Toxicology

Question 1

MOA of organophosphates and carbamate poisoning

Answer 1

• inhibition of acetylcholinesterase
• stimulation of muscarinic and nicotinic receptors

Question 2

SLUDGEM/BBB for organophosphate poisoning

Answer 2

salivation, lacrimation, urination, defecation, GI upset, emesis, miosis

bronchorrhea, bronchospasm, bradycardia

Question 3

Dose of Atropine for Organophosphate Poisoning

Answer 3

1-2mg IV/IM, double the dose q 5min until effect

Question 4

What does atropine do for organophosphate poisioning?

Answer 4

• control secretions, correct bradycardia and hypotension (secretions will respond more slowly)
• reverse muscarinic symptoms not nicotinic effects

Question 5

Clinical s/s of TCA poisoning

Answer 5

• sedation, confusion, delirium, hallucinations
• anticholinergic effects - hyperthermia, flushing, dilated pupils
• hypotension

Question 6

ECG findings in TCA overdose

Answer 6

QRS > 100ms
Deep S waves in leads I, aVL
Tall R waves in lead aVR
Tachycardias

Question 7

Common TCAs

Answer 7

amitriptyline (elvail)
clomipramine (anafranil)
desipramine (norpramin)
doxepin (silenor, sinequan)
nortriptyline (aventyl, pamelor)
amoxapine (ascendin)

Question 8

Why might TCAs be prescribed

Answer 8

major depressive disorder, OCD, neuropathic pain, migraines, anxiety, insomnia

Question 9

Indication and Dosage for Sodium Bicarbonate in TCA

Answer 9

wide complex tachycardia in known or suspected TCA overdose

1mEq/kg IV/IO slow push
repeat 0.5mEq/kg q 10-15 PRN

*TCA may require higher dosages 2-3mEq/kg

Question 10

MOA of TCA overdose

Answer 10

• sodium channel blockade leading to wide complex dysrhythmias and hypotension
• potassium channel blockage causing QT prolongation
• anticholinergic, alpha-adrenergic, GABA receptor antagonist effects

Question 11

ECG Changes in Beta-Blocker Overdose

Answer 11

• PR elongation
• prolonged QRS
• bradydysrhythmias

Question 12

Primary Mechanism for Beta-Blocker Overdose

Answer 12

• adrenergic blocking action
• pro-arrhythmic tendencies (sotalol, propanolol, acebutolol)

Question 13

What is the scale/score used to assess severity of alcohol withdrawl?

Answer 13

CIWA

Question 14

When do delirium tremens generally start

Answer 14

48-72hr after last alcohol intake, can last 7-10 days

Question 15

Serotonin Syndrome

Answer 15

• can occur with SSRI, MAOI, TCA, lithium, stimulants, opioids
• s/s generally within 6hr of ingestion: delirum, tachycardia, hypertension, diaphoresis, diarrhea, muscle rigidity, myoclonus, hyperreflexia, trismus

Question 16

Serotonin Syndrome treatment

Answer 16

• airway management
• sedation for agitation
• hospital : cyproheptadine

Question 17

Simple Aphyxiants

Answer 17

• examples: carbon dioxide, methane, propane
• gases that displace O2 in air and dilute O2 concentration in air

Question 18

Chemical Asphxiants

Answer 18

• examples: hydrogen cyanide, carbon monoxide, hydrogen sulfide
• displace O2 in air and interfere with tissue oxygenation