Term
| What kinds of drugs cause sedative/hypnotic toxidrome? |
|
Definition
| narcotics, tranquilizers, alcohol, GHB |
|
|
Term
| What is the presentation of sedative/hypnotic toxidrome? |
|
Definition
| decreased respirations, pulse may be slow or normal, decreased level of consciousness, sedation/confusion/slurred speech, abnormal gait, coma |
|
|
Term
| T/F Tachycardia and nystagmus are both signs of ETOH toxication. |
|
Definition
|
|
Term
| What other medicial problems can present much like a drug toxicity? |
|
Definition
| intracerebral bleed or metabolic causes |
|
|
Term
| All overdose victims should get tested for what two drugs? |
|
Definition
| acetaminophen and salicylate |
|
|
Term
| What causes elevated anion gap metabolic acidosis? |
|
Definition
| alcoholic ketoacidosis, cyanide, carbon monoxide, alcohol, toluene, methanol, uremia, DKA, paraldehyde, iron, isoniazid, lactic acidosis, ethylene glycol, salicylates, strychnine |
|
|
Term
| How do you measure serum osmolality? |
|
Definition
| 2(Na) + glu/18 + BUN/2.8 + EtOH/4.6 |
|
|
Term
| How do you calculate the osmol gap? |
|
Definition
| measured-calculated osmol |
|
|
Term
| What is a normal osmol gap? |
|
Definition
|
|
Term
| What increases the osmolal gap? |
|
Definition
| acetone, ethanol, ethylene glycol, isopropyl alcohol, mannitol, methanol, propylene glycol |
|
|
Term
| How toxic is isopropyl alcohol? |
|
Definition
| twice as toxic as ethanol |
|
|
Term
| T/F Isopropyl alcohol causes an anion gap acidosis. |
|
Definition
|
|
Term
| What is the single best specimen for a toxicology screen? |
|
Definition
|
|
Term
| When would you use serum for a toxicology lab? |
|
Definition
| to quantify levels of a specific drug |
|
|
Term
| When should you quantify drug levels? |
|
Definition
| when the drug level can predict subsequent toxicity or guide specific therapy (acetaminophen, ASA, theophylline, digoxin) |
|
|
Term
| T/F Qualitative blood levels of a drug correlate with time of ingestion and impairment. |
|
Definition
|
|
Term
| Which drugs are detected in routine urine drug screens? |
|
Definition
| amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine metabolites, opiates, propoxyphene, PCP, ethanol |
|
|
Term
| When is the detection period for ethanol? |
|
Definition
|
|
Term
| When is the detection period for amphetamines? |
|
Definition
|
|
Term
| When is the detection period for short acting barbiturates? |
|
Definition
|
|
Term
| When is the detection period for long-acting barbiturates? |
|
Definition
|
|
Term
| When is the detection period for long acting barbiturates? |
|
Definition
|
|
Term
| When is the detection period for benzodiazepines? |
|
Definition
|
|
Term
| When is the detection period for cannabis (single use)? |
|
Definition
|
|
Term
| When is the detection period for cannabis (habitual use)? |
|
Definition
|
|
Term
| When is the detection period for cocaine? |
|
Definition
|
|
Term
| When si the detection period for codeine/morphine? |
|
Definition
|
|
Term
| When is the detection period for euphorics (MDMA)? |
|
Definition
|
|
Term
| When is the detection period for heroin? |
|
Definition
|
|
Term
| When is the detection period for LSD? |
|
Definition
|
|
Term
| When is the detection period for methadone? |
|
Definition
|
|
Term
| When is the detection period for methaqualone? |
|
Definition
|
|
Term
| When is the detection period for opiates? |
|
Definition
|
|
Term
| WHen is the detection period for PCP? |
|
Definition
|
|
Term
| When is the detection period for phenobarbital? |
|
Definition
|
|
Term
| When is the detection period for propoxyphene? |
|
Definition
|
|
Term
| When is the detection period for anabolic performance enhancing steroids? |
|
Definition
| oral= 14 days; parentally= 1 month |
|
|
Term
| What is the detection period for nicotine? |
|
Definition
| detection time is long and variable becasue nicotine is fat soluble |
|
|
Term
| What is characteristic upon urinalysis of a person with ethylene glycol toxicity? |
|
Definition
|
|
Term
| What should you do to prevent renal failure in ethylene glycol poisoining? |
|
Definition
|
|
Term
| What causes noncardiogenic pulmonary edema? |
|
Definition
