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cspi review
some review stuff to help answer some questions
| Question | Answer |
|---|---|
| What is the treatment of choice for beta blocker overdose? | Glucagon |
| What is the treatment of choice for Calcium channel blocker overdose? | Calcium infusion usually as Ca Gluconate or Ca Chloride |
| What is the treatment of choice for digoxin overdose? | Digifab or Digibind |
| TCA overdose one can expect what changes on the ECG? | QRS prolongation QTc prolongation Tachycardia |
| What is the antidote for Opiate OD? | Naloxone |
| What is the antidote for Benzodiazepines? | Flumazenil |
| What is the antidote for acetaminophen toxicity treatment? | N-acetyl cysteine |
| What is the antidotal treatment for Iron toxicity? | Deferoxamine |
| Organophosphate poisoning treatment of choice for muscarinic s/s? | atropine |
| Organophosphate poisoning treatment of choice for nicotinic s/s? | pralidoxime |
| What are the muscarinic s/s of organophosphate poisoning? | Salivate, Lacrimate, Defecate, urinate, Brady, Bronchorrhea, Bronchospasm |
| What are the nicotinic s/s of organophosphate poisoning? | Fasiculations miosis weakness |
| What is the antidote for Toxic alcohols? | Fomepizole (4-MP) |
| Miotic pupils may be suggestive of what drug? | opiates, cholinergics |
| Mydriatic pupils are suggestive of what drug? | anticholinergics |
| when should the use of flumazenil be questioned? | when the pt is known or suspected of using BZD chronically |
| What can flumazenil cause when used on the wrong patient? | seizures |
| which drug exhibits enterohepatic recycling? | carbamazepine |
| what is the mechanism of enterohepatic recycling and what best way can it be managed? | drug is excreted by liver via bile and small intestine reabsorbs the med causing cyclical coma |
| what is the toxic metabolite of acetaminophen toxicity that damages the liver? | NAPDQI |
| what insecticide is produced from chrysanthemums? | pyrethrins |
| Why should cocaine intoxications never be treated with beta blockers? | because you leave the alpha effect from the cocaine unopposed risk of stroke or MI or death. |
| What drug is known to cause tinnitus (ringing of the ears) when taken in toxic amounts? | ASA |
| What is the most common source of lead poisoning today? | lead paint from old buildings |
| what is one of the by-products of ethylene glycol toxicity? | oxalate crystals in the urine |
| what is one of the irreversible side effects of methanol poisoning? | blindness |
| Chloracne is associated with exposure to what? | dioxin (victor yuschenko) agent orange |
| which herbicide is known to cause pulmonary fibrosis? | Paraquat P for pulmonary |
| which herbicide is known to cause neurological impairment and even death? | Diquate D for D-brain. |
| what is the treatment choice in a patient with methemoglobinema | methylene blue |
| with Digoxin toxicity, what laboratory marker is very important r/t morbidity | potassium >5.5 usually means death |
| Which Beta blocker is associated with Torsade de Pointes | Soltalol |
| This beta blocker when given to asthmatics can be very dangerous for them | Propranolol |
| the function of this organ system is very important when dealing with Li toxicity | renal system |
| this mushroom when ingested along with alcohol can produce a disulfuram reaction | coprinius |
| this mushroom can produce seizures when ingested vit. B6 treats it | Gyromitra |
| this snake can give you both neurological signs and tissue desctruction aswell | mojave |
| This gas smells of rotten eggs and has a rapid knock down effect | H2S |
| Exposure to this gas can kill you it is odorless, colorless & created burning fossil fuels | Carbon Monoxide |
| This chemical used as a varnish or paint stripper can produce this dangerous prod | Carbon Monoxide |
| this supplement at times recommended by a Dr to lower cholesterol can cause intense flushing | Niacin |
| this alpha 2 agonist very popular medication can cause HoTN, Brady, CNS depression | clonidine |
| This fish poison is from improperly handled fish poorly stored on skin of fish conversion of histidine to histamine | scombroid |
| This marine toxin is very likely the most dangerous toxin and will kill if eaten, popular in Japan what is this toxin called | tetrodotoxin |
