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Toxicology - Medbullets
Toxicology - Medbullets
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Author:DamianApollo
TopHighYieldTopics
ToxicologyDrugIntroduction
Analgesics
Antibiotics
Antivirals
CardiovascularMedications
EndocrineMedications
Treatment
Pulm
Poison(s)
MetallicPoisoning
ObstetricMedications
Renal
Rheum
Feedback
Anatomy
Drugs
Notes
Iron
Usedforaluminumpoisoninginrenal
failure
Usedinironoverloadwithrepeat
transfusions(thalssemia)
Ironoverload,hemochromatosis
Prussianblue
Cesium
Thallium
Usedinthecaseofaradioactiveincident
Penicillamine
Copper(Wilson's
disease)
Watersolubleformofpenicillin
Avoidinpatientswhohavepenicillin
allergy
Chelatescopper
EDTA
Lead
Canchelateanddepletecalciumions
Dimercaprol(BAL)
Arsenic
Lead
Mercury
UsedinconjunctionwithEDTAforlead
poisoning
Succimer
Arsenic
Lead
Mercury
Usedmorecommonlyinchildren
Deferoxamine
Toxicology
PulmonaryMedications
Psych
About
Immunosuppressants
PsychiatricMedications
Peds
Messages
Toxicologymedicationscanbebrokendownintothefollowingcategories
metallicpoisoning
gaspoisoning
prescriptiondrugsoverdose
illegaldrugsoverdose
householdsubstanceoverdose
AnesthesiologyMedications
OncologyMedications
Colleagues
19
Topicupdatedon03/22/1611:59am
DrugsbySpecialty
GastrointestinalMedications
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Toxicology
STEP2/3Drugs
ENTMedications
Deferasirox
GasPoisoning
100%O2(consider
hyperbaricO2)
Carbonmonoxide
(CO)
CObindswithmuchgreateraffinitythan
O2
Cyanide
Cyanidefoundinrodenticides"gopher
goitter",releasedinburningofplastics
andwool,andplantssuchascassava
Cyanidebindscytochromecofthe
electrontransportchain(ETC)arresting
cellularrespiration
Nitritescreatemethemoglobin(Fe3+)
intentionallytocompeteforandbind
cyanidesoitdoesnotgettotheETC
Amylandsodium
nitrite
Sodiumthiosulfate
Hydroxycobalamin
PrescriptionDrugOverdose
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Acetaminophen
Nacetylcysteine
Step1
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Sodiumbicarbonate
Heme ID Neuro Nutri
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OB Tricyclic
Onc Ophtho Ortho
antidepressants
(TCA)
Bestifgivenwith810hours
Alsoamucolytic
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FirstsignofODishyperventilationand
Messages
About
Feedback
respiratoryalkalosis
Peds Donotgivewithphysostigmine
Psych Pulm Renal Rheum Anatomy Drugs
FirstcheckanEKGforQRSprolongation,
thentreatwithsodiumbicarbonateinTCA
overdose
Colleagues
DrugsbySpecialty
TopHighYieldTopics
Analgesics
Radioactiveiodine
(I131)
GiventopreventtheuptakeofI131
Amphetamines
(basic)
Eliminatesamphetaminesbyacidifying
urinewhichresultsinacharged
amphetaminemoleculewhichisexcreted
Anticholinesterases
Organophosphates
Sarin(nervegas)
Removedcontaminatedclothingifpatient
wasexposedtoinsectisides
Atropineasananticholinergicand
combatstheexcessAch
Pralidoximeifgiveninatimelymanner
regeneratesacetylcholinesterase
reversingthecondition(timingiscritical)
Antimuscarinic
Anticholinergic
agents
Atropineoverdose
DonotgiveifpatientmayhaveTCAOD
asitmayleadtoheartblockorasystole
Tertiaryaminethatcancrosstheblood
brainbarrierandreverseanticholinergic
effectsintheCNS
Opioids
Precipitateswithdrawalsymptomsin
chronicopioidusers
Useinpatientswithrespiratory
depression
OpioidwithdrawalwillNOTkillapatientit
isjustunpleasant
Flumazenil
Benzodiazepines
Maycauseseizuresinaddicted
benzodiazepineusers
Rarelyusedwithbenzodiazepine
overdoseunlessconcernedforrespiratory
depression
Otherwiseletthepatient"sleepoff"the
benzodiazepines
Glucagon
blockers
IMglucagonbesttoreversebetablocker
overdose
blockers
(propranolol,
esmolol)
Theophylline
ODsymptomsaredueto2activation:
hypotension,tachycardia,hypokalemia,
hyperglycemia
Digitalisantibody,
lidocaine,Mg2+
Digitalis
VisualandGIsymptomsclassicallyseen
inoverdose
Methemoglobin
IroninthehememoleculeisFe3+which
cannotbindoxygenuntilitisreducedto
Fe2+bytreatment
Potassiumiodide
AnesthesiologyMedications
Antibiotics
Antivirals
Ammoniumchloride
(NH4Cl,acidic)
CardiovascularMedications
EndocrineMedications
ENTMedications