| Meprobamate, Methadone, Opiates, Phenobarbital, Propoxyphene, Salicylates |
|
|
Term
| What toxins are radiopaque on radiograph? |
|
Definition
| chloral hydrate, cocaine packets, opiate packets, iron (other heavy metals such as Pb, As, Hg), neuroleptic agents, sustained release products/enteric coated preparations |
|
|
Term
|
Definition
| international transport of narcotics and drugs inside a body cavity |
|
|
Term
| What is a "body stuffer"? |
|
Definition
| intentional ingestion of drugs to evade being arrested or evade prosecution |
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|
Term
| What should you do to monitor someone going through a toxin overdose? |
|
Definition
| monitor vitals, serial physical exams, treat low blood pressure aggresively, monitor mental status, urine output and rectal temperature |
|
|
Term
| What is a "coma cocktail"? |
|
Definition
| dextrose, thiamine, naloxone, flumazenil, oxygen |
|
|
Term
| What should you give all patients with altered sensorium unless a POCT glucose assessment demonstrates eu or hyperglycemia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What must you do before giving a patient naloxone? |
|
Definition
| restrain them because the naloxone will precipiatate acute withdrawal |
|
|
Term
| What is the half life of naloxone? |
|
Definition
|
|
Term
| T/F If a person is given naloxone after an opioid overdose and has completely normal mental status and vital signs, it is ok to discharge that patient home. |
|
Definition
| false; do not discharge the patient because of the short t1/2 of naloxone |
|
|
Term
| Why is the use of nalmefene controversial? |
|
Definition
| it acts longer so patients can be discharged; but patients may try to give themselves a larger dose of narcotics to get the same effect |
|
|
Term
| T/F You should give thiamine to every comatose patient to prevent Wernicke's encephalopathy. |
|
Definition
| false; should be reserved for alcoholic, malnourished patients |
|
|
Term
|
Definition
| benzodiazepine reversal agent |
|
|
Term
| T/F Flumazenil may induce acute withdrawal symptoms in chronic benzodiazepine abusers. |
|
Definition
|
|
Term
| What are the contraindications of flumazenil? |
|
Definition
| history of chronic benzodiazepine use, history of seizure disorder, concomitant TCA ingestion |
|
|
Term
| What is the RANSAC mneumonic? |
|
Definition
| remove the toxin, adsorb the toxin, neutralize the toxin, support the patient, ancillary menas of removal, continually reassess/consultation |
|
|
Term
| What do you do to remove toxins from the eye? |
|
Definition
|
|
Term
| What are hte methods of decontamination? |
|
Definition
| gastric emptying (ipecac and gastric lavage), activated charcoal, and whole bowel irrigation |
|
|
Term
| Is ipecac used in the hospital? |
|
Definition
|
|
Term
| What are the contraindications for ipecac? |
|
Definition
| children less than 6 months, coma/seizures, corrosives, hydrocarbons, sharp objects, late stage pregnancy, protracted emesis |
|
|
Term
| What are the complications of syrup of ipecac? |
|
Definition
| protracted emesis, ineffective if over 1 hour post ingestion, delays the administration of charcoal, patients with unknown overdose may rapidly become unstable and develop seizures and coma, prolong abuse can be cardiotoxic |
|
|
Term
| In what situations is gastric lavage used? |
|
Definition
| extremely toxic substances, in cases of unknown ingestions or when loss of consciousness is present |
|
|
Term
| T/F It has never been demonstrated that gastric lavage makes a difference clinically. |
|
Definition
|
|
Term
| What are the contraindications to gastric lavage? |
|
Definition
| 1. >1 hr 2. decreased level of consciousness unless intubated 3. risk of hemorrhage or GI perforation 4. corrosives 5. hydrocarbons 6. insignificant overdoses |
|
|
Term
| What are the complications of gastric lavage? |
|
Definition
| aspiration pneumonia, esophageal perforation, epistaxis, electrolyte imbalance, hypothermia, laryngospasm, hypoxia and hypercapnia, mechanical injury to the throat, esophagus, and stomach |
|
|
Term
| Although unproven, delayed gastric lavage may be efficacious when... |
|
