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93 Cards in this Set
- Front
- Back
Accidental poisonings account for what percentage of poisonings each year?
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90%
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What portion of the population is most often accidentally poisoned?
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Children
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If 90% of poisoning are accidental, what percentage is intentional?
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10%
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What portions of the population make up the intentional poisonings?
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adolescents and adults
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95% of poisonings in children involve how many substances?
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One substance
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TRUE or FALSE: all adult poisonings are mixed ingestions.
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FALSE-- 50% of adult poisonings are mixed
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About what percentage of poisoning deaths are intentional?
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About 50%
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Those lethal intentional poisonings occur most often in what portion of the population?
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Adolescents
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These two classes of substances are the most commonly ingested substances.
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1)Household cleaning substances
2)OTC analgesics |
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These two types of drugs are most commonly involved in fatal ingestions
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1)antidepressants
2)analgesic drugs |
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Which two types of poisonings are frequently misdiagnosed (Hint: we're talking situational)?
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1)occupational
2)enviromental |
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TRUE or FALSE: only primary care and ER physicians deal with poisonings
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FALSE: docs in many specialties encounter poisonings
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TRUE or FALSE: understanding a general approach to the poisoned pt can improve clinical outsome significantly.
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TRUE
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Name the six steps in the general approach to the poisoned pt.
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1)pt stabilization
2)rapid pt eval 3)prevent reabsorption of toxic agent 4)enhance elimination of toxic agent 5)use specific antidote (where available) 6)supportive care |
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This type of assessment/therapy is paramount in initial phases of management
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Basic Life Support (BLS)
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Pts w/depressed levels of consciousness, including coma, get these four drugs
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1)naloxone
2)D50 3)thiamine 4)oxygen |
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TRUE or FALSE: drug-induced seizures are easily controlled
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FALSE
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What two aspects of respiration must be carefully assessed in the pt?
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1)ventilation
2)oxygenation |
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TRUE or FALSE: the history in drug overdose is quite reliable and your best source of info
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FALSE: it's quite unreliable; seek ancillary info
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TRUE or FALSE: the physical exam is extremely important for gathering key data.
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TRUE!
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HTN and tachycardia on PE may point to this illicit drug as cause of OD
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Cocaine
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Hyperpnea and elevated temp suggest this as a cause of OD
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Salicylate poisoning
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Anticholinergic poisoning may cause your skin to become *what* and *what*?
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Warm and Dry
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This physical finding may suggest methemoglobinemia or hypoxia.
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Cyanosis
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Needle tracks in a comatose pt may suggest what type of overdose?
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Narcotic overdose
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Miosis may be see with what two types of agonists?
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Opiate and Cholinergic agonists
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Mydriasis may be seen with what two types of agents?
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Sympathomimetic or Anticholinergic agents
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Combined vertical and horizontal nystagmus are seen with OD on what drug?
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PCP
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A bitter almond smell on the pt's breath points to *what* as the cause of poisoning?
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Cyanide
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Chemical burns visible in the oral cavity suggest what?
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Ingestion of caustic substances (drano, anyone?)
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Tachycardia and an unexpected S3 gallop suggest heart failure from what what type of OD?
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OD on negative inotropic agents (Ca2+ channel- or beta-blocking drugs)
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Narcotic, antimuscarinic and sedative poisonings cause what type of bowel sounds?
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hypoactive bowel sounds
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Organophosphate and theophylline poisoning cause what type of bowel sounds?
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hyperactive bowel sounds
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Toxic or metabolic encephalopathy are suggested by neuro findings in what type of distribution?
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Symmetric distribution
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Increased muscle tone is seen when you OD on what type of drug?
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Sympathomimetic drugs
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Tremor, seizures and brisk reflexes are seen when pts OD on these two drugs
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Lithium and theophylline
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Ataxia, dysarthria and nystagmus are seen if you overdose on these three drugs.
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1)ethanol
2)phenytoin 3)sedative hypnotics |
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What are the four main toxic syndromes?
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1)cholinergic
2)anticholinergic 3)narcotic 4)sympathomimetic |
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Mild hypotension, bradycardia, hypoventilation, lethargy and miosis suggest which toxic syndrome?
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Narcotic syndrome
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TRUE or FALSE: you should delay tx while waiting for the labs on your poisoned pt; you don't want to treat something that's not there!.
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FALSE!
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Name 7 drugs for which there is rapid, direct quantitation (pnemonic: I SALTED)
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1)Iron
2)Salicylate 3)Acetominophen 4)Lithium 5)Theophylline 6)Ethanol 7)Digoxin |
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Serum bicarb less than what concentration indicates metabolic acidosis?
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18 meq/L
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How do you confirm metabolic acidosis?
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Measure arterial pH
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What is the formula for the anion gap?
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AG = [(Na)-(HCO3)+(Cl)]
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What is the normal value for the anion gap?
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12 plus or minus 2
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Break down the causes for metabolic acidosis given by the pneumonic AT MUD PILES
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1)Alcohol
2)Toluene 3)Methanol 4)Uremia 5)Diabetic Ketoacidosis 6)Paraldehyde 7)Iron/Isoniazid 8)Lactic Acid 9)Ethylene Glycol 10)Salicylate |
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Drug-induced pulmonary edema or drug-induced lung injury may cause what finding on arterial blood gas?