| the lionfish has spines that can be very painful and in USA most common cause of marine mechanical injuries why is this true if the fish is mainly a tropical fish | popular fish in aquariums |
| this toad has a poison very similar to Digoxin what is the name of this toad | Bufo Toad |
| this plant has is prepared by double boiling and eaten has been know to cause toxicity when poorly prepared what is the name of it | Pokeweed |
| this plant has cardioglycosides in it's leaves and stems very dangerous used as an ornamental plant mainly in the Southern USA | Oleander |
| This bipolar medication used for many years has been associated with Nephrogenic Diabetes insipidus | Lithium |
| This short acting beta blocker can only be given IV | Esmolol |
| The Calcium Channel blockers block Calcium at which channel | L- type |
| What is the drug to treat malignant Hyperthermia | Dantrolene |
| Bretylium, Soltalol and Amiodarone are what classification of anti-arrhythmics | Type III anti-arrhythmics |
| People with allergies to Iodine should avoid this antiarrhythmic | Amiodarone |
| Mexiletene is what type of anti-arrhythmic | IB |
| What is the abbreviation for the gas Sarin | GB |
| The toxic component of matches is | Chlorates chlorates |
| The toxic component of fireworks is | Nitrates |
| These toxic chemicals used for warfare cause chemical burns on the skin what is the general name given to them | vesicants |
| which chem causing skin burns/blistering has been used by the US military | mustard gas |
| a pt has a positive PCP on urine drug screen, no Hx of abuse of this, pt states he was "robo-trippin" why is PCP positive | Dextromethorphan |
| This illicit drug is the only drug known to cause horizontal and vertical nystagmus aka "rotatory"nystagmus | Phencyclidine (PCP) |
| This gas forms blisters, used in warfare, the blisters may show a "string of pearls"pattern | Mustard Gas |
| patient is in the emergency department, Hx of MDMA abuse and is having symptoms what on the street this person is called a what | tweaker he is tweaking |
| Police bring in patient that attempted to flee from them while selling drugs, Hx that he swallowed the evidence (drugs) this patiend is a "packer" or "stuffer" | stuffer a packer carefully packs as if going on a trip a stuffer, stuffs and runs. |
| which of the 2 is more likely to rupture in GI track a packer or stuffer | stuffer |
| which of the 2 a packer or stuffer is more likely to die if baggie ruptures | packer, usually packer has more product packed per baggie |
| a packer or stuffer would have a gastric lavage or a whole bowel irrigation | WBI: lavage too turbulent may rupture baggies pitfallthat may cause death |
| Lewisite also a chem warfare product is a vesicant how do the vesicles differ from those of mustard gas | eventually form a very large blister or bullae |
| Phosgene is abbreviated by which: CX, VX, GB, IB, TX | CX |
| What level of Lithium (lab value) would require hemodialysis even if the patient is not having any signs and symptoms | > 4.0 |
| The drug of choice to chelate Lead (Pb) is | succimer...It SUCCs to feel MAL (Hg, As, Pb) |
| a pt with Hx of Lithium use is suspected of having toxicity d/t neurological s/s, at what level would hemodialysis be considered | 3 or greater because level will very likely increase |
| a pt that eats lots of seafood is likely to have a higher than normal Hg level, is this Hg organic, inorganic or elemental | organic |
| A child bites into an Hg thermometer and ingested some of the HG, is this Hg organic, inorganic or elemental | elemental |
| mercury has been found in cosmetic products frequently is this Hg organic, inorganic or elemental | inorganic |
| Succimer is an FDA approved chelator for mercury True or False | False not FDA approved only one is Pb, but it is highly effective in removing Hg. |
| Fomepizole used in toxic alcohol ingestions as an antidote works where exactly | enzyme alcohol dehydrogenase |
| This beta blocker aside from it antagonistic effects also has beta agnonistic effects | Pindolol |
| This poison once used as a rodenticide resembles the cation potassium, banned in USA | Thallium |
| Beta blockers in general can be dangerous to patients with diabetes mellitus why is that | masks s/s of hypoglycemia |
| a patient with Pb toxicity has better protection from such toxicity if they exhibit anemia true or false | False they have a higher risk |
| what is the risk factor when one finds a potato in the pantry with greenish skin | solanine poisoning :NVD, abd cramps |
