POISONING AND DRUG ABUSE 1330-1530 Wed

Animal source of Crotalid antivenin. HORSE (EQUINE) OR SHEEP (OVINE)

True or False: Sensitivity Testing is required for the above antidote. TRUE
True or False: Antivenin for crotalids is not available in the Philippines. TRUE
Adverse reactions to the above antidote. URTICARIA, HYPERSENSITIVITY
What does APAP stand for? ACETAMINOPHEN
What is the INPN and Trade name of the antidote for APAP: N-ACETYLCYSTEINE
What is the Loading dose of the above antidote? 140MG/KG
An anticholinergic antidote: ATROPINE
Initial dose of this anticholinergic antidote in adults: ADULT DOSE: 1-2MG IV
Initial dose of this anticholinergic antidote in children: 0.05MG/KG IV
3 signs of complete atropinization.
 DRYING OF SECRETIONS, DRYNESS OF THE MUCUS MEMBRANES
 MYDRIASIS
 FLUSHING, TACHYCARDIA
Antidote for Lead poisoning. CALCIUM EDTA
Contraindicated to give activated charcoal
 ETHANOL POISONING
 HYDROCARBONS
 METALS
Dose of activated charcoal in children: 1G/KG PO
When do you administer Multiple-dose of activated charcoal?
 PHENOBARBITAL OVERDOSE
 SALICYLATES OVERDOSE, CARBAMAZEPINE

Bonus: Parameter measured to monitor Organophosphate poisoning

SERUM CHOLINESTERASE LEVEL

Match the poison and its presenting heart rate

 Iron
o Tachycardia
 Carbamates
o Tachycardia
 Baclofen
o Bradycardia
 Methylxanthines
o Bradycardia

Blindness is one of the pathognomonic manifestations of Methanol poisoning. What medical conditions
should be eliminated prior to considering this type of poisoning?
 All of the above
 Uremia
 Grand Mal Seizures
 Lactic acidosis

A 19 year old male indigenous artist from TAM AWAN VILLAGE in Baguio was brought to Baguio General
Hospital ER because of behavioural change described as “kakainin nya lahat ang utak niyo” after drinking
a decoction of a plant’s leaves. On PE vital signs revealed the following: BP= 130/90, Heart rate=
POISONING AND DRUG ABUSE 1330-1530 Wed

120bpm, Respiratory rate = 18 cpm, Temp= 37.6 oC Weight 60 kg. Remaining PE which the patient
presented with includes pupils 4-5 mmERTL, no murmurs with occasional wheezing. Mini mental status:
patient is uncooperative and combative. Which is TRUE of the above case?
 Effects include Hypertension, tachycardia and mydriasis
 Eliminated from the system via urinary alkalinization
 Poisoning is due to a sympathomimetic plant
 Origin is from Erythroxylon coca leaves

Which is the correct sequence of management and antidotal measure in this drug overdose? Consider
the steps enumerated below.
Administer the computed amount of N-acetylcysteine
Perform gastric lavage until the eluent becomes clear
Admit patient to a critical care unit for observation and continuity antidotal therapy
Administer 100 grams of charcoal slurry per orem
Give a cathartic to evacuate charcoal 
Initially stabilize patient upon arrival
 1, 2, 3, 4, 5
 6, 1, 2, 5, 3
 2, 6, 1, 5, 3
 6, 4, 5, 1, 3

A 45 year old female designer was brought to St Luke’s Medical Center due to intentional ingestion of a
car fire extinguisher after a fraternity initiation when the patient was brought to the ER because of
shortness of breath described as “gasping for breath” after. On PE vital signs revealed the following: BP=
140/90, Heart rate(HR)= 120bpm, Respiratory rate (RR)= 30 cpm, Temp= 37.6 oC Weight 75
kg. Remaining PE which the patient presented with includes burns over the throat with eschar
formation, no murmurs with occasional wheezing.. Which is TRUE in the management of the above
case?
 Administer an alkali for this acid
 Stabilize the airway and vital signs
 Sedate patient with Diazepam
 An NGT may be inserted readily

A 23 y/o BPO from a graveyard shift was brought to the ED-SLMCQc after drinking Empy Light  ~8 oz of
ethanol. His laboratory results include :Na-143 mmoL, K-5 mmoL, Cl-92mmoL, HCO3-15 meq, Glucose-
180, BUN-56, Crea-1.7, Osmolality-346. What is the osmolal gap of the patient above?
 346
 10
 30
 20

An Angkas driver was brought to the ED by police authorities when his vehicle collided with a Grab
motorcycle along T. Morato. The Angkas passenger hit his head with an intact helmet however
passenger did not survive. Alcohol level was requested by the police when he observed smell of chico
fruit from the driver. Estimate the amount of Ethanol in the blood by computing the biochemical tests
done on the driver. Consider the following labs. Na-130, K-3.5, Cl-107, pH= 7.35, pCO2= 36, pO2= 95,
HCO3-27, Glucose-90, BUN=20, Crea-1.7, Osmolarity-346
POISONING AND DRUG ABUSE 1330-1530 Wed

 280 mg/dL
 can not be computed
 12 mg/dL
 50 mg/dL

Which modality during decontamination may be performed after ingestion of Methamphetamine will
enhance its elimination?
 Activated charcoal lavage
 Urine acidification with ammonium chloride
 Urinary alkalinization with bicarbonate
 Emesis

