Toxins

Question 1

Tricyclic antidepressant symptoms

Answer 1

PNS blocked

• early tachycardia
• widening of QRS (late sign)
• Aberrant SVT
• Torsades, VFVT

Question 2

Tricyclic antidepressant treatment

Answer 2

• Magnesium for Torsades,
• Sodium bicarbonate (ion trapping, alkaline blood promotes drug binding to proteins, Na overrides Na blockade)
• norepinephrine pressor of choice
• dialysis not helpful.

Question 3

Cardioselective beta blocker OD

Answer 3

Atenolol, metoprolol, esmolol, betaxolol

• effects heart only
• bradycardia w/ hypotension
• escape rhythms

Question 4

Cardioselective beta blocker OD: Caution with B agonists (Epi) why?

Answer 4

Inverse Epi response, beta 1 blockade, alpha 1 = vasoconstriction, baroreceptors note increase pressures! stimulate parasympathetic system! will result in bradycardia and hypotension

Question 5

Non-cardio selective OD

Answer 5

Propanolol, sotolol, nadolol, timolol

-respiratory distressed, exacerbation RAD

Question 6

Beta block OD treatment

Answer 6

• Atropine - parasympathetic rule out
• TCP
• dopamine for hypotension (in conjunction with tcp)
• glucagon (release cAMP via glucagon cells on heart)

Question 7

Cardioselective Ca Cannnel blockers

Answer 7

Verapamil, Diltiazem

• sever bradycardia
• AV dissociation (3rd degree HB)
• hypotension

Question 8

Vasculomotor specific

Answer 8

Nifedipine, nicardipine, amlodipine

-sever hypotension

Question 9

Ca channel blocker OD tx

Answer 9

Calcium chloride/Gluconate 
-override blockade
-will increase HR, BP. 
TCP -backup to Ca
Monitor BS
-as we drive Ca, cells bUrn sugars

Question 10

Digitalis examples

Answer 10

Digoxin, digitoxin, foxglove, oleander

Question 11

Digitalis process

Answer 11

Poisons Na/K pump

• Na retained, Antiporter removes Na, Ca exhanged
• Ca improves squeeze, performance, slows repolarization
• stronger squeeze, slower rate
• can alter K, can lower K

Question 12

Digitalis s/s

Answer 12

Visual disturbances, yellow / green halos
Bradycardia
SVT, VT, AV block

Question 13

Digitalis treatment

Answer 13

• Digoxin immune fab (digiband) - binds dig
• correct electrolytes (k first, then Ca, mg)
• TCP for bradycardia
• lidocaine, mg sulfate, phenytoin (Dilantin) for tachycardia
• Procainamide will make pt worse,
• defibrillation and cardioversion will put pt right into asystole

Question 14

Hypokalemia causes

Answer 14

-Loop Diuretic misuse/OD
-“Diet Pills”
-Serum Potassium important as well as pH
-Think Acid/Base first.

Question 15

Hypokalemia EKG findings

Answer 15

-Peaked Pwaves
-flattened/slurred T waves
-Appearance of U waves

Question 16

Asa mild intoxication

Answer 16

  -Tinnitus (ringing in the ears)***
  -Hyperventilation***
  -HA
  -Vertigo
  -Mental Confusion
  -Thirst
  -Sweating
  -N/V

Question 17

Asa severe intoxication

Answer 17

  -Seizures***
  -Electrolyte Disturbances (TCO2, HCO3)***
    -Metabolic Acidosis
  -Agitation / restlessness
  -Coma
  -Non-cardiac pulmonary Edema

Question 18

Asa OD tx

Answer 18

  -Gastric empyting
  -Charcoal
  -Alkaline Diuresis using NaHCO3
    -Ion Trapping mechanism
  -Hemodialysis
    -Can work
  -Management of Acid/Base & Electrolyte disturbances.

Question 19

Acetaminophen (APAP) poisoning - Stage 1

Answer 19

Stage I - Flu Like Symptoms***
  -Occurs within 30 minutes to 24 hours ***
    -Stage 1 - Day 1
  -N/V
  -Anorexia
  -Pallor
  -Diaphoresis

Question 20

Tricyclics antidepressants action and examples

Answer 20

Examples: imipramine, amitriptlyine, nortriptyline, desipramine

Mimic class I AA (blocks Na channels)
Inhibits NE reuptake. (NE secreted into synaptic cleft, exhibits action, reuptook by secreting cell. This mechanism prevented. Excess NE in cleft)

Question 21

Acetaminophen (APAP) poisoning Stage 2

Answer 21

Stage II - Owe My Liver ***
  -24-48 hours ***
    -Stage 2 - Day 2
  -R upper quadrant pain/tenderness
  -Increased liver enzymes ***
    -Liver is taking a hit
  -Increases serum Bilirubin ***
    -Liver processes Bilirubin
  -Increased Prothrombin Time ***
    -Liver cannot make clotting factors
    -Worse bleeding
  -Oliguria asresult of ATN
    -Acute tubular necrosis

Question 22

Acetaminophen (APAP) poisoning stage 3

Answer 22

Stage III - Gonna Die Now *
-72-96 hours *
-Stage 3 - Day 3.
-Peak for liver function abnormalities
-Return of anorexia, N/V and malaise
-Jaundice becomes apparent*
-Hepatic Encephalopathy *
-DIC*
-Death*
-Due to fulminant hepatic necrosis

Question 23

Acetaminophen (APAP) poisoning stage 4

Answer 23

Stage IV - Im not dead yet***
  -IF they don’t die in stage III
  -4 days - 2 weeks***
    -Stage 4 - day 4
  -Resolution Period
  -Liver functions return tonormal***
    -Baseline Values
  -Patients are asymptomatic

Question 24

Acetaminophen (APAP) poisoning Toxic level

Answer 24

-Ingestion of 7.5 g or 150 mg/kg istypically toxic
-Measure serum levels 4 hours after ingestion
-Otherwise could show false low.

Question 25

Acetaminophen (APAP) poisoning treatment

Answer 25

     -N-Acetylcysteine (Mucomyst)***           -Orally 140 mg/kg           -Maint. 70mg/kg q 4 hours for 14 dosings                -May be given IV                -Used to complete the liver’s normal biotransformation in place of glutathione. 

Question 26

Glutathione

Answer 26

Glutathione used in last step of tyelenol biotransformation to non-harmful substance.  Overwhelmed by high tyelenol levels. Precursor to glutathione intervention is very harmful and kills liver. Mucomyst can substitute glutathione.