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Assessment 3
Lecture 1- toxicology
92
Anatomy
4th Grade
10/28/2013

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Term
majority of toxicities occurs where?
Definition
resident's home
Term
most poisonings are cuased by 1 or more than 1 drug
Definition
1
Term
what are teh 2 mian medicaiton error
Definition
accidently took med twice
wrong med was taken
Term
1_ can kill a child?
Definition
verapamil
Term
some sypmtoms of a toxic patient?-3
Definition
hypotension
altered mental status(AMS)
GI
Term
Treatment for a toxic patient acronym-2
Definition
ABC; DON't; EFG
Term
meaning for ABCDEFG
Definition
A- airway
b-breathing
c-circulation
d- decontam
e-elimination
f-focused therapy
g0 get help
Term
acronym for bradycardia?
meaning?
Definition
PACED
P-propanol
A-antiarrythmics
c-clonidine
E-eTOH
D-digoxin
Term
acronym for tachycardia?
meaning?
Definition
FAST
F-free cocaine
a- antihistamine
s-sympathomiimetc
t-theophylline
Term
acronym for hypothermia
meanings
Definition
COOLS
carbon monoxide
opioids
oral insulin
liquor
sedatives
Term
acronym for hyperthermia
meaning
Definition
NASA
n-nicotine
a-AWDS - alcohol withdrawal
s-salicylates
a-anticholinergics
Term
acroynm for hypotension
Definition
CRASH
c-clinidne
r-rodenticides
a-antihypertens
s-sedative
h-heroin
Term
acronym for hypertension
Definition
CTSCAN
c-cocaine
t-thyoid
s-sympathomimetc
c-caffeine
a-amphetamine
n-nicotine
Term
acronym for toxicites causing coma
wht ones to know?-5
Definition
LETHARGIC
ethanol, glycol, TCA, rohypnol, cyanide
Term
acronym for what cuases seizures (4 letters)
what need to know-2
Definition
OTIS
sympathomimetics, salicylates
Term
acronym for what cuases seizures (more than 4 letters)
what need to know?
Definition
CAMPBELL
propanolol, BDZ/ethanol withdrawl, ehtylene glycol
Term
which med most assoc with seizures?
Definition
propanolol
Term
equation for anion gap:
normal range
Definition
NA- (Cl+HCO3)
8 + or - 4
Term
elevated anion gap ancronym and meds
Definition
MUDPILES
m-metofrmin
u-uremia
d-DKA
p-propopfol
i-iron/ibuprofen
l-lactate
e-etoh
s-salicylates
Term
equation for osmolal gap
1)
2)
wha is normal range?
Definition
1)2Na + glc/18 + BUN/2.8 OH/correction factor
2)measured-calculated
-14-10
Term
acronym for elevated osmolal gap
Definition
MEDIE
M-methanol
e-ehtylene glycol
d-diuretics
i-isoproyl
e-ethanol
Term
why dont do lab tests-3
Definition
cost
lack of cut-offs
false tests
Term
what tests can be used?
Definition
urine drug screen
serum blood
Term
serum conc of these drugs may be useful for managment-3
Definition
APA, saliclyate, alcohols
Term
if unknown what pt ingested alwys run what test
Definition
quantitatve APA test
Term
qualitative drug screening should be when
Definition
results alter maangment
Term
quantitavte dru screens (blood) should be done when?
Definition
for drugs that guide therapy like in other flashcard
Term
toxidrome for cholinergics
Definition
DUMBELLS
d-duarrhea
u-urination
m-miosis
b-bradycardia
e-emeisis
l-lacrimation
l-lethargy
s-salivation
Term
low dose anticholinergic=
Definition
dryness
Term
medium dose of anticholinergic=-2
Definition
tachycardia, mydriasis
Term
high dose of anticholinergics cause-2
Definition
agitation, hallunication
Term
toxidrome symtpoms of anticholinergics-4
Definition
hot, red, dry, mad
Term
toxidrome for smypathomimetics-3
Definition
hyperthermia, tachycardia, seizures
Term
opiod toxidrome symtpoms-3
Definition
miosis
bradycardia
hypotension
Term
toxidrome for sedative-3
Definition
CNS depression
resp depression
hypothermia
Term
sedative withdrawal may appear like what toxidrome?
Definition
sympathomimetic (can die formt his)
Term
opioid withdrawal symptoms-2
Definition
anxiety
myalgias
Term
look at slide 30 right before test for quick toxidorme review
Definition
Term
what is decontamination
Definition
prevetn reabsorption of subtance after its ingested
Term
deconamtination types-3
Definition
emesis
acitavted charcoal
gastric lavage
Term
what induces emeiss
the thing to note:
Definition
syrup of ipecac
no longer reccomedned
Term
is gastric lavage indicated for most meds?
Definition
nope
Term
activated charcoal MOA
Definition
surface area for adsorption of toxins
Term
dose of activated charcoal-
most effective if given how mnay hrs after ingestion
Definition
25-100gm
1-2
Term
mult dose acitvated charcoal (MDAC):
dose:
don';t give with
Definition
25 gm q 2 hrs
cathartics like sorbitol
Term
ADEs of charcoal-2
Definition
apsiration, bloating
Term
susbtances adsrobed by MDAC-4
Definition
ABCD
A-aspriin/theophylline, antimalarial, barbs, carbamez, dapsone
Term
3 things not adsorbed by AC
Definition
lithium, alcohol, potassium
Term
AC is contraindicated when?