Which is an advantage of a Ryle’s tube over an Ewald tube during gastric lavage?
 Used for most poisons
 All of the above
 Inserted orally when the patient is unconscious
 Large bore diameter

During gastric lavage which is the ideal position of a suspected poisoning patient?
 Semi-Fowler's position
 Trendelenberg position
 Prone position
 Left Lateral decubitus position

A 24 year old male action star was brought to St Luke’s Medical Center due to an overdose of this white
powdery substance which he shared with another movie star. This patient was brought to the ED due to
chestpain described as “may elepanteng nakadagan sa dibdib”. On PE vital signs revealed the following:
BP= 150/90, Heart rate(HR)= 135bpm, Respiratory rate (RR)= 20 cpm, Temp= 37.6 oC Weight 75
kg. Pertinent PE of this patient includes pupils dilated pupils at 4-5 mm, tachycardic no murmurs no
crackles. Which is TRUE of the above case after a clinical pharmacist was consulted?
 Give Naloxone 0.2mgIV every 2 minutes
 This white powdery substance methadone
 This white powdery substance injected was liquid ecstasy
 This white powdery substance cocaine

Which is the most significant clinical property of Activated Charcoal?

 According to first aid sources a burnt toast is an effective substitute as a home remedy
 Pediatric dose of 0.5-1g/kg
 Administered only through a tube
 Its surface area per gram of charcoal is effective in adsorbing most poisons

A 30 year old banana farmer was brought to the ED of Southern Philippines Medical Center (SPMC) in
Davao City due to restlessness after a workday of spraying an illegal pesticide. He was called in for
transfer to St. Lukes’s Medical Center QC Emergency Department by his employer. What is an expected
clinical presentation of this patient?
 Dryness of buccal mucosa due to dehydration
 Nicotinic effects
POISONING AND DRUG ABUSE 1330-1530 Wed

 Tachycardia due to patient’s anxiety of his condition

 Cholinergic effects due to inhibition of the enzyme acetylcholinesterase

In a buy-bust operation of the police a cohort of medical students was caught due to possession of a
sympathomimetic white powder . Which is TRUE about this white powder?
 Expected effects among those caught in the “Tokhang” include Hypertension, tachycardia and
mydriasis
 Eliminated from the system via urinary alkalinization
 Origin is from the dried white flowers of Datura metel (Talumpunay)  leaves
 This is a weak acid

Laboratory tests in poisoning are used as an action level and therapeutic guidance during management
of toxicity in the ED. Which poison can be determined using laboratory techniques?
 Isoniazid
 Roofies
 Tricyclic antidepressants
 Digoxin

Which is the most biased informant in performing a clinical history of a poisoned patient?
 Pharmacist
 Patient
 Housemate
 Emergency Medical Technician

A 23 y/o BPO from a graveyard shift was brought to the ED-SLMCQc after drinking Empy Light  ~8 oz of
ethanol. His laboratory results include :Na-143 mmoL, K-5 mmoL, Cl-92mmoL, HCO3-15 meq, Glucose-
180, BUN-56, Crea-1.7, Osmolality-346. 
What is the patient’s Anion Gap?
 Decreased
 Undertermined
 Elevated
 Normal

Which is a FALSE statement about toxidromes?

 Described by a combination of the vital signs and clinically apparent end-organ manifestations.
 Cholinergic toxidrome presents with fasciculation
 Describe the groups of signs and symptoms that consistently result from particular toxins.
 Opiods presents with hyperreflexia

Which is the LEAST to be considered in the initial management of poisoning in the emergency
department?
 Clinical Evaluation
 Prevention of further toxin absorption
 Enhancement of toxin elimination
 Identification of the offending poison
POISONING AND DRUG ABUSE 1330-1530 Wed

Xray of the abdomen is a useful tool to determine location of a toxicant. Which poisoning will this tool
be of use to determine location or possible ingestion?
 Paperclips
 Toluene
 Pesticide
 Chloral hydrate

In an unconscious patient with cancer who had an overdose of Fentanyl citrate dermal patch. What is
the antidote?
 Ascorbic acid
 Flumazenil
 Sodium Thiosulfate
 Naloxone

Multiple dose activated charcoal is considered LEAST to which of the following?

 Ethanol intoxication
 Paracetamol poisoning
 Drugs undergoing glucuronidation metabolism in the liver
 Poisons undergoing enterohepatic recirculation

A mother brought her 3 year old son when the child accidentally drank the jewelry cleaner of his yaya. It
is known to be cyanide containing. The child weighs 25 kg. Compute for the dose of Activated Charcoal
to be administered in a 25 kg child.
 1OOO mg
 no need to compute
 25,000 mg
 1 g/kg

A 45 year old female with recurrent suspected poisoning patient was unconscious GCS=3 eye opening=1
verbal output= 1, motors=1to the emergency department. In this unknown ingestion of a poison due to
a suspected pharmaceutical causing coma in which possible time of ingestion is approximately 2 hours
activated charcoal was considered to be administered. Which should be done to decontaminate this
patient?
 Administer an antidote like Naloxone and Flumazenil
 Perform gastric lavage until the eluent is clear using a Ryle’s tube
 Check capillary blood sugar upon arrival
 Since it is still early post ingestion administer syrup of ipecac

Many xenobiotics affect the autonomic nervous system, which in turn affects the vital signs via the
sympathetic pathway, the parasympathetic pathway, or both
 True
 False

Which is TRUE of Gastric Lavage performed in the Emergency Department (ED)?