GastrointestinalMedications
Atropine
Immunosuppressants
ObstetricMedications
OncologyMedications
Toxicology
Pralidoxime
PsychiatricMedications
PulmonaryMedications
Physostigmine
Naloxone/naltrexone
Methyleneblue
VitaminC
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Aminocaproicacid
tPA
Streptokinase
VitaminK
Warfarin
Bridgewithheparinaswarfarincan
depleteproteinCandSfirst
(anticoagulants)leadingtoaninitial
prothromboticstate
Heparin
Protamineisahighlypositivelycharged
peptidewhichstronglybindstothe
negativelychargedheparin
Plasmainfusion
Protamine
HouseholdSubstanceOverdose
EthanolIVinfusion
Fomepizole
Causticfluid
Antifreeze
(ethyleneglycol)
Methanol
Thinkantifreezewheningestedsubstance
issaidtobesweetandindividualappears
"drunkwithoutthetypicalsmellofalcohol"
Perform
endoscopy
Irrigationx15mins
forocular
exposure
Donottrytoinducevomitinginpatient
Couldperhapsusesmallamountof
diluent
Other
Antivenin
Rattlesnakebite
IronPoisoning
Mostdeathsduetoironpoisoning(ingestionofirontablets)occurinchildrenbetween1224
monthsofage
Symptomsoccurwithin30mintoseveralhours
abdominalpain,diarrhea,vomiting
cyanosis,drowsiness,hyperventilationresultingfromacidosis
Deathcanresultinsixhours,butanapparentrecoverymayhappenfrom612hourswithdeath
ensuinginthenext12hours
Ifnottreatedearly,damagetothestomachcanleadtopyloricstenosisorgastricscarring
Earlytreatmentwithdeferoxaminecanreducemortalitysignificantlyfrom45%to1%
Mechanismofactionofironrelateddamage
ironoverdoseresultsintheperoxidationofmembranelipidsleadingtocelldeath
MethanolandEthyleneGlycolToxicity
Eacharecompetitivesubstratesforalcoholdehydrogenase
(ADH)
Methanol
metabolizedbyADHtoformaldehydefollowedby
aldehydedehydrogenasetoformformicacidwhichis
toxictotheopticnerve
earlytoxicityofformicacidismetabolicacidosisby
formicaciditself
formicacidalsobindstocytochromeoxidase
blockingoxidativephosphorylation
resultinginlacticacidosiswhichisthelatterandleadingcauseofthemetabolic
acidosis
signsandsymptomsappearwithin1224hoursafteringestion
CNSdepression
methanolactssimilarlyasethanolasaCNSdepressant
metabolicacidosis
visualchanges
blindnessoccurswithaslittleas30mLanddeathat100mLingestion
Ethyleneglycol
colorless,odorless,sweettastingliquid
toxicityderivesfromthehepaticoxidationofethyleneglycoltooxalicacid
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degradedbysamepathwayasmethanol
theglycolicacidproducedbyaldehydedehydrogenaseisconvertedinoxalic
acid
oxalicacidbindscalciumandformscalciumoxalatecrystalsthatdamagetheheart,
brain,lungs,kidneys
signsandsymptomsdevelopinstagesafteringestion
firststage:0.512hours
strongerinebriantthanmethanolandethanolcausingmilddepressionofCNS
resultinginseizuresandcoma
patientsappear"drunkwithoutsmellinglikealcohol"
within412hours,calciumoxalatecrystalsdepositinthebraincausingCNS
toxicity,cerebraledema,meningismus(nuchalrigidity,photophobia,headache
withoutinfectionorinflammation)
hypocalcemiaoccursduetobindingofcalciumbyoxalicacidandcancause
prolongedQT,arrhythmias,myocardialdepression
secondstage:1224hours
tachypneaoccurstooffsetthemetabolicacidosisduetothetoxicmetabolites
produced
multiorganfailure(CHF,lunginjury,myositis)duetowidespreadcrystal
deposition
NOTE:mostdeathsoccurinthesecondstage
thirdstage:2472hours
acuteanuricrenalfailurefromcrystaldepositionbutfullrecoveryoccurswithin
weekstomonths
Treatment
IVethanol
competitivesubstrateforADHandhasgreateraffinityforADHthanmethanoland
ethyleneglycol
fomepizole
inhibitsADHpreventingproductionoftoxicmetabolites
Miscellaneous
Whenbehavioralchangesarerecognizedinadolescentsscreenforsubstanceuse
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(M3.PH.3)Afiveyearoldgirlcomestotheemergencydepartmentcrying,holdingherstomachandcoughingup
pinkishsputum.Herfatherfranticallyreportstoyouthatshe"swallowedsomething"athomeabouttwohoursago.
Afterappropriateairwayandhemodynamicstabilization,youwouldnextperformesophagogastroduodenoscopy
(EGD)ifthefathertellsyouthatthepatienthadingested: ReviewTopic
1.
2.
3.
4.
5.
Ironpills
Cyanide
Anticholinergics
Acetaminophen
Draincleaner
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