Toxicology (Pharm Block 1)

Front 1

Emergency Stabilization protocol before SHORTE

Back 1

ABC

Front 2

SHORTE definition

Back 2

A structured aproach to the patient with uknown poisoning

Front 3

Shorte

Back 3

Substrate respnose= DONT protocol
Dextrose for hypoglycemis
O2
Naloxone (Narcan) for opiod overdose
Thiamine for Wernickes

Front 4

sHorte

Back 4

History
type, time of ingestion
symptoms
accidental/intentional
Home remedies used
PMH

Front 5

shOrte

Back 5

Observations
pil bottles, chemicals, odors

Front 6

shoRte

Back 6

Rule-out

head CT for any altered mental status or unknown etiology
EKG

Front 7

shorTe

Back 7

Toxidrome

signs and symptoms

Front 8

shortE

Back 8

EKG

Front 9

What lab tests to I get?

Back 9

The 4 As
Acetominophen
Alcohol
ABG
Anion Gap

Front 10

Most common pharmaceutical toxin?

antidote?

Back 10

Acetaminophen

NaC

Front 11

Reliable early clinical signs of tylenol poisoning?

Back 11

NONE

Front 12

1) Above the probably hepatic toxicity line for tylenol poisoning, what percent die?

2) below the no hepatic toxicity line how many people die?

Back 12

1) 35%

2) 0%

Front 13

How does NAC work?

Back 13

substitutes for hepatic glutatione

Front 14

NAC is most effective if given within ___1____ but may reduce hepatotoxicity up to ____2_____

Back 14

1) 8 hours
2) 24-36 hours

Front 15

If you are considering alcohol poisoning, you need to caculate the ___________

Back 15

osmol gap

Front 16

An ABG is indicated for any pt. with this sign

Back 16

abnormal respirations

Front 17

An ABG can be helpful in identifying this condition (1) and this poisoning (2)

Back 17

1) acidosis
2) salicylate poisoning

Front 18

1) In order to get an anion gap how do you manipulate the BMP?

what is normal?

Back 18

1) Na - Cl - HCO3

2) 8-12 mmol/L

Front 19

Anion Gap acidosis pnemonic?

Back 19

CATMUDPILES

Front 20

Caclulate an osmol gap

Back 20

2[Na] + BUN/2.8 + Glu/18 + [EtOH]/4.6

Front 21

Toxins causing an osmolar Gap?

Back 21

MEDIE

Front 22

What is the "5th A" of lab tests

Back 22

Aspirin

Front 23

If you see R' in AVR on the ECG think.....

Back 23

TCS poisoning!!!

Front 24

Pneumonic for what you might find an abdominal fil,?

Back 24

CHIPES

Important ones--- iron, iodide, packers

Front 25

Treatment of an asymptomatic packer?

Back 25

GoLytely

Front 26

What is a stuffer?

why are they not usually a huge concern?

Back 26

dealer who ingests drugs to hide

most already use cocaine

Front 27

Gastric lavage and charcoal have what window of effectiveness?

Back 27

1 hour

Front 28

MultidoseCharcoal is indicated for what 6 drugs?

TPCQDS

Back 28

theophylline
phenobarbital
carbemazepine
quinine
dapsone
salicylate

Front 29

1) What is the key to sucessful urinary alkalinization?

2) What would be your prescription

3) for which two drug toxicities would you do this?

Back 29

1) Potassium

2) Bicarb and K+

3) phenobarbital and salicylates

Front 30

What are the properties of drugs that are amenable to hemodialysis detox?
1) MW
2) protein binding
3) water solubility
4)Volume of distribution

Back 30

1) low
2) low
3) high
4) small

Front 31

What 5 drugs that are amenable to hemodialysis detox?

Back 31

Lithium
ASA
Theophylline
Ethylene Glycol
Methanol

Front 32

Urine to screens have prominent false positives and negatives for these five drug classes.

Back 32

Opitates
Amphetamines
PCP
TCA
Benzodiazepines

Front 33

Young man found down by EMS; unconscious, and ice cubes in briefs
Respirations 6/minute and shallow
Miotic (“pinpoint”) pupils.
Needle tracks seen on arms

Back 33

Opioid toxidrome

Front 34

opioid treatment?

Back 34

Naloxone

Front 35

Tachycardia
Dilated Pupils (Mydriasis)
Diarrhea
Abdominal Cramps
Piloerection
Yawning
Itching

Back 35

Opioid Withdrawl

Front 36

Vomiting
Diarrhea
Urinary incontinence
Bronchorrhea (rhonchi)
Drooling

Back 36

Cholinergic Toxdrome (Organophosphates) (SLUDGE!!!)
This is a misnomer because this is actually AChE inhibitor poisoning but it causes high ACh so it is called "cholinergic"

Front 37

AChE Inhibitor poisoning (Cholinergic toxidrome) treament?

Back 37

Atropine (block Muscarinics)
Pralidoxime (2-PAM) reativates AChE
Diazepam if needed for seizures

Front 38

Fever
Tachycardia
Skin is warm, dry, flushed
Dry mouth
Decreased visual acuity
Agitated delirium

Back 38

Anticholinergic (Atropine Poisoning)

Front 39

1) Anticholinergic toxidrome most often from?

2) Treatment?