 For almost all types of ingested poisons a Ryle’s tube is preferably used
 Prevention of aspiration of gastric contents when the patient is in the Fowler’s position
 Performed when the involved poison is a corrosive type of substance
POISONING AND DRUG ABUSE 1330-1530 Wed

 Best done when the patient is brought to the ED 4 hours after ingestion of a poison

A 17 year old male indigenous person from Mountain Province was brought to Baguio General Hospital
after a fraternity initiation when the patient was brought to the ER because of behavioural change
described as “gustong kumain ng tao” after drinking a decoction of a plant’s leaves. On PE vital signs
revealed the following: BP= 130/90, Heart rate(HR)= 120bpm, Respiratory rate (RR)= 18 cpm, Temp=
37.6oC Weight 60 kg. Remaining PE which the patient presented with includes pupils 4-5 mmERTL, no
murmurs with occasional wheezing. Mini mental status: patient is uncooperative and combative. Which
is TRUE of the above case?
 Activated Charcoal may be effective
 The plant has sympathomimetic effects
 Antidote for this patient’s poisoning is Physostigmine (Antelerium)
 Admit patient for observation and hydration with referral to psychiatry

57/70
Which is TRUE of Gastric Lavage performed in the Emergency Department (ED)?
 For almost all types of ingested poisons a Ryle’s tube is preferably used
 Performed when the involved poison is a corrosive type of substance
 Prevention of aspiration of gastric contents when the patient is in the Fowler’s position
 Best done when the patient is brought to the ED 4 hours after ingestion of a poison

A 45 year old female with recurrent suspected poisoning patient was unconscious GCS=3 eye opening=1
verbal output= 1, motors=1to the emergency department. In this unknown ingestion of a poison due to
a suspected pharmaceutical causing coma in which possible time of ingestion is approximately 2 hours
activated charcoal was considered to be administered. Which should be done to decontaminate this
patient?
 Since it is still early post ingestion administer syrup of ipecac
 Perform gastric lavage until the eluent is clear using a Ryle’s tube
 Check capillary blood sugar upon arrival
 Administer an antidote like Naloxone and Flumazenil

A 24 year old male action star was brought to St Luke’s Medical Center due to an overdose of this
colored tablet with a SMILEY which was shared to him by an actor colleague. This patient was brought to
the ED due to chestpain described as “may elepanteng nakadagan sa dibdib”. On PE vital signs revealed
the following: BP= 150/90, Heart rate(HR)= 135bpm, Respiratory rate (RR)= 20 cpm, Temp= 37.6oC
Weight 75 kg. Pertinent PE of this patient includes pupils dilated pupils at 4-5 mm, tachycardic no
murmurs no crackles. Which is TRUE of the above case after a clinical pharmacist was consulted?
 It has sympathetic effects
 It is also called Molly
 contains Ecstasy
 All of the above

An Joy Ride driver was brought to the ED by police authorities when his vehicle collided with a Grab
motorcycle along T. Morato. The Angkas passenger hit his head with an intact helmet however
passenger did not survive. Alcohol level was requested by the police when he observed smell of chico
POISONING AND DRUG ABUSE 1330-1530 Wed

fruit from the driver. Estimate the amount of Ethanol in the blood by computing the biochemical tests
done on the driver. Consider the following labs. Na-130, K-3.5, Cl-107, pH= 7.35, pCO2= 36, pO2= 95,
HCO3-27, Glucose-90, BUN=20, Crea-1.7, Osmolarity-346
 280 mg/dL
 12 mg/dL
 50 mg/dL
 can not be computed

Which is a TRUE statement on activated charcoal in pediatrics?

 all of the above
 Cathartics should be given after every dose
 initial dose is 250mg per kg
 Add soda to make it more palatable for children

Which is an advantage of a Ryle’s tube over an Ewald tube during gastric lavage?
 Inserted orally when the patient is unconscious
 Used for most poisons
 Large bore diameter
 All of the above

Determine appropriateness to administer Activated Charcoal in a specific poisoning.

Prompts Submitted Answers
 Arsenic Do not give Activated Charcoal
 Carbamates Do not give Activated Charcoal
 Cyanide Give Activated Charcoal
 Kerosene Do not give Activated Charcoal
 Methanol Do not give Activated Charcoal

A 30 year old banana farmer was brought to the ED of Southern Philippines Medical Center (SPMC) in
Davao City due to restlessness after a workday of spraying an illegal pesticide. He was called in for
transfer to St. Lukes’s Medical Center QC Emergency Department by his employer. What is an expected
clinical presentation of this patient?
 Dryness of buccal mucosa due to dehydration
 Cholinergic effects due to inhibition of the enzyme acetylcholinesterase
 Nicotinic effects
 Tachycardia due to patient’s anxiety of his condition

Which is a TRUE statement on the antidote N-acetylcysteine?

 Watch out for rashes when given PO
 IV loading dose is 150mg/kg
 oral loading dose is 140mg/kg
 Maintenance dose is half the initial dose 75mg/kg

A 23 y/o BPO from a graveyard shift was brought to the ED-SLMCQc after drinking Empy Light ~8 oz of
ethanol. His laboratory results include :Na-143 mmoL, K-5 mmoL, Cl-92mmoL, HCO3-15 meq, Glucose-
180, BUN-56, Crea-1.7, Osmolality-346.
 What is the patient’s Anion Gap?
POISONING AND DRUG ABUSE 1330-1530 Wed

 Undertermined
 Normal
 Decreased
 Elevated

EB,a 26 year old male musician who arrived at the ER because of chest pain. He apparently wasn’t able
to sleep for several nights and described an experience of hearing voices from heaven. His BP was
180/90, tachycardic at 120 bpm with dilated pupils. He revealed that he snorted a corn-size amount of S
about 6 hours before consultation. Impression on admission was Acute Myocardial Infarction secondary
to Unknown Substance Ingestion.
 First intervention of the toxicologist wound be?
 Refer to Psychiatry because he is hearing singing voices
 Do an ECG to document tachycardia
 Give an antidote
 Stabilize the patient

Multiple dose activated charcoal is considered LEAST to which of the following?