| a patient states he was pruning back some overgrowth on his dry scape garden, no in ED with intense pain to eye, states he got some sap in it, which plant | pencil cactus |
| a frantic mother calls you about her 2 yr old son that bit the pencil leads of all the pencils and she is concerned with lead poisoning what is the risk here | no lead poisoing, pencils are graphite tips only risk is aspiration |
| Prussian blue (radiogardase) is the antidote for what | Thallium |
| these seeds of fruits have what in common: apple seeds, cherry pits, plum pits, peach pits | cyanide |
| where would one find grayanotoxin | seeds of mountain laurel |
| would activated charcoal benefit a patient that ingested thallium | yes |
| agent orange is also known as | dioxin |
| what is the most commonly reported marine poisoning | ciguatera |
| Abuser of methamphetamine that develops psycho motor agitation and psychic symptoms similar to schizophrenia i.e. halluc, agit, delusions, paranaoia is called | Tweaker |
| A common complication of MDMA is hypoNatremia why does this occur | altered ADH release or it can be d/t rapid oral hydration with hypotonic solutions like alcohol and water |
| This illicit drug has rapid effects (15min-1hr) the pt presents with bruxism, increased arousal, overly alert, jaw clenching, muscular tension, restless legs, they may ask for water, c/o HA, have not slept or eaten in some times which drug | ecstacy or MDMA |
| the arylhexamines usually involved with abuse are | PCP (illicit), ketamine (pedi anesthesia), DM OTC cough suppressant |
| Gamma-Hydroxybutyrate (GHB) resembles which Neurotransmitter | GABA (gamma amino butyric acid) |
| What is the principal effect of GHB | CNS depression |
| Dextromethorphan causes sedation but can it also cause respiratory depression | yes in massive amt. regular abuse usually won't cause resp affects |
| GHB causes CNS depression what CV signs and resp. signs are of concern with toxicity | bradycardia and bradypnea (resp depression) severe is Cheyne stoke resp very close to death |
| Curare attacks where causing paralysis | N-M junction |
| What enzyme is affected with curare | acetylcholinesterase |
| A curare exposure can be treated using what | cholinergic like physostimine or neostigmine |
| where would one find curare | usually plant from Strychnos plant usually used to poison darts also poison dart frog. |
| Which mushroom is considered the most deadly accounting for the most reported deaths by mushrooms | Amanita phalloides |
| The false morel mushroom is toxic if ingested which toxin is associated with this mushroom | Gyromitrin |
| Mothballs will sink or float in a concentrated salt solution this aides in identifying them as paradichlorbenzene or napthalene which floats | Napthalene |
| what metabolic disturbance can occur when a toddler ingests perfume, cologne, body sprays or some mouthwashes | Hypoglycemia, d/t poor reserves of glycogen ETOH uses up glucose fast with low stores hi risk of Hogly |
| Due to what prod exposure would one see Mee's lines | As main one but also with Thallium |
| Metal fume fever is seen in soldering/welding metals which metal is associated with this specifically | galavanized metals which are zinc |
| which mothfall would sink to the bottom of a concentrated salt solution | Paradichlorobenzene |
| which opiate receptor is associated with pain control when stimulated by an opiate | kappa |
| which opiate receptor is associated with addiction to opiates | Mu 2 |
| this opiate receptor is associated with constipation, resp depression, addiction | the Mu receptors |
| Of the mothballs, which are radio-opaque, paradichlorbenzene or napthalene | PDB |
| The most common symptoms are rash, diarrhea, flushing, sweating, headache, and vomiting which marine poisoning | scombroid |
| NVD, cramps, excessive sweating, HA, and muscle aches. A feeling of burning and "pins and needles" as well as weakness, itching, and dizziness can occur. may also experience unusual taste sensations(metallic), nightmares, and hallucinations. | ciguatera |
| Symptoms include an upset stomach, dizziness, headache, disorientation, and short-term memory loss. Seizures may occur in severe cases. | domoic acid key word is short term memory loss amnesia |
