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PCTExam1

QuestionAnswer
what age group does poisonings occur most often? <6 years old
what time of day are poisonings most prevalent? early evening-late morning
what percentage of poisonings are unintentional? intentional? 81.4%; 14.7%
how many poison control centers are there in the US? 57
data collections thru AAPCC includes what? substance/amount, symptoms, treatment, outcome, location, age, reason for exposure, and name
how many deaths occurred of the 33,000 calls the palmetto poison center got in 2010? 6
why should neutralization not be performed? exothermic rxn
what are the 3 drugs that might be started in the ED if a poisoned patient is in a coma or has AMS? Dextrose, Thiamine, Naloxone
milk should only be used if what is ingested? why? toothpaste; binds fluoride
how long does it take for Ipecac to work? how much stomach contents is emptied? 20 minutes; 30-40%
how can chronic use of Ipecac cause cardiotoxicity and myopathy? Emetine is an alkaloid that causes inhibition of protein synthesis and a blockade of sodium and calcium channels
what is the mechanism of gastric lavage? push fluid in with syringe, drawn out with a syringe (Water or Saline)
highly adsorbent powder made from distillation of wood pulp activated charcoal
what is activated charcoal mixed with to form an aqueous slurry? water
what can be added to activated charcoal to decrease the risk of constipation? sorbitol (cathartic use)
how long after ingestion should activated charcoal be given? within one hour
what is the mechanism of WBI? wash out intestines
how long should you administer WBI? until rectal effluents are clear
what ingredient is in WBI? PEG
when do we see increased LFTs in APAP ingestion? phase 3 - 72-96 hours
how can you predict toxicity of APAP if not a single ingestion? amount - 7.5grams/24 hours
what are treatment strategies for APAP overdose? GI decontamination (Activated Charcoal), NAC, and Supportive Care
LD of NAC? maintenance? 140mg/kg; 70mg/kg x 17 doses q
when do you order APAP levels? 4 hours post ingestion
what strength is NAC given? how does it come? 5%; 10 & 20%
ER APAP have been shown to have toxic levels how long after ingestion? 11-14 hours
toxic doses of what can cause bezoar? salicylates
1 concentrated tsp of oil of wintergreen equals what? 7.5g of ASA
difference in acute and chronic toxicity with salicylates chronic - no significant gastroenteritis, acidotic, usually mental deterioration, severe dehydration Acute - N/V, stomach pain, hyperventilation, respiratory alkalosis, dehydration
why is it important to continue drawing levels of salicylates q 4 hours? bezoar and EC/SR tablets
what is thought to be the causes of most of the effects seen with NSAID toxicity? decreased prostaglandin synthesis (COX inhibition)
toxic amounts of NSAIDs in pediatrics? >250mg/kg
why can't enhanced elimination be preformed with NSAIDs? highly protein bound
what are the most common salt forms of iron that are seen in toxicity sulfate, gluconate, or fumarate
what is the calculation for elemental iron? FSG=359
what is the mechanism of toxicity with iron? direct corrosive effect on mucosal tissue and may cause hemorrhagic necrosis and perforation (Fluid Loss); absorbed iron causes cellular dysfunction and death, resulting in lactic acidosis and organ failure
what is deferoxamine? when is it used? Iron Chelator; Fe>500 or >350 + Serious Sx
why is lead toxicity more serious and common in children? 40-50% absorption in children and only 10-15% in adults
what is the cornerstone of treatment for all heavy metal toxicities? chelation
what is BAL used for? High Lead Levels with Symptoms of Toxicity/Encephalopathy
what is CaNa2EDTA used for? Lead Toxicity
what is Succimer used for? Asymptomatic Lead Toxicity with Levels 45-69%, Lead Levels of 35-44% in <2y/o, elevated erythrocyte protoporphyrin, or hint of mild sx
key in lead toxicity treatment prevent re-exposure
drugs with narrow therapeutic indexes, <10x daily dose can cause severe intoxication cyclic antidepressants
what is the primary cause of death in cyclic antidepressant overdose CV (QRS Widening)
what is the order of CV events in cyclic antidepressant toxicity? sinus tachy, conduction defects, ventricular tachy, ventricular fibrillation
why are blood levels generally not drawn for cyclic antidepressants? they are qualitative not quantitative (not a good measure of severity)
why are children at an increased risk of toxicity with cyclic antidepressant toxicity? smaller lipid compartment, low capacity for binding to albumin, and more free drug
what should you do upon discovery of cyclic antidepressant overdose? call 911
what should you treat rhythm disturbances due to cyclic antidepressant toxicity with? lidocaine
why should physostigmine not be used in refractory dysrhythmias due to cyclic antidepressant toxicity? can cause seizure and CV effects
how long should you monitor an asymptomatic cyclic antidepressant overdose patient? at least 6 hours
why is hemodialysis not recommended in cyclic antidepressant toxicity? highly lipophillic, high protein binding, and lg VoD
cyclic antidepressant that has less cardiac SE and more prominent CNS effects and can have excessive muscular hyperactivity amoxapine
cyclic antidepressant that has a higher incidence of seizures, cardiac dysthythmias and duration of coma than TCAs maprotiline
cyclic antidepressant that interferes with SE reuptake with little effect on adrenergic system, little to no effect on heart, toxicity is mostly CNS depression and some hypotension trazodone
which 2 SSRIs can cause QTc widening? citalopram and escitalopram
what can be seen in SSRI overdose? SE Syndrome