 Paracetamol poisoning
 Drugs undergoing glucuronidation metabolism in the liver
 Ethanol intoxication
 Poisons undergoing enterohepatic recirculation

Xray of the abdomen is a useful tool to determine location of a toxicant. Which poisoning will this tool
be of use to determine location or possible ingestion?
 Chloral hydrate
 Pesticide
 Toluene
 Paperclips

During gastric lavage which is the ideal position of a suspected poisoning patient?
 Prone position
 Left Lateral decubitus position
 Semi-Fowler's position
 Trendelenberg position

Eyes signs are helpful cues to determine a toxidrome. Match the eye signs with the class of poisons.
Prompts Submitted Answers
 Anticholinergics Mydriasis
 Sympathomimetics Mydriasis
 Cholinergics Mydriasis
 Antidepressants Mydriasis
 Organophosphates Mydriasis

Which is the LEAST to be considered in the initial management of poisoning in the emergency
department?
 Enhancement of toxin elimination
 Clinical Evaluation
POISONING AND DRUG ABUSE 1330-1530 Wed

 Identification of the offending poison

 Prevention of further toxin absorption

In a buy-bust operation of the police a cohort of medical students was caught due to possession of a
sympathomimetic white powder . Which is TRUE about this white powder?
 This is a weak acid
 Expected effects among those caught in the “Tokhang” include Hypertension, tachycardia and
mydriasis
 Eliminated from the system via urinary alkalinization
 Origin is from the dried white flowers of Datura metel (Talumpunay) leaves

EB,a 26 year old male musician who arrived at the ER because of chest pain. He apparently wasn’t able
to sleep for several nights and described an experience of hearing voices from heaven. His BP was
180/90, tachycardic at 120 bpm with dilated pupils. He revealed that he snorted a corn-size amount of S
about 6 hours before consultation. Impression on admission was Acute Myocardial Infarction secondary
to Unknown Substance Ingestion. Since the patient is awake, what is the primary intervention of the
toxicologist?
 Hemodialysis
 Give 1g/kg activated charcoal
 Administer oral NaHCO3 enhance renal excretion
 Saline cathartic

A 19 year old male indigenous artist from TAM AWAN VILLAGE in Baguio was brought to Baguio General
Hospital ER because of behavioural change described as “kakainin nya lahat ang utak niyo” after drinking
a decoction of a plant’s leaves. On PE vital signs revealed the following: BP= 130/90, Heart rate=
120bpm, Respiratory rate = 18 cpm, Temp= 37.6oC Weight 60 kg. Remaining PE which the patient
presented with includes pupils 4-5 mmERTL, no murmurs with occasional wheezing. Mini mental status:
patient is uncooperative and combative. Which is TRUE of the above case?
 Eliminated from the system via urinary alkalinization
 Effects include Hypertension, tachycardia and mydriasis
 Poisoning is due to a sympathomimetic plant
 Origin is from Erythroxylon coca leaves

Match the specific symptom/sign for that poison.

Prompts Submitted Answers
 Ethanol Tachycardia
 Propranolol Bradycardia
 Angel's Trumpet Tachycardia
 Digitalis Bradycardia
 Amphetamines Tachycardia

A 23 y/o BPO from a graveyard shift was brought to the ED-SLMCQc after drinking Empy Light ~8 oz of
ethanol. His laboratory results include :Na-143 mmoL, K-5 mmoL, Cl-92mmoL, HCO3-15 meq, Glucose-
180, BUN-56, Crea-1.7, Osmolality-346. What is the osmolal gap of the patient above?
 346
 10
 30
POISONING AND DRUG ABUSE 1330-1530 Wed

 20

In an unconscious patient with cancer who had an overdose of Fentanyl citrate dermal patch. What is
the antidote?
 Sodium Thiosulfate
 Flumazenil
 Naloxone
 Ascorbic acid

Test your Mnemonics

Prompts Submitted Answers
 Hyperventilation No Match
 Hypertension AT MUDPILES
 Radio-opaque poisons CT SCAN
 Cholinergic poisons DUMBBELS
 Elevated Anion Gap with Acidosis CHIPE

Which is the correct sequence of management and antidotal measure in this drug overdose? Consider
the steps enumerated below.
Administer the computed amount of N-acetylcysteine
Perform gastric lavage until the eluent becomes clear
Admit patient to a critical care unit for observation and continuity antidotal therapy
Initially stabilize patient upon arrival
Administer 100 grams of charcoal slurry per orem
Give a cathartic to evacuate charcoal
 4, 6, 1, 2, 5, 3
 2, 6, 1, 5, 3, 4
 1, 2, 3, 4, 5, 6
 4, 2, 5, 6, 1, 3

Match the poison and its presenting rate of respiration

Prompts Submitted Answers
 Salicylates Tachypnea
 Ethanol Tachypnea
 Magnesium sulfate Tachypnea
 Cyanide Tachypnea

Which modality during decontamination may be performed after ingestion of Methamphetamine will
enhance its elimination?
 Urine acidification with ammonium chloride
 Activated charcoal lavage
 Urinary alkalinization with bicarbonate
 Emesis

Which is a FALSE statement about toxidromes?

