline, Tricyclic antidepressants, Ethanol, Phenothiazines, Monoamine oxidase inhibitor overdose, Phencyclidine, Phenylopropanolamine, Salicylates, Nicotine, Hydrocarbons, Toxic alcohols, Iron

Front 10

List the poisons that may result in the following abnormal physical findings: Bradycardia

Back 10

Beta-blockers, Calcium-channel blockers, Clonidine, Opioids, Organophosphates, Barbiturates, Ethchlorvynol

Front 11

List the poisons that may result in the following abnormal physical findings: Hyperventilation

Back 11

Alcohol withdrawl, Amphetamines, Anticholinergic, Caffeine, Cocaine, Serotonin syndrome, Theophylline, Monoamine oxidase inhibitor overdose, Sedative hypnotic withdrawl, Phenylpropanolamine, Salicylates, Nicotine, Hydrocarbons, Toxic alcohols, Iron

Front 12

List the poisons that may result in the following abnormal physical findings: Hypoventilation

Back 12

Baclofen, Methaqualine, Tricyclic antidepressants, Clonidine, Ethanol, Phenothiazines, Opioids, Organophosphates, Meprobamate, Phencyclidine, Barbiturates, Ethchlorvynol, Glutethamide

Front 13

List the poisons that may result in the following abnormal physical findings: Hyperthermia

Back 13

Alcohol withdrawl, Amphetamines, Anticholinergic, Cocaine, Serotonin syndrome, Phencyclidine, Sedative hypnotic withdrawl, Salicylates

Front 14

List the poisons that may result in the following abnormal physical findings: Hypothermia

Back 14

Baclofen, Clonidine, Phenothiazines, Opiods, Monoamine oxidase inhibitor overdose, Barbiturates

Front 15

List the poisons that may result in the following abnormal physical findings: Red Colored Skin

Back 15

Vancomycin, carbon monoxide, boric acid

Front 16

List the poisons that may result in the following abnormal physical findings: Blue Colored Skin

Back 16

Anything causing deoxyhemoglobin or methemoglobin

Front 17

List the poisons that may result in the following abnormal physical findings: Mydriasis

Back 17

Sympathomimetic, Anticholinergic

Front 18

List the poisons that may result in the following abnormal physical findings: Myosis

Back 18

Opioid

Front 19

Describe what a toxidrome is based on

Back 19

physiologically based abnormalities of vital signs, appearance, skin, eyes, mucous mem, lung heart, abd, neuro exam known to occur with specific class of substances & typically helpful in establishing a dx when exposure not well defined. Grouped according to drug class or physiologic effect

Front 20

Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Opioid:

Back 20

heroin, morphine. CNS depression, miosis, respiratory depression. Intervention: ventilation or naloxone

Front 21

Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Sympathomimetic:

Back 21

cocaine, amphetamine. Psychomotor agitation, mydriasis, diaphoresis, tachycardia, hypertn, hyperthermia. Intervention: cooling, sedation with benzo’s, hydration

Front 22

Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Cholinergic:

Back 22

organophosphate insecticides, carbamate insecticides. Salivation, lacrimation, diaphoresis, n/v, urination, defecation, fasciculations, weakness, bronchorrhea. Intervention: airway protection, ventilation, atropine, pralidoxime

Front 23

Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Anticholilnergic:

Back 23

scopolamine, atropine. Altered mental status, mydriasis, dry flushed skin, urinary retention,k decreased bowel sounds, hyperthermia, dry mucous membranes. Intervention: physostigmine, sedation with benzo’s, cooling, supportive care

Front 24

Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Hypoglycemia:

Back 24

sulfonylureas, insulin. Altered mental status, diaphoresis, tachycardia, hypertension. Intervention: glucose containing solution IV, po feedings if able, frequent blood su\gars, octreotide

Front 25

Explain the goal of GI decontamination:

Back 25

general goal is to bind toxins within the gut lumen to make them unavailable for absorption or have their elimination enhanced from the gut

Front 26

List the three main choices for GI decontamination:

Back 26

a.Removal of the toxin from the stomach via the mouth
b.Binding it inside the gut lumen
c.Mechanically flushing it through the GI tract

Front 27

What is the goal of the following treatments for poisonings

Back 27

multiple dose activated charcoal therapy (MDAC), urinary alkalinization, hemodialysis, hemoperfusion

Front 28

For Syrup of Ipecac identify how long it takes to produce emisis

Back 28

90% vomit within 20 minutes of first dose; second dose may be given after 30 minutes—97% of patients vomit after the second dose

Front 29

For syrup of Ipecac know the indications for using it:

Back 29

limited; recent ingestion of substance not expected to compromise airway or lead to altered mental status, hemodynamic derangement, seizure; recent ingestion of pill known not to fit into holes of OG tube; or substance known not to adsorb to activated charcoal

Front 30

For syrup of Ipecac know the contraindications for using it:

Back 30

ingestions that have potential to alter mental status; active or prior vomiting; caustic ingestion; toxin with more pulmonary than GI toxicity (e.g. hydrocarbons); and ingestions of toxins that have the potential for inducing seizures

Front 31

List other treatments that ipecac can interfere with

Back 31

delays the time to administration of oral antidotes such as N-acetylcysteine by 1 to 6.5 hours

Front 32

Discuss activated charcoal in regard to the following: How it works:

Back 32

by adsorbing the toxin within the gut lumen, makes the toxin less available for absorption into the tissues. Enhances elimination by creating a gradient (GI dialysis). Also binds substances excreted in bile

Front 33

Discuss activated charcoal in regard to the following: Benefits:

Back 33

Decontaminates the gut without requiring invasive procedures. Proven safe, rapid

Front 34

Discuss activated charcoal in regard to the following: Route of administration:

Back 34

given in a slurry of water or juice by mouth or through an NG tube

Front 35

Discuss activated charcoal in regard to the following: Contraindications to its use:

Back 35

should not be given if esophageal or gastric perforation are suspected, or if emergency endoscopy might be needed (e.g. as in caustic ingestion)

Front 36

Discuss activated charcoal in regard to the following: Indications for its use:

Back 36

ingestion of any drug known to adsorb to it or after an unknown ingestion by patients with protected airways.

Front 37

Discuss the following in regard to whole bowel irrigation (WBI): Its therapeutic purpose:

Back 37

produces rapid catharsis by mechanically forcing ingested substances through the bowel at a rapid rate

Front 38

Discuss the following in regard to whole bowel irrigation (WBI): Indications for use:

Back 38

ingestion of potentially toxic doses of substances known not to adsorb to activated charcoal, such as heavy metals, body packers, iron, lithium, sustained or delayed release formulations and substances with potential for bezoar formation

Front 39

Discuss the following in regard to whole bowel irrigation (WBI): Contraindications for use:

Back 39

patients with preceding diarrhea; ingestions that are expected to result in significant diarrhea and patients with absent bowel sounds or with obstructions

Front 40

Discuss the following in regard to whole bowel irrigation (WBI): Most commonly used agent and its route of administration:

Back 40

polyethylene glycol in an osmotically balanced electrolyte solution by mouth or via NG tube

Front 41

List the drug class and clinical indications for the following antidotes: Naloxone:

Back 41

opioid antagonist. Indicated for reversal of opioid-induced respiratory depression, mental status changes, miosis and analgesia

Front 42

List the drug class and clinical indications for the following antidotes: Atropine:

Back 42

anticholinergic. Indicated for treatment of poisoning with organophosporous compounds and carbamates

Front 43

List the drug class and clinical indications for the following antidotes: Dextrose:

Back 43

Indicated for treatment of hypoglycemia secondary to overdose of hypoglycemic agents (e.g. sulfonylureas, insulin, etc)

Front 44

What is the main risk of naloxone use?

Back 44

May precipitate opioid withdrawal syndrome

Front 45

TOXICOLOGY

Back 45

TOXICOLOGY