| # Symptoms usually begin with numbness or tingling in the face, arms, and legs, followed by headache, dizziness, nausea, and loss of coordination. Symptoms are usually mild, although severe symptoms have occurred. # Cooking may not destroy the toxins, | saxitoxin |
| caused by a type ofdino-flagellate. Usually found in oysters, clams, and mussels from the Gulf of Mexico and S. Atlantic coast. s/s numbness, ataxia, an upset stomach, and tingling in the mouth, arms, and legs. | brevetoxin from red tide |
| This marine shellfish poisoning present mostly in bivalves and causes massive diarrhea | okadaic acid think of diarrhea and caca spelled KaKa |
| The antiarrhythmics which include Type Ia,Ib, Ic, II, III, IV have what in common | They block ionic channels |
| which of the antiarrhythmics are K channel blockers | Type III |
| Beta blockers are what type of antiarrhythmics | Type II |
| Type Ia, Ib, Ic antiarrhythmics block which ionic channels | Na channels |
| which popular herbal product used for depression acts like an MAO-I | St John's Wort |
| what is the mainstay of therapy with serotonin syndrome | Sedation (BZD) and cooling |
| citalopram a commonly prescribed SSRI has been associated with these serious effects with toxicity | QT prolongation and SZ |
| A pt on an antidepressant med takes an herbal supple to help with depression, develops HTN, tachy, mydriasis, diaphoresis, agitation, Dx | Serotonin syndrome |
| A pt on an antidepressant med takes an herbal supple to help with depression, develops HTN, tachy, mydriasis, diaphoresis, agitation, what herbal prod probably ingested | St. John's Wort |
| A pt on an antidepressant med takes an herbal supple to help with depression, develops HTN, tachy, mydriasis, diaphoresis, agitation, Treatment of choice is | Sedation (BZD)and cooling |
| A pt having Serotonin syndrome what aspect of it can cause a fatality | CV and Neurological collapse |
| What OTC meds have been implicated in causing serotonin syndrome | DM and ephedrine |
| Which med given for pain usually in the ED has been implicated in triggering Serotonin Syndrome ,IM med | Meperidine |
| This deadly plant looks like a turnip or "white carrot" will cause miosis or mydriasis | mydriasis |
| What is 5 HT | Serotonin |
| Drugs that block 5 HT of following which do cocaine, Meperidine, Dextromethorphan | All of the ones listed do this |
| It is safe to assume that in a hemlock plant the stems and leaves have no poisoin T or F | False the root has the most but all parts are poisonous |
| what is the worst outcome of hemlock poisoing | besides seizures it is metabolic acidosis and resp depression |
| what level of Fe in the blood is considered a toxic level (mg/kg) | 40 mg/kg |
| what level of Fe in the blood is considered a lethal level (mg/kg) | 60 mg/kg |
| Lithim and ecstasy have been associated in influencing the physiology of 5HT do they enhance release or inhibit release of 5HT | enhance release |
| Buproprion well known for it's antidepressant effects has been assoc. with sz how many can cause a sz | as little as 10 tabs (600 mg)21% of OD have shown sz activity. |
| WOTF drugs have been associated with QRS prolongation: buproprion TCAs | Both and both can cause sz. |
| cyproheptadine has been used to treat this potentially life threatening condition | serotonin syndrome |
| Why is it that MAOI tox effects present with tachy, HTN, flushing, Diaphoresis, agitation, | increase release of catecholamines |
| a pt suffering from serotonin syndrome is at risk of renal failure why is this | rhadomyolysis |
| A pt just had lunch then c/o heart pounding, dizzy,N&V has HOTN hr 130, severe HA, pt states he is on antidepressant his MD Rx in mexico | tyramine food ingestion pt on MAOI |
| This MAOI when it breaksdown metabolically is converted to what product | amphetamines |
| Pt in ED with priapism, on the ECG Polymorphic Ventric Tachy,Labs HypoNatremia,tremors seen and friend reported a sz Hx of depression what drug likely causing effects | trazodone |
| This beta blocker has been responsible for Torsades which drug is this | Torsades |
| This type III antiarrhythmic is a beta blocker where do beta blockers usually classify as when talking of antiarrhythmics | type II drug is soltatol |
| With MAOIs CV collapse and Neurological collapse are seen why does this occur | catecholamine depletion |
| pt on an MAOI ingested a sandwich of salami and now in ED d/t crisis r/t tyramine that his body cannot breakdown, how do u treat this | Phentolamine |