 Describe the groups of signs and symptoms that consistently result from particular toxins.
 Cholinergic toxidrome presents with fasciculation
POISONING AND DRUG ABUSE 1330-1530 Wed

 Opiods presents with hyperreflexia

 Described by a combination of the vital signs and clinically apparent end-organ manifestations.

Laboratory tests in poisoning are used as an action level and therapeutic guidance during management
of toxicity in the ED. Which poison can be determined using laboratory techniques?
 Digoxin
 Tricyclic antidepressants
 Roofies
 Isoniazid

A mother brought her 3 year old son when the child accidentally drank the jewelry cleaner of his yaya. It
is known to be cyanide containing. The child weighs 25 kg. Compute for the dose of Activated Charcoal
to be administered in a 25 kg child.
 1 g/kg
 no need to compute
 25,000 mg
 1OOO mg

A 17 year old male indigenous person from Mountain Province was brought to Baguio General Hospital
after a fraternity initiation when the patient was brought to the ER because of behavioural change
described as “gustong kumain ng tao” after drinking a decoction of a plant’s leaves. On PE vital signs
revealed the following: BP= 130/90, Heart rate(HR)= 120bpm, Respiratory rate (RR)= 18 cpm, Temp=
37.6oC Weight 60 kg. Remaining PE which the patient presented with includes pupils 4-5 mmERTL, no
murmurs with occasional wheezing. Mini mental status: patient is uncooperative and combative. Which
is TRUE of the above case?
 The plant has sympathomimetic effects
 Admit patient for observation and hydration with referral to psychiatry
 Antidote for this patient’s poisoning is Physostigmine (Antelerium)
 Activated Charcoal may be effective

Which is the most significant clinical property of Activated Charcoal?

 According to first aid sources a burnt toast is an effective substitute as a home remedy
 Administered only through a tube
 Its surface area per gram of charcoal is effective in adsorbing most poisons
 Pediatric dose of 0.5-1g/kg

Many xenobiotics affect the autonomic nervous system, which in turn affects the vital signs via the
sympathetic pathway, the parasympathetic pathway, or both
 True
 False

Which is the most biased informant in performing a clinical history of a poisoned patient?
 Pharmacist
 Housemate
 Emergency Medical Technician
 Patient
POISONING AND DRUG ABUSE 1330-1530 Wed

Which is NOT an indication for Atropine as an antidote?

 Propoxur
 Bradycardia
 Donepezil
 Malathion

A 45 year old female designer was brought to St Luke’s Medical Center due to smoke inhalation after a
fraternity initiation when the patient was brought to the ER because of shortness of breath described as
“gasping for breath” after. On PE vital signs revealed the following: BP= 140/90, Heart rate(HR)=
120bpm, Respiratory rate (RR)= 30 cpm, Temp= 37.6oC Weight 75 kg. Remaining PE which the patient
presented with includes burns over the throat with eschar formation, no murmurs with occasional
wheezing.. Which is TRUE in this case?
 This is carbon monoxide poisoning
 Administer high oxygen
 Administer an alkali for this acid
 Sedate patient with Diazepam

Blindness is one of the pathognomonic manifestations of Methanol poisoning. What medical conditions
should be eliminated prior to considering this type of poisoning?
 All of the above
 Lactic acidosis
 Grand Mal Seizures
 Uremia

The following drugs undergo enterohepatic recirculation EXCEPT.

 Malathion
 Ethanol
 TCAD
 INH

LEGEND: INCORRECT
CORRECT
NOT SURE

0/1 Which is a TRUE statement about the antidote Deferoxamine?

 For chronic overdoses of iron
 The urine is discolored to red to pink -orange in color
 Endpoint of treatment is when serum iron is less than 150 mg/dL
 All of the above

4/5 Match the antidote to the poisoning

Prompts Submitted Answers
 Deferoxamine Ferrous salts
 Glucagon Nicardipine
 BAL in oil Dimethyl mercury
 Flumazenil Flunitrazepam
POISONING AND DRUG ABUSE 1330-1530 Wed

 Fomepizole Ethanol

1/1 Which is a TRUE statement on the antidote Flumazenil?

 It may be given initially at 2 mg
 Maximum dose is 30 mg
 Antidote may cause withdrawal symptoms on chronic use of BZD
 It reverses the effect of tricyclic antidepressants

0/1 What is the antidote used in Methanol poisoning

 Disulfiram
 Ethylene glycol
 Ethanol
 Lambanog

2/2 A chocolate colored blood due to sodium nitrate is an endpoint to which antidote used for cyanide
poising

1/1 Which is used for Beta blocker overdose?

 Beta agonists
 Glucagon
 Digoxin
 Insulin

0/1 In cyanide poisoning sodium thiosulfate is administered to convert hemoglobin to methemoglobin

 True
 False

1/1 What is the Philippine Brand name of Flumazenil?

 Algesia
 Alvedon
 Anexate
 Anectine

0/1 Which is NOT an adverse drug reaction to ethanol

 CNS depression
 Dizziness
 Inebriation
 Hypoglycemia

Match the dose of Dimercaprol to the specific poisoning.