Definition
| the drug ingested causes slowing of peristalsis (anticholinergics, opioids) or large gastric concretions (salicylates, iron) |
|
|
Term
| What should be taken with the first dose of charcoal? |
|
Definition
| cathartics such as sorbitol to prevent constipation |
|
|
Term
| T/F Activated charcoal can be used after IV overdoses. |
|
Definition
| true; causes "gut dialysis" |
|
|
Term
| What drugs are cleared by repetitive doses of charcoal? |
|
Definition
| antidepressants, salicylates, aminophylline, barbiturates, carbamazepine, digitalis, dilantin, dapsone |
|
|
Term
| What substances are poorly adsorbed by activated charcoal? |
|
Definition
| caustics and corrosives, cyanide, heavy metals (arsenic, iron, lead, lithium, mercury), alcohols (ethanol, methanol, isopropyl) and glycols (ethylene glycol), rapid onset or absorption cyanide and strychnine, chlorine and iodine, others insoluble in water (substances in tablet form), aliphatic and poorly absorbed hydrocarbons (petroleum distilates), laxatives (sodium, magnesium, and potassium based) |
|
|
Term
| What is the most efficacious decontamination method with very few adverse side effects in patients with unknown ingestions? |
|
Definition
|
|
Term
| What are the complications of activated charcoal? |
|
Definition
| intestinal obstruction and spiration pneumonitis |
|
|
Term
| What should be done to prevent complications from cathartics? |
|
Definition
| do not use them repetitively |
|
|
Term
| What are the complications of using cathartics? |
|
Definition
| electrolyte imbalance, dehydration, hypermagnesemia |
|
|
Term
| What are the contraindications of cathartics? |
|
Definition
| renal/cardiac failure, diarrhea, ileus, recent bowel surgery, elecrolyte imbalance, extremes of age |
|
|
Term
| How is whole bowel irrigation performed? |
|
Definition
| a polyethylene glycol solution is given at a rate of 2 L/hr until the rectal effluent is clear; most of the times requires the placement of an NG tube for administration |
|
|
Term
| When is whole bowel irrigation indicated? |
|
Definition
| iron/heavy metals/lithium, body stuffers/packers, sustained release products, foreign bodies (batteries) |
|
|
Term
| How does alkalinization cause elimination enhancement? |
|
Definition
| traps weak acids in ionized state thereby decreasing reabsorption |
|
|
Term
| How is alkalinization performed? |
|
Definition
| NaHCO3 is given at 0.5 to 2 mEq/kg/hour IV drip after a bolus of 1-2 mEq/kg; titrate to keep urine pH 7.5 to 8.0 |
|
|
Term
| Can acidification of the blood enhance elimination of certain drugs? |
|
Definition
| contraindicated because not very effective |
|
|
Term
| How do you perform forced diuresis? |
|
Definition
| give fluids at 1.5-2x maintenance; urine output should approach 3-6 cc/kg/hr |
|
|
Term
| What kinds of substances are enhanced by hemodialysis? |
|
Definition
| those with low protein binding, small volumes of distribution, water solubility, and low molecular weight |
|
|
Term
| Name the specific agents removed by hemodialysis. |
|
Definition
| isopropanol, salicylates, theophylline, uremia, methanol, barbiturates, lithium, ethylene glycol |
|
|
Term
| What is the antidote for acetaminophen? |
|
Definition
|
|
Term
| What is the antidote for anticholinergics? |
|
Definition
|
|
Term
| What is the antidote for beta-blockers? |
|
Definition
|
|
Term
| What is the antidote for benzodiazepines? |
|
Definition
|
|
Term
| What is the antidote for carbon monoxide poisoning? |
|
Definition
|
|
Term
| What is the antidote for cyanide? |
|
Definition
|
|
Term
| What is the antidote for digoxin? |
|
Definition
|
|
Term
| What is the antidote for ethylene glycol? |
|
Definition
|
|
Term
| What is the antidote for iron? |
|
Definition
|
|
Term
| What is the antidote for INH? |
|
Definition
|
|
Term
| What is the antidote for methanol? |
|
Definition
|
|
Term
| What is the antidote for methemoglobinemia? |
|
Definition
|
|
Term
| What is the antidote for opioids? |
|
Definition
|
|
Term
| What is the antidote to organophosphates? |
|
Definition
|
|
Term
| What is the antidote for TCAs? |
|
Definition
|
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