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77 Cards in this Set

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most common category of exposure according to the AAPCC
analgesics
seizure, hypoglycemia, bradycardia, low blood pressure from grandma's house =
beta blockers (i.e. propanol)
topical benzocaine results in ...
methemoglobinemia
CV drug overdose from grandpa, hyperkalcemia =
digitoxin
brown recluse spider bites produces
dermonecrotic skin lesion
what affects cytochrome system?
carbon monoxide
clinical scenario:
~gas exposure
~presentation: oral secretions, salivation, lacrimation, miosis, sweating, nausea, wheezing, and copious sputum, weakness
sarin
counsel for pregnant woman using lisinopril (ACE inhibitor)
fetus may have hypotensive effects from drug
~tell mom to stop using the drug
salicylate elimination curve?
salicylate elimination curve?
Figure C
cause for homelessness and seizures
withdrawal from alcohol
location of renal failure from suspected toxicant + reactive metabolites
proximal convoluted tubule
clinical scenario:
presentation: confused, agitated, picking at things in the air
HR 150bts/min, dilated pupils, flushed, dry skin, absent bowel sounds
anticholinergic toxidrome
diquat toxicity
renal
black widow spider bite
enhances ACh release
clinical scenario:
facial grimacing, dystonia, gyric movements of eyes and tongue, conscious
benztropine mesylate
(antidote for dystonia by anticholinergic mechanism)
clinical scenario:
abdominal pain, gastroenteritis
2 wks into illness: hair comes out in clumps, eyebrow lost hair, weak, sensorimotor polyneuropathy
ferric hexacyanoferrate (thallium poisoning)
arisolachia fangchi associated with ...
kidney damage and renal cancer
clinical scenario: alcoholic runs out of alcohol
decreased consciousness, vomiting, gastric bleeding, no anion gap acidosis -- ketoisis and osmolar gap
isopropanol
antifreeze poisoning, anion gap (methanol)
fomepizole treatment
clinical scenario:
agitation, confusion, hyperreflexia, tremors, inducible clonus, diaphoresis, ocular clonus, fluctuations in HR and BP, normal WBC, CK
fluoxetine and dextromethorphan
clinical scenario:
apparent hepatitis, all viral Ag and Ab markers are negative. Liver biopsy: centrilobular necrosis
dose-related hepatic toxicity
distal renal tubular acidosis, cerebral atrophy (on MRI) and hepatotoxicity...
toluene abuse
What characteristic of a chemical or drug makes it more amenable to removal by hemodialysis?
MW of <500 daltons
clinical scenario: exposure to unknown gas
cough, difficulty breathing, pulmonary edema, no upper airway or mucous membrane irritation, no tearing or throat irritation
phosgene
BAL can be administered with calcium disodium EDTA for what kind of poisoning?
lead
clinical scenario: child treat with lindane lotion for head lice and wrapped in plastic wrap. Developed toxicity

In addition to dermal decontamination, what other treatment is indication?
benzodiazepine (i.e. lorazepam or diazepam)
clinical scenario: works in a lead smelter, notices during pregnancy a lactation increase in bld lead level.

Source of lead mobilization?
deep bone compartment
clinical scenario: ingests cyclic antidepressant
sinus tachycardia, wide QRS, long QT, Vtach, hypotension

Treat with?
sodium bicarbonate
Patient has acute onset of cranial nerve dysfunction and symmetric and descending paralysis

characteristic of?
botulism
muscle rigidity, hyperthermia, recent use of haloperidol, elevated CK (>1,000U/L), Tach

signs consistent with?
NMS
after an hour of indigestion, GI decontamination is...
not likely to be much of a benefit
What is the preferred method for confirmation of positive drug test?
gas chromatography-mass spectrometry (GC/MS)
clinical scenario: bite on foot
swollen, less muscle strength, no piloerection, no rigidity, bite site discolored
crotalinae (pit vipe) snake envenomation
Patients of Mediterranean descent with a history of G6PD deficiency should avoid...
methylene blue
clinical scenario: overdose of multiple medicines, cocaine body packs, lead, sustained release meds
1. whole bowel irrigation
2. protection of airway (due to risk of aspiration)
clinical scenario: took medicine for cold, anxiety and mood effects
confused, agitated, ocular clonus, hyperreflexis, diaphoretic, suspect serotonin toxicity