Prompts Submitted Answers
 Lead encephalopathy 4mg/kg alone in the first dose
 Chronic mercury poisoning no match
 Severe Arsenic poisoning 3 mg/kg every 4 hours for 2 days
 Less severe lead poisoning 3 mg/kg after the initial dose

0/1 Which is a TRUE statement about Syrup of Ipecac?

POISONING AND DRUG ABUSE 1330-1530 Wed

 Adverse reaction is vomiting

 All are true statements
 May be safely given in any patient with overdose
 Used for GI decontamination

1/1 First line antidote for lead poisoning is EDTA.

 True
 False

1/1 Which antidote for cyanide poisoning causes headache, hypotension?

 Sodium thiosulfate
 Amyl nitrate
 both A and B
 Sodium nitrate

PARACETAMOL
?

BENZODIAZEPINE

1. Which of the following is the antidote for the toxin of Benzodiazepines?

a. Flumazenil
b. Methylene blue
c. Deferoxamine
d. Alkaline urine

2. In this case, what is the drug that was ingested by the patient that caused her to be
brought in the emergency department?
a. Diazepam
b. Lorazepam
c. Alprazolam
d. Xanax
e. C and D only
f. A and B only

3. Select the uses of Alprazolam

a. Seizures
b. Anxiety
c. Panic disorders
d. Depression

4. True or False: Based on the given case, the patient obtained the medication in the United
States. False

5. True or False: Benzodiazepines are prescription medications. True

POISONING AND DRUG ABUSE 1330-1530 Wed

6-10. Match the following benzodiazepine to its trade name

alprazolam Doral
diazepam Ativan
lorazepam Xanax
chlordiazepoxide Valium
quazepam Librium
Answer: alprazolam (Xanax®), chlordiazepoxide (Librium®), diazepam (Valium®), lorazepam
(Ativan®), quazepam (Doral®)

ORGANOPHOSPHATE

1. Which of the following drugs should be avoided in treating infections with patients under
organophosphate poisoning?
a. Chloramphenicol
b. Gentamicin
c. Amikacin
d. Tobramycin
e. All of the above

2. What medication can be used as an antidote in the case of organic poisoning that occurs within 36
hours after exposure? Pralidoxime

3. What medicine can be used to treat pulmonary congestion in people who have been exposed to
organophosphates?
a. Spironolactone
b. Furosemide
c. Hydrochlorothiazide
d. Acetazolamide

4. What medications can be used to treat seizures in organophosphate-exposed patients?

a. Diazepam
b. Lorazepam
c. Phenytoin
d. All of the above

5. What drug should be given every 10-15 minutes to people suffering from organic phosphate
poisoning until the pre-symptom parameters are met?
a. Pralidoxime
b. Paracetamol
c. Atropine
d. Furosemide

6. Which is not used as an antidote for organophosphate poisoning?

a. Atropine
b. Pralidoxime
c. Diazepam
d. N-acetylcysteine
POISONING AND DRUG ABUSE 1330-1530 Wed

7. The following are side effects of organophosphate poisoning except:

a. Mydriasis
b. Constipation
c. Vomiting
d. A & B
e. B & C

8. In individuals who have been poisoned by organophosphates, what laboratory tests should be
monitored? plasma cholinesterase

9. What is the polarity of organophosphate?

a. Lipophilic
b. Hydrophilic
c. Hydrophobic
d. A & C

10. During organophosphate poisoning, which enzyme is inhibited? Acetylcholinesterase

11. What are the products of the degradation of acetylcholine? Acetate and Choline

12. What type of neurotransmitter is Acetylcholine (ACh)?

a. Excitatory
b. Inhibitory

13. Acetylcholine is the primary neurotransmitter in which branch of the autonomic nervous system?
Parasympathetic Nervous System

14. In the lowest doses used to treat organophosphate poisoning patients, what medicines have
significant potentiated synergism? Atropine and cimetidine

15. Organophosphate poisoning is absorbed through

a. Ingestion
b. Inhalation
c. Dermal contact
d. All of the above

16. Diagnostic tool in organophosphorus pesticide poisoning, but may not help in managing the illness.
Cholinesterase Levels

17. Signs and Symptoms of Acute OP poisoning can be seen on

a. muscarinic receptor
b. nicotinic receptor
c. CNS
d. All of the above

18. Clinical effects of OP Pesticide Poisoning in the CNS would include: (Select all that apply)
a. metal confusion
b. fasciculation of muscles
POISONING AND DRUG ABUSE 1330-1530 Wed

c. restlessness
d. bronchoconstriction

19. Mild poisoning symptom of Organophosphates would include

a. muscarinic
b. nicotinic
c. A & B
d. none of the above

20. Effect of Acute OP poisoning through inhalation would include:

a. bronchoconstriction
b. increased activity of the secretory glands
c. pulmonary edema
d. all of the above
POISONING AND DRUG ABUSE 1330-1530 Wed

TCA (Amitriptyline)
POISONING AND DRUG ABUSE 1330-1530 Wed

METHAMPHETAMINE
POISONING AND DRUG ABUSE 1330-1530 Wed

MIDTERMS
51.5/73

Question 1
Which is used for Beta blocker overdose?
 Beta agonists
 Insulin
 Glucagon
 Digoxin

Question 2
What is the antidote used in Methanol poisoning
 Lambanog
 Ethylene glycol
 Ethanol
 Disulfiram