| priapism by trazodone has been well documented in OD and therap dosing this is caused why | alpha 1 effect it is blocked no constriction of vessels corpus opens up allowing blood in=erection |
| this atypical antidepressant has been associated with hypoNatremia | trazodone |
| on an ECG what would show up if a Na channel was blocked | QRS prolongation |
| when TCA is taken for therapeutic reasons, Na channels are blocked are these channels blocking Na from entering or leaving the cell. | entering |
| TCAs can block alpha 1 adrenergic receptors what can result from this | priapism and HOTN |
| Pt on a TCA has a QRS prolongation >100msec, what is pt at risk for now | seizures |
| A pt with psyche history presents to ED with confusion as per family,pt is taking valproic acid what do you recc to check next | ammonia level |
| What visual disturbances are associated with lamotrigine | dbl vision, blurred vision |
| a pt is taking clozapine chronically what medical condition is this pt at risk for | infections d/t neutropenia |
| when we mention Lithium toxicity the renal system is very important since med is renally excreted how much of this pt is excreted by kidneys | ~95% |
| pt tells his doctor he has taken up running and is training for a marathon, pt is on antipsychotics what risk factor exists d/t meds | anhydrosis |
| Haloperidol puts pt at risk for CV affects that can be serious which are those | QT prolongation and Torsades |
| A pt is brought in to the ED and having neurological s/s you find a bottle of Lithium (empty) in his pocket no date on fill and no history is this effect r/t acute or chronic use of this med | chronic |
| How can a pt on an MAOI that is prescribed amantadine be affected | can develop serotonin syndrome |
| Lilly of the Valley, Red squill, rhododendron have what toxin in common | cardiac glycosides also oleander |
| elderly patient has blurry vision, c/o halos around lights, weakness, malaise, color vision changes, says he feels like he has the flu | digoxin toxicity |
| Bradycardia with an AV block is suggestive of what toxicity | cardiac glycoside |
| Bradycardia with varying degrees of AV blockade, dysrrhythmias, hyperkalemia should think of what | Digoxin the brady w av blk and hyperKalemia give it away >5.5 K usually means death |
| someone mentions cicutoxin what should pop into your mind | poison hemlock |
| if someone mentions to you toxalbumin what should come to mind | Ricin |
| the most lethal plant in the USA with effects like: bradycardia, HOTN, violent sz, cyanosis you should think of | cicutoxin aka hemlock |
| if you hear the work monomethylthyrazine, you should be thinking of what | gyromytra mushroom or false morel |
| what is the antidotal therapy against sz purpoted by monomethylthyrazine | pyridoxine |
| what antimicrobial treatment is very similar to monomethylthyrazine and tox of this requires exact same antidote | isoniazid (INH) |
| a pt with Hx of DMII is being treated using a biguanide (Metformin) he has severe lactic acidosis what treatment would help this pt | hemodialysis |
| This older beta blocker has been used for stage fright and is highly lipophilic so enters CNS easily it has been associated with delerium | Propranolol |
| the use of organophosphates in the USA has decreased d/t adverse effects to humans and improved pesticides which one cont to be used in the USA | malathion |
| In organophosphate toxicity, which sign on the pt is the most reliable sign suggesting toxicity from the OP | Pupils: muscarinic-miosis; nicotinic-mydriasis |
| a pt with suspected OP toxicity you assess his tongue and it looks like a "bag of worms" fasciculations is this a muscarinic or nicotinic effect | nicotinic think of cigarettes when someone smokes them they do so by putting them on their lips so tongue is first contact of nicotine |
| a pt with suspected OP toxicity you assess his CV status and he is tachycardic at 120 beats /min is this a muscarinic or nicotinic sign | nicotinic |
| What do the following drugs have in common in respect to urine: Rifampin, Deferoxamine, Pyridium, | they turn urine red in color |
| This beta blocker has beta antagonistic effects and in toxic doses can have agonistic effects causing HTN and Tachy what is that Beta blocker | Pindolol |
| All nerve gases used in chemical warfare have what in common when being treated (enzyme) | inhibit Acetylcholinesterase |