Definition
ariway reflexes protected or not intact
Term
sorbitol can be given as sweetner with only?
Definition
AC not MDAC
Term
whole bowel irrigaiton dose:
when to use?-3
Definition
1 L/hr
lithium, ER/SR agents, others not adsroed by charcoal
Term
what is the step of tox managment AFTER drug has been absrobed?
Definition
eleiminated
Term
how do you enhance eliminaiton-2
Definition
alkinilization
hemodialysis
Term
look thruout lect for the quesiotn sldies
Definition
Term
CCB/BBs toxiciity symtpoms-3
Definition
bradycardia ,conduction block, myocardium depression
Term
what is first line therapy for BB/CCB overdose and dosing ofr it
Definition
Ca gluconate 0.6 mL/kg
Term
when do you avoid Ca?
Definition
digoxin overdose
Term
what are 2 toher therapies for CCB/BB overdose ?
when do you use the 3rd line?
Definition
glucagon 3 mg
HIET (regular insulin) 1 unit/kg
do HIET as soon as other 2 dont work bc delayed onset
Term
what are the toxic alcohols-2
which causes eyesight changes? renal falirure?
Definition
methanol
ehtlyene glycol;
methanol; glycol
Term
treatments and dosing for toxic alcohol over dose-2
which has ease of admin and lasck of aDEs?
Definition
alcohol 100 mg
fomepizole 15 mg/kg;
fomepizole
Term
biggest cyanide toxic cause?
signs?-2
Definition
nitroprusside
lactate >8, tachycadia
Term
treatment for cyanide toxicity? -2
which can be given in all siutaitons
Definition
1 amp of amyl nitrate
Nathiosulfate 12.5 gm IV
Nathiosulfate
Term
VitB12a can be givne for what toxicity but needs speerate line?
Definition
cyanide
Term
if deciding to use antidote for BDZ overdose need to consider-2
Definition
pecipitation fo withdrwala
removal of protective effects of BDZ
Term
treatment and dose for BDZ overdose
Definition
flumazenil .2 mg IV max of 3 mg
Term
for opiod overdose use?
Definition
nalaxone 0.04 mg IV then double every min. max of 10 mg
Term
acute tox of digoxin symtpoms?-3
Definition
N/V**
HyperK
Term
chronic tox of digoxin symtpms-3
Definition
GI symtpms
neurospychiatric
visual
Term
how mnay vials for chronic overdose of dignoxin of fab anti0digoxin antibodies
Definition
3-6
Term
how many vials for acute digoxin overdose of the fab fragments
Definition
10-20
Term
APAP toxicity is dose of
Definition
7.5 gm
Term
typical presentaiton of APAP toxicity?
Definition
just vomitting
Term
what is the med for APAP overdose?
what does it replenish?
Definition
n-acytlcysteine
glutathione
Term
what is IV dosing over 1 hr for APAP overdose
what is PO?
Definition
150mg/kg
140mg/kg
Term
N-acytl cystine reccomedned also if-3
Definition
APAP level not avail in 8 hrs
repeated ingestion and APA>20
unknown time of ingestion and measurable APAP
Term
the triad of symtpoms fo salicylte overdose
Definition
hyperventilation
tinnitis
GI irritaiton
Term
treatment for salicylate overdose-2
Definition
MDAC 25 mg q2hrs
fluid resusications
Term
use hemodialysis for salicylate overdose-3
Definition
apsirin>100
acidosis
renal failure
Term
glycemic toxicity from antidiabetics is when BG<
Definition
70
Term
what do you use for hypoglecmia?
Definition
AC if wihtin 1-2 hrs
Term
if pt symtpomatic or BG <60, what do you use?
Definition
dextrose to get BG>80
Term
if pt needs a lot of rescue dextrose doses for hypoglycemia, consider using?
Definition
octreotide
Term
TCA toxic symtpoms-4
Definition
hypotension, arrythmia, anticholinergic, CNS
Term
1st line for TCA toxicity?
Definition
AC
Term
for cardiac instability with TCA toxicity, stpes for treatment-4
Definition
IV fluids
NaHCO3 1 meQ/kg
Ne if still hypotensive
glucagon 10 mg for slavage
Term
for prevention of seizures with TCA toxicity use?
avoid?
Definition
lorazepam
phenytoin
Term
if TCA toxicity is refractros use
Definition
IV fat emulsion (is a lipid sink, the drugs will get held in fat)
Term
what is dosing for IV fat emulsion
Definition
20% IVFE 100 mL over 1 min
then .25 ml/kg/min following bolus
Term
what is max dose for IV fat emulsion?
Definition
no max dose!
Term
wtihdrawal of opioid treatment? -2
Definition
slow taper of long acting opiod
symtpoms control like anteemtic, clonidine
Term
drugs not adsrobed by AC acronym and meaning
Definition
LIPSHA
L- lithium
I-iron
P-potassium
S-solvents
H- hydrocarbons
A-alcohol
Term
how is whole bowel irrigaiton admin?
Definition
nasograstric tube
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