Back 39

1) Diphenhydramine

2) AChE Inhibitor

Front 40

Hypertension
Tachycardia
Hyperthermia
Agitated delirium
Dilated pupils

Back 40

Sympathomimetic toxidrome (Cocaine/meth)

Front 41

Sympathomimetic (cocaine/meth) oxidrome treatment?

Back 41

Benzodiazepines first

Front 42

Lethargy or coma
Respiratory depression
Hypotension
Bullae
Decreased temp

Back 42

Hypnotic/sedative toxidrome

Front 43

Hypnotic/sedative toxidrome treament

Back 43

Phenobarbital

Front 44

Altered mental status
TINNITUS
Rspiratory alkalosis Followed by
Metabolic acidosis
low CSF glucose

Back 44

Salicylism

Front 45

Salicylism treatment

Back 45

alkalinize urine (bicarb and K+)

Front 46

Why would someone OD on aspirin?

Back 46

websites suggest aspirin, caffeine, and ephedrine for weight loss

Front 47

Pt with Psych history
Deliberate overdose of own meds
Hypotension
Tachycardia
Altered Mental Status
Wide QRS complex / QTc prolongation
Seizure
R' in AVR

Back 47

TCA poisoning

Front 48

Name the three tricyclics mentioned which can cause TCA poisoning

Back 48

Amitryptyline, Citalopram, Venlafaxine

Front 49

Magnificent 7 effects of TCSA

Back 49

Anticholinergic
Serotonin and NE uptake inhibition
Alpha-antagonist
iKr blockade
Na channel blockade (Torsades)
GABAa antagonist
Histamine blockade

Front 50

Treatment of TCA toxicity?

Back 50

Alkalinize to increase protein binding
Give Na+ to overcome Na+ blockade
terminate seizure with benzo, barb, or propofol

Front 51

Pt treated for depression
Recently taking OTC cough and cold medicines
Anxiety / mild agitation
Fever, tachycardia
Tremor, hyperreflexia, motor restlessness, hypertonicity

Back 51

Serotonin Syndrome

Front 52

you CAN recognize ____1_____

1) what is the toxidrome?
2) what does CAN stand for?

Back 52

1) Serotonin Syndrome
2) Cognitive (anxiety to catatonia)
Autonomic (tachy, BP, nausea, cramps)
Neuromuscular ( myoclonus, hyperreflexia, increased motor tone)

Front 53

Sertonin syndrome Rx?

Back 53

Cyproheptadine

Front 54

4 Drug classes that can cause Serotonin Syndreom

Back 54

MAOIs
SSRIs
TCAs
Sympathomimetics

Front 55

Libby Zion dies of?

Back 55

Serotonin Syndrome

Front 56

1) Treated for positive PPD
Seizures with poor response to diazepam

2) Rx?

Back 56

1) Isoniazid poisoning

2) Pyridoxine (B6)

Front 57

35 y/o man arrives in the ED 2 hours after drinking a liquid from a jug found in his garage.
Appears inebriated but no detectable ethanol.
Lab testing reveals wide anion gap metabolic acidosis.

Back 57

Toxic Alcohol syndrome (Methanol, Ethylene Glycol)

Front 58

1) Rx for Ethylene Glycol?


2) Dialysis criteria?

Back 58

1) Fomepizole or Ethanol Also thiamine, MG, pyridoxine

2) if EG > 20 just Fomepizole
if EG >50 fomepizole and dialysis

Front 59

1) Rx for Methanol?


2) dialysis criteria?

Back 59

fomepizole and EtOH
and Folic acid, folinic acid


2) if EG > 20 just Fomepizole
if EG >50 fomepizole and dialysis

Front 60

Difference between Rx for Ethylene glycol and methanol

Back 60

Both- fomepizole, EtOH, and maybe dialysis

EG- MG, thiamine, pyridoxine
MeOH- folic acid and folinic acid

Front 61

4 general categories of antidote

Back 61

1) block toxic effect (atropine)
2) block formation of toxic metabolite (fomepizole)
3) toxin inactivation (Fab fragments)
4) metabolism to less toxic compound (NAC)

Front 62

Antidote of: CO

Back 62

O2, HBO

Front 63

Antidote of: Opiates

Back 63

NAloxone

Front 64

Antidote of: Anticholinergic

Back 64

Physostigmine O

Front 65

Antidote of: Organophosphate (2)

Back 65

Atropine, pralidoxime

Front 66

Antidote of: Acetaminophen

Back 66

NAC

Front 67

Antidote of: MeOH, EG

Back 67

EtOH, Fomepizole

Front 68

Antidote of: Nitrates/Nitrites

Back 68

Methylene Blue

Front 69

Antidote of: Cyanide

Back 69

Nitrites and Sodium thiosulfite and hydroxycobalamin

Front 70

Antidote of: Digoxin

Back 70

Digibind Fab fragments

Front 71

Antidote of: B-blockers

Back 71

Glucagon

Front 72

Antidote of: Ca++ channel blockers

Back 72

Ca++, glucagon

Front 73

Antidote of: Iron

Back 73

Deferoxamine

Front 74

Antidote of: Heavy metals

Back 74

chelators ( EDTA, DMSA, BAL)

Front 75

Antidote of: Heparin

Back 75

Protamine

Front 76

Antidote of: Coumadin

Back 76

Vitamin K

Front 77

Isoniazid (INH)

Back 77

Vitamin B6

Front 78

Snakebite (rattle, water mocc)

Back 78

Crotalidae Fab Fragments

Front 79

Snakebite copperhead

Back 79

Wyeth antivenom