| In CCB toxicity the ion Calcium can be used effectively but will not be effective given as just Calcium, it must be in a compound form what are those compounds | CaGluconate and CaChloride |
| What is the concentration of Calcium in Calcium Gluconate? | 4.3 meq |
| What is the concentration of Calcium in Calcium Chloride? | 13.4 meq |
| We know that N acetyl cysteine has been used to treat acetaminophen toxicity for years but as an antidote, what other products can it be used for as an antidote to protect the liver? | CCl4, Chloroform and pennyroyal oil |
| The chemical warfare agent GB is known as | Sarin |
| This chemical warfare agent has an odor that has been characterized as "freshly mown hay" what is this warfare agent? | Phosgene |
| What is the antidote to the vesicant Lewisite? | British Anti Lewisite (BAL) |
| When would BAL be used in Pb toxicity? | when encephalopathy develops |
| A child stabs himself on the thumb with his mother's epipen autoinjector. The wound is red swollen some blood but at the tip of the digit it is cold pale (blanching) it is reported "poor cap refill." What can be injected to finger that may help? | Phentolamine injected |
| This beta blocker has both beta blocking effect and alpha blocking effect in toxic levels what is it? | Labetolol |
| This chemical warfare agent ages the enzyme acetylcholinesterase the most rapid of any nerve agent including organophosphate insecticides which is it? | Tabun |
| This poison killed a Russian spy, they tend to lose hair in clumps over time then eventually die from multi system organ failure which poison? | Pollonium |
| This historical event of a famous poisoning where a man was punctured with the tip of an umbrella loaded with such poison what is this poison called that was injected? | Ricin |
| This famous case deals with the poisoning of the Ukrane president at the time, he developed chloracne but today lives and cont in his recovery what is this poison? | Dioxin |
| This plant called the Autumn Crocus is known for its medicinal value for acute gout, and with a narrow therapeutic index a dosing error can be fatal what is the name of this drug? | Cholchicine |
| the most reliable sign of an organophosphate poisoning is the pupilary signs, what would the pupils look like if the pt is having muscarinic signs? | miosis |
| the most reliable sign of an organophosphate poisoning is the pupilary signs, what would the pupils look like if the pt is having nicotinic signs? | mydriasis |
| What is the treatment of choice in a pt suspected of being exposed to antrax (Anthracis bacillus)? | ciprofloxacin |
| Grandmother calls to report that 5 yo grandson bit into a plant she called it an ivy. pt is crying mouth red swelling in obvious pain, what is this plant called gen term? | probably a "dumbcane" diffenbachia, ask grandma if the kid is retarded or just dumb...dumbcane memory trick also mother in laws tongue is diffenbachia. |
| A pt with history of bipolar disorder is on a bipolar medication and the family member tells you he is constantly thirsty and constantly urinating what drug and why is this occuring? | Lithium get a level. this is due to nephrogenic DI the aquaporin channel remains open allowing water to filter out of kindneys to urine.ADH is also inhibited! |
| A pt with no s/s on Lithium would require dialysis if the serum Li level is what ? | 4< |
| A pt on Lithium chronically is having s/s his lithium level is 3.0, his s/s are neurologica in nature, do you dialyze? | yes very likely his level would continue to rise. |
| What percentage of pt born to a mother that was exposed to CO during her pregnancy and did not receive HBO treatment will likely be affected d/t exposure? | 60% |
| HCP calling to report a tox level of Li on male pt 20s. Li 2.8 mumbling cannot sit still is drinking any liquid he grabs the urinal uses it then drinks his urine why is this happening? | Nephrogenic Diabet Insipidus d/t Li affecting the aquaporin channel. Pt with Neuro s/s and level 3.0 will very likely require dialysis. |
| Pt was landscaping he picked up green berries and ate 4 of them alerted home owner he ate green black berries, she alerted him they were lantana berries what do you tell him when he calls | instruct him on anticholinergic effects if experience tremors chest pain rapid heart rate hallucination see med attn. |
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sxirsrick