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Hypoxia
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Respiratory depression (which is common with any sedating toxin) can cause what finding on ABG?
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Hypercapnia
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These two findings on ABG can be primary respiratory or metabolic and are commonly found in poisoned pts
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Acidemia or alkalemia
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Certain toxic agents are osmotically active in plasma and can be inferred by determining what?
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the osmolar gap
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How do you calculate the calculated serum osmolarity?
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CSO = (2xNa)+(Glucose mg/dL / 18)+(BUN mg/dL / 2.8)
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How do you calculate the osmolar gap?
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OG = measured serum osmolarity - calculated serum osmolarity
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Normally, the osmolar gap is what value?
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Zero (<10 is still considered normal)
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Significant osmolar gaps are seen in poisoning with what four substances (hint: all the same type)?
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1)methanol
2)ethanol 3)ethylene glycol 4)isopropranolol |
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Prolonged QRS duration suggests OD on what type of med?
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TCA
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Intact capsules of this mineral can be visualized on plain films of the abdomen.
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Iron
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This is the preferred emetic agent.
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Syrup of Ipecac
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What are the four contraindications for use of Syrup of Ipecac?
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1)ingestion of corrosive substances
2)pt age < 6 mos 3)absent gag reflex 4)seizures |
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What is the most important consideration in the performance of gastric lavage?
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Protection of the airway
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When is gastric lavage most useful?
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Recent (within 1 hour) ingestion in which emesis cannot be performed
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What is the contraindication for gastric lavage?
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Ingestion of corrosive substances
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This is the recommended tx for practically all ingestions.
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Activated charcoal
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How do you dose activated charcoal?
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1-2 gm/kg body weight
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A cathartic (like sorbitol or magnesium citrate) should be administered when in relation to giving the charcoal?
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Administered with or immediately after charcoal
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TRUE or FALSE: if a pt has had a dermal exposure, you should leave on all contaminated clothing to avoid spreading the substance.
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FALSE: contaminated clothing should be removed and properly secured
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How do you treat an eye exposure?
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Immediate copious irrigation with saline
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Ophthalmology consult is required in what two cases?
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1)caustic exposure
2)complaints of double vision |
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Renal elimination of weak acids is greatly increased by alkalinizing urine (pH=8) by giving what?
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Sodium bicarb
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Alkalinizing the urine is particularly helpful when?
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Mild-to-moderate salicylate intoxication.
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Poisoning with toxins with high water solubility, low volume of distribution, low molecular weight (<500) and low protein binding can be treated how?
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Hemodialysis
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This detox technique is more effective than hemodialysis for lipid soluble, high-weight poisons with a low volume of distribution.
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Hemoperfusion
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What *is* hemodialysis?
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blood dialyzed extracorporeally through permeable membranes against electrolyte solutions
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What *is* hemoperfusion?
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blood filtered extra-corporeally through a cartridge containing activated charcoal or resin
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Hemoperfusion is used most commonly in intoxication with what drug?
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Theophylline
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This is a frequent adverse effect associated with hemoperfusion.
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Thrombocytopenia
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This method of poison removal is good for drugs that undergo enterohepatic circulation and a few that don't
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Serial oral activated charcoal
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How do you dose serial oral activated charcoal?
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0.5 gm/Kg every 2-4 hours
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Serial oral activated charcoal is particularly good for poisoning with which three drugs?
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1)theophylline
2)digitoxin 3)phenytoin |
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Which two procedures are only employed in severe poisonings of infants?
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1)plasma exchange
2)exchange transfusion |
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Fab fragments to digoxin are the prototype in this antidote category
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Immunologic antidotes
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How do the Fab fragments work?
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They bind digoxin and the compound gets filtered by the kidney. This causes a marked reduction in toxicity followed by greatly increased elimination
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This type of antidote is used to treat pts intoxicated with lead, iron, arsenic, gold, copper and mercury.
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Chelator antidotes
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These agents exert pharmacologic actions which oppose those of the poison; also, agents that compete for receptors that mediate toxic actions
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Pharmacologic antidotes
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Give two examples of pharmacologic antidotes
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1)atropine for organophosphate poisoning
2)isoproterenol for beta-blocker overdose |
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These agents provide substrates for detox of reactive intermediates or that compete for enzymes that create toxic metabolites
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Biochemical agents
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Name two biochemical antidotes
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1)N-acetyl-L-cysteine
2)4-methylpyrazole for ethylene glycol |
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What is the final phase in the management of the poisoned pt?
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Supportive care and observation
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In the poisoned pt, special attention should be paid to what three aspects of ICU care?
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1)ventilation
2)oxygenation 3)hemodynamics |
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TRUE or FALSE: cardiac monitoring and frequent lab assessments are done initially.
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TRUE
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You should anticipate what ICU complication in your poisoned pt?
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Aspiration pneumonia
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You should frequently reassess what in your poisoned pt in the ICU?
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fluid and electrolyte status
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TRUE or FALSE: formal psych eval is required for all pts who have attempted suicide before removing them from a one-to-one nursing setting.
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TRUE
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TRUE or FALSE: i am so
&*%$#%@ glad to be done with pharm |
True. :) Way to go, ladies!
*I second that... welcome to the group! |