Question 3
Which is NOT an adverse drug reaction to ethanol
 Dizziness
 CNS depression
 Hypoglycemia
 Inebriation

Question 4
What is the Philippine Brand name of Flumazenil?
 Anectine
 Anexate
 Algesia
 Alvedon

Question 5
Which is a TRUE statement on the antidote Flumazenil?
 Maximum dose is 30 mg
 It may be given initially at 2 mg
 Antidote may cause withdrawal symptoms on chronic use of BZD
 It reverses the effect of tricyclic antidepressants

Question 6
Which is a TRUE statement about Syrup of Ipecac?
 Adverse reaction is vomiting
 May be safely given in any patient with overdose
 Used for GI decontamination
 All are true statements

Question 7
In cyanide poisoning sodium thiosulfate is administered to convert hemoglobin to methemoglobin
POISONING AND DRUG ABUSE 1330-1530 Wed

 True
 False

Question 8
Which antidote for cyanide poisoning causes headache, hypotension?
 Sodium nitrate
 Amyl nitrate
 Sodium thiosulfate
 both A and B

Question 9
Which is a TRUE statement about the antidote Deferoxamine?
 For chronic overdoses of iron
 Endpoint of treatment is when serum iron is less than 150 mg/dL
 The urine is discolored to red to pink -orange in color
 All of the above

Question 10
Match the dose of Dimercaprol to the specific poisoning.
Prompts Submitted Answers
Lead encephalopathy 4mg/kg alone in the first dose
Chronic mercury poisoning No match
Severe Arsenic poisoning 3 mg/kg every 4 hours for 2 days
Less severe lead poisoning 3 mg/kg after the initial dose

Question 11
First line antidote for lead poisoning is EDTA.
 True
 False

Question 12
Match the antidote to the poisoning
Prompts Submitted Answers
Deferoxamin Ferrous salts
Glucagon Nicardipine
BAL in oil Dimethyl mercury
Flumazenil Flunitrazepam
Fomepizole Ethanol

Question 13
A chocolate colored blood due to sodium nitrate is an endpoint to which antidote used for cyanide
poising

Question 14
APAP: The Rumack-Matthew nomogram may be used until 4-48 hours after ingestion.
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 15
APAP: Peak plasma concentration of APAP is approximately at 6 hours
 True
 False

Question 16
APAP: Conversion of APAP to NAPQi utilizes which isozyme of CYP 450?
 CYP2E1
 CYP1A2
 CYP2A6
 CYP3A4

Question 17
APAP: Which area in the liver will NAPQi cause more toxicity?
 Zone I
 Zone II
 Zone III
 Porta hepatis

Question 18
APAP: Which amino acid is NOT a component of glutathione?
 Glycine
 Glutamate
 Thionine
 Cysteine

Question 19
APAP: Match the stage of APAP toxicity and the clinical manifestations.
Prompts Submitted Answers
Pallor Stage 1
Prolonged PT Stage 2
Encephalopathy Stage 3 Stage 2
Coma Stage 4 Stage 3
Elevated creatinine Stage 2 Stage 3

Question 20
MET: All amphetamines are drugs of abuse
 True
 False

Question 21
MET:Chronic CNS toxicity of amphetamines may deplete dopamine and serotonin in the synapse.
 True
 False

Question 22
POISONING AND DRUG ABUSE 1330-1530 Wed

MET: Match the effect of the amphetamines as either acute or chronic

Prompts Submitted Answers
Tolerance Chronic
Anxiety Acute
Bruxism Chronic
Schizophrenia Acute Chronic
Hypertension Chronic Acute

Question 23
MET: External cooling is an effective way of managing hyperthermia of amphetamine toxicity
 True
 False

Question 24
MET: Match the therapy with the symptoms of amphetamine toxicity
Prompts Submitted Answers
Acute ingestion Activated Charcoal
Hypertension Nicardipine
Delirium agitation Propofol Benzodiazepines
Sezure Benzodiazepines
Status epilepticus Benzodiazepines Propofol

Question 25
TCAD: Amitryptylline is a tertiary amine metabolized into a secondary amine desipramine
 True
 False

Question 26
TCAD: All of the CAs are competitive antagonists of the muscarinic acetylcholinereceptors,
 True
 False

Question 27
TCAD: The CAs also antagonize peripheral α1-adrenergic receptors.
 True
 False

Question 28
TCAD: The TCAs are potent inhibitors of both peripheral and central postsynaptic histamine receptors
 True
 False

Question 29
TCAD: TCADs blocks and depolarizes sodium channels
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 30
TCAD: Cardiovascular toxicity is primarily responsible for the morbidity and mortality attributed to CAs.
 True
 False

Question 31
TCAD: Match the clinical manifestation of acute toxicity and its therapy (No repetition)
Prompts Submitted Answers
Torsade de Point Magnesium sulfate
Hypotension Noreepinephrine
Seizure Benzodiazepines
Ventricular tachycardia Lidocaine
Refractory poisoning Dialysis

Question 32
TCAD: All TCADs are weakly basic
 True
 False

Question 33
TCAD: Sodium bicarbonate may be administered in TCAD toxicity both orally and intravenously
 True
 False

Question 34
OP: Choose the manifestation of ATROPINIZATION in Organophosphate poisoning therapy
 Decrease bowel sounds
 Miosis
 Tachycardia
 Copious secretions
 Bronchospasm

Question 35
OP: Atropine is a pharmacologic antidote during OP poisoning
 True
 False