caused by...
paroxetine and dextromethorphan
Most likely category of pharmaceutical deaths
sedative/hypnotics/antipsychotics
clinical scenario: infant born with myelomeningocele

exposed to ?
valproic acid or carbamazepine
ciguatera fish poisoning causes...
cold/hot temperature sensation reversal
When patient presents with hepatitis (neg for infection) periportal necrosis, heavy inflammatory infiltrate sparing the centrilobular zones....

course of action? (exclude...)
exclude cytochrome P450 (centrilobular necrosis)
Both _____ and _________ influence the risk of structural defects
timing
dose of teratogen exposure
acute ingestion of metal salts causes...
gastroenteritis
hyperkeratotic eruption of palms and soles is caused by ...
arsenic poisoning
Most likely toxic etiology of elevated anion gap metabolic acidosis
salicylates
Prominent detoxifier to free radical metabolites
glutathione
Agent increases incidence of primary liver cancer in dose related fashion
ethanol
The setting regulations for allowable concentration of toxins in environmental media or acceptable daily intake of toxins depends heavily on what parameter?
highest NOEL modified by appropriate safety factors
clinical scenario: sudden onset of gastroenteritis followed by shock, 5 hours later

administer? which route?
BAL, intramuscularly
childhood lead poisoning characterized by ...
colic-like abdominal pain
Ipecac has potential for ...
abuse
What may cause a false positive for marijuana on urine drug screens?
efavirenz
Recently started on ziprasidone and haloperidol can indicate what?
NMS
if a child develops ___________ from a snake bite, it is possible it will recur in __________.
coagulopathy, 2 weeks
_______ and _______ cause cellular hypoxia as an underlying mechanism of toxicity
carbon monoxide and cyanide
Clinical toxicity of organophosphate insecticides...
excessive secretions
poisoned with toxin that causes severe abdominal pain, profuse watery diarrhea and possible death from shock
arsenic trioxide
certain non-steroidal pain medication may give a _______ for benzodiazepines on some immunoassays
false-positive
the hazard of a chemical ...
cannot be changed
__________ is an effective antidotes for INH poisons and it is dosed on a __________ basis according to the estimated amount of INH ingested
pyridoxine (B6) , gram for gram
Use N-acetylcysteine for what overdoes?
acetaminophen
Liver biopsy of patient with 40 yr occupation exposure to cadmium =
normal lobular architecture and hepatocytes
Testicular toxin that impairs fertility
ethanol
Overdose of diarrhea medicine composed of naroctic belladonna alkaloids might cause...
cyclic coma
increase excretion of 2,4D- with urinary alkalinization with ...
sodium bicarbonate (ion trapping)
acetaminophen exhibits _______ order kinetics through overdose situations
first order
Iron causes what kind of toxic damage (mechanism)?
O2 radical damage
Pyrethroid insecticide toxicity
paresthesia amenable by Vitamin E
antidotal mechanism of atropine for poisoning by ACEi like nerve gases
bind to toxin after its absorption
clinical scenario: agitated delirium after "pharming" party

antidote?
diazepam
herbacide glyphosphate = (toxic or non toxic)
non toxic
clinical scenario: neck contorted to side for several hours after "pharming" party

antidote?
diphenhydramine
clinical scenario: ingests bottle of 100 enteric-coated aspirin tablets

What happens? treatment?
prolonged absorption. Treat with sodium bicarbonate
Pulmonary edema associated with ...
heroin overdose or serious salicylate intoxication
Amanita mushrooms exert their toxic mechanism via inhibition of...
RNA polymerase II
Butane, propane, and nitrous oxide may cause hypoxia by displacing ....
alveolar O2
A toxidrome of miosis, respiratory depression, and coma may be seen with...
fentanyl patch abuse
Transition metal association with O2 radical damage...
Mn, Fe, Ch
manganese, iron, chromium