most bites occur during what month range? may-october
7 Poisonous Snakes in SC Eastern Diamondback Rattlesnake, Timber Rattlesnake, Canebrake Rattlesnake, Pigmy Rattlesnake, Cottonmouth Moccasin, Copperhead Moccasin, Eastern Coral
pit vipers are all members of what genus? crotalidae
eastern coral snake is member of what family? elapidae
what type of toxin is associated with eastern coral snake? neuro toxin
reaction to foreign antigens serum sickness
how long does it take for serum sickness to present following tx with antivenom? 7-14 days
what is the antivenom for coral snakes and black widows derived from? horses
what tx is available for poisonous snake bites? coral snake bites? crofab; antivenin derived from horses
what tx is available for brown recluse bites? supportive care
what is a unique diagnostic feature of a black widow bite? diaphoresis around bite site
how long must you monitor a patient with a black widow bite? minimum of 6-8 hrs
act primarily by phosphorylation of acetylcholinesterase at nerve endings which blocks AChE lead to accumulation of Acetylcholine at muscarinic and nicotinic receptors and the CNS Organophosphates
aging (permanent inhibition of AChE Thru Covalent Binding) can occur following 24-48 exposure to what? Organophosphates
what is seen following massive exposures of organophosphates? SLUD Symptoms
what do organophosphates smell like? garlicky or solvent odor
how long must you monitor a patient with organophosphate toxicity? at least 72 hours
therapeutic endpoints desired with atropine given to patient with organophosphate toxicity drying of bronchial secretions, reversal of wheezing and bradycardia
what is the goal in giving pralidoxime to a patient with organophosphate toxicity? reactivate the phosphorylated cholinesterase enzyme which treats the nicotinic effects
what organochorine insecticide is still used? lindane
where are pyrethrins derived from? chrysanthemum plant
natural insecticide pyrethrins
why is there low toxicity associated with pyrethrins and pyrethroids? limited absorption and rapid degradation
what is the treatment for skin contact with pyrethrins or pyrethroids? vitamin E
paraquat is used on what type of plants? diquat? land plants; aquatic plants
formed during production of some organochlorines dioxins
L-type channels are located where? in the plasma membrane of all types of muscle cells
allows for normal propagation of electrical impulses via the specialized myocardial conduction tissues, particularly the AV node calcium
what does skeletal muscle depend on for excitation contraction coupling? intracellular calcium stores
what type of tissue is calcium influx critical? cardiac and smooth muscle
what class of CCB is diltiazem in? benzothiazepine
what class of CCB is verapamil in? phenylalkylamine
what class of CCB are nifedipine, amlodipine, and felodipine in? dihydropyridines
which CCB is the most potent inhibitor of cardiac conductions and has the mot prominent effects electrophysiologically verapamil
CCB that has essentially no effect on SA/AV conduction but is a potent peripheral vasodilator nifedipine
CCB that displays the effects of verapamil and nifedipine but less prominently diltiazem
what is the doc in BB toxicity? glucagon
how long should a patient be monitored following CCB toxicity? minimum of 24 hours even if asymptomatic if SR & 8 hrs if IR
what causes the positive ionotropic effects of digoxin? inhibition of Na-K ATPase Pump & Increased intracellular Ca++
why in chronic digoxin overdose is there only normal-mild digoxin levels? tissues and receptors are saturated
why are chronic digoxin overdose patients usually seen with hypokalemia? usually also on diuretic
when should a digoxin level be drawn? 6 hours after acute ingestion
antidote for digoxin digoxin-specific antibody fragments
each vial of digoxin-specific antibody fragments will bind how much digoxin? 0.5mg
schedule I drugs LSD, marijuana, heroin, cocaine
schedule II drugs morphine, methadone, topical cocaine, PCP
schedule III drugs anabolic steroids, codeine, hydrocodone, some barbituates
schedule IV drugs benzos, talwin
georgia home boy, vita g, liquid ecstasy are all slang terms for what? gamma hydroxybutyric acid
what is converted by alcohol dehydrogenase and aldehyde dehydrogenase to GHB? 1, 4 butanediol (Found on Aquadots)
semisynthetic opioids heroin, oxycodone
synthetic opioids methadone, meperidine
opiates morphine, codeine
opiate receptor responsible for spinal and supraspinal analgesia, & cough suppression delta
opiate receptor responsible for spinal analgesia, miosis, and diuresis kappa
opiate receptor responsible for supraspinal analgesia, peripheral analgesia, sedation, euphoria, respiratory depression, GI dysmotility, pruritus, and bradycardia mu
what receptor is naloxone most potent at? mu
what is naloxone's onset? duration? 1-2 min; 20-90 min
inhalation of volatile substance directly from container (i.e. airplane glue, rubber cement) sniffing
pouring a volatile liquid onto fabric and placing over nose/mouth huffing
spraying a solvent into a plastic/paper bag and rebreathing from the bag several times bagging
sodium and potassium account for what percentage of extracellular cations? 95%
chloride and bicarb account for what percentage of extracellular anions? 85%
what causes blindness with methanol toxicity? formic acid
is osmolality usually measured or calculated? osmolarity? measured; calculated
what are the toxins associated with ethylene glycol? glycoaldehyde & oxalic acid
what happens to oxalic acid in the body? precipitates with calcium in the kidneys (envelope-like crystals)
Created by: templets
 

 



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