Question 36
OP: Pralidoxime is always administered before atropine
 True
 False

Question 37
Atropine does not reverse nicotinic effects.
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 38
OP: Activated charcoal cannot be given in unresponsive patients
 True
 False

Question 39
BZD: Flumazenil is effective for non-benzodiazepine overdoses like Zolpidem
 True
 False

Question 40
BZD: Maximal improvement after flumazenillasts approximately 1 to 2 hours and gradually dissipates
within 6 hours.
 True
 False

Question 41
Match the structure with the agent

Prompts Submitted Answers

Very potent antagonist
Amphetamines functions like this

Alprazolam
It is reversed by Sodium bicarbonate

Amphetamines functions like this

Use the nomogram
POISONING AND DRUG ABUSE 1330-1530 Wed

It is reversed by Sodium bicarbonate

Very potent antagonist

Alprazolam

POST MIDTERM QUIZ – 3.18.22

Question 1
In amphetamine toxicity give antipyretics for fever
 True
 False

Question 2
A 54 y/o male Chinese patient was diagnosed with far-advanced pulmonary tuberculosis extending to
the Liver and kidneys. Patient appears cachectic with a weight of 45kg. Arterial blood gas revealed the
following pH=6.9, PaCO2-32, HCO3-5, O2Sat 96%. CBC: Hgb=7, Hct-34, WBC-12000, Seg: 75 Lymphos: 18
Platelet 175000. BUN 25, Creatinine=5. The ABG is interpreted as Metabolic alkalosis Metabolic
Acidosis

Question 3
Pure vitamin B6 may be administered in INH toxicity.
 True
 False

Question 4
MET: All amphetamines are drugs of abuse
 True
POISONING AND DRUG ABUSE 1330-1530 Wed

 False

Question 5
OP: Choose the manifestation of ATROPINIZATION in Organophosphate poisoning therapy
 Decrease bowel sounds
 Bronchospasm
 Copious secretions
 Miosis
 Tachycardia

Question 6
Which of the following condition would increase the blood levels of TCAD?
 Elevated pH
 Acidosis
 both A & B
 Elevated Albumin
 both C & D
 Low albumin

Question 7
Forrest reagent using the patient's plasma results to a yellow green discoloration
 True
 False

Question 8
Physostigmine is the mainstay antidote for TCAD toxicity which counteracts its cholinergic
manifestations.
 True
 False

Question 9
Match the structure with the agent
Prompts Submitted Answers
Sympathomimetic
POISONING AND DRUG ABUSE 1330-1530 Wed

Anticholinergic

Administered for Zolpidem overdose

Depletes GSH

Xanor
Administered for Zolpidem overdose

Depletes GSH
Xanor

Question 10
Atropine does not reverse nicotinic effects.
 True
 False

Question 11
Diazepam increases blood levels and enhances the toxicity of TCAD.
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 12
Diazepam administered in excess of 20 mg should be intubated
 True
 False

Question 13
OP: Activated charcoal cannot be given in unresponsive patients
 True
 False

Question 14
In bedside toxicologic test for presence of INH, a red discoloration of the urine is a positive test
 True
 False

Question 15
Sodium bicarbonate when administered prevents an increase in the free form of TCAD
 True
 False

Question 16
Which is the definitive management of seizures in INH toxicity?
 Diazepam
 Lorazepam
 Pyridoxine
 Phenytoin

Question 17
OP: Pralidoxime is always administered before atropine
 True
 False

Question 18
OP: Atropine is a pharmacologic antidote during OP poisoning
 True
 False

Question 19
Management of Benzodiazepine toxicity depends on the level of benzodiazepine detected in the urine
or blood.
 True
 False

Question 20
TCAD: Cardiovascular toxicity is primarily responsible for the morbidity and mortality attributed to CAs.
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 21
Alprazolam has a longer half life than lorazepam.
 True
 False

Question 22
What is the lethal dose of crystal meth among adults ?
 25 mg per kg
 50 mg per kg
 5 mg per kg
 1-2 grams per kg

Question 23
Flumazenil has no role in unknown overdose who present with coma
 True
 False

Question 24
A 54 y/o male Chinese patient was diagnosed with far-advanced pulmonary tuberculosis extending to
the Liver and kidneys. Patient appears cachectic with a weight of 45kg. Arterial blood gas revealed the
following pH=6.9, PaCO2-32, HCO3-5, O2Sat 96%. CBC: Hgb=7, Hct-34, WBC-12000, Seg: 75 Lymphos: 18
Platelet 175000. BUN 25, Creatinine=5. At half correction Sodium Bicarbonate vials will be administered
as IV push ? 3

Question 25
Which is a FALSE statement in the toxicity of amphetamines?
 Ascorbic acid may be given in all patients with amphetamine toxicity
 ALL are false statements
 Urinary acidification to pH less than 5.5 may cause renal tubular acidosis
 Amphetamines may cause a prolonged gastric emptying time

Question 26
Atropine does not reverse nicotinic effects.
 True
 False

Question 27
Flumazenil may be administered as IV infusion like overdose to Flurazepam
 True
 False

Question 28
Single dose activated charcoal is beneficial for TCAD
 True
 False
POISONING AND DRUG ABUSE 1330-1530 Wed

Question 29
Which is a TRUE statement in the decontamination of amphetamine overdose?
 All are TRUE statements
 Give Sodium sulfate 15 grams in 100mL water after activated charcoal
 Perform emesis during overdose
 Activated charcoal 100grams in 200mL water single dose