PHARMACOLOGY

TOXICOLOGY SHIFT 4
REVIEWER 4
REVIEWER | MAY 2020

OUTLINE • Endotracheal intubation

I. Definition of terms → In cases of respiratory insufficiency (loss of consciousness,
II. General approach to the poisoned patient impaired gag reflex, status epilepticus)
III. Emergency stabilization → Administer humidified air to prevent drying, crusting or
IV. Clinical evaluation sloughing of tracheal mucosa
V. Elimination of poison → Rule out cervical fracture first before intubating
VI. Excretion of absorbed substance • Mobilization of secretions
VII. Antidotes → Remove foreign bodies (dentures, secretions)
VIII. Supportive therapy
LEGEND (2) ADEQUATE OXYGENATION/VENTILATION
MUST KNOW SAMPLEX • Identify causes of hypoxia
  → e.g. cyanide, organophosphate, opioid ingestion
• Mode of oxygen delivery
I. DEFINITION OF TERMS → e.g. nasal canula, breathing mask, invasive ventilation
• Poisoning: overdose of drugs, medicaments, chemicals, and → ABG: accurate assessment of ventilation
biological substances
• Self-poisoning and parasuicide: deliberate ingestion of more (3) MAINTAIN ADEQUATE CIRCULATION
than the therapeutic dose of a drug or substance not intended for • Secure venous access
consumption by an adult in a moment of distress • Leg elevation (15 cm) to increase venous return to heart
→ Death classed as suicides (not parasuicides), regardless of • IVF
whether or not this was the intended outcome • Fluid challenge
• Accidental poisoning: non-intentional ingestion, overdose or → Adult: 200 ml saline
exposure to drugs, medicaments or poisonous substance → Children: 10 ml/kg D5 0.3 NaCl
• Toxicokinetics: study of absorption, distribution, metabolism, • Vasopressors
and excretion of drugs and toxins • In severe hypotension
→ Maintenance drip and fluid challenge ineffective
EXPOSURE
→ Central venous line inserted, hydration status monitored and
• Acute: dose delivered as single event; e.g. accidental exposure plasma expanders infused to augment intravascular volume
• Chronic: small quantities of a substance administered or subject → If still unsuccessful: Dopamine 1-2.5 μg/kg/min to increase
is exposed to it over a long period of time; e.g. heavy metals renal blood flow
Table 1. Duration of Exposure → With adequate urine output, high doses of dopamine given to
EXPOSURE DURATION maintain good BP
Acute <24 hours, usually 1 exposure
Subacute 1 month, repeated doses (4) TREAT COMA
Subchronic 1-3 months, repeated doses • Naloxone for opioid intoxication
Chronic >3 months, repeated doses → 2 mg/IV, repeated for 3-5 mins if necessary
→ If no response after a total dose of 10 mg, causes of coma
• Sources of poisoning other than opioid overdose is considered
→ Active ingredient → Children: 10μg/IV initially followed by 100 μg/kg
→ Solvent • Thiamine for alcohol intoxication
→ Carrier → 100 mg/IV followed by 50-100 ml D50-50
→ Residues
→ Batch impurities (5) TREAT CONVULSIONS
• Causes of convulsions
II. GENERAL APPROACH TO THE POISONED PATIENT → Direct convulsant effect of the drug (INH)
1. Emergency stabilization → Cerebral hypoxia
2. Clinical evaluation → Hypoglycemia
3. Elimination of the poison → Severe muscle spasm
4. Excretion of absorbed substance → Withdrawal reactions
5. Administration of antidotes → Decrease seizure threshold
6. Supportive therapy and observation
7. Disposition Drugs taken in excess amounts that result in convulsions:
• Aminophylline • Opioids
III. EMERGENCY STABILIZATION • Amphetamine • Organophosphates
(1) MAINTAIN ADEQUATE AIRWAY • Carbon monoxide • Phenothiazine
• Airway patency • Cocaine, cyanide • Salicylates
→ Awake patient = likely to have intact airways • Ethylene glycol • Strychnine
• Hypoglycemic agents • Theophylline
→ Patient with decreased sensorium due to intoxication =
• INH • TCAD
compromised airway patency • Lead, Lithium • Withdrawal of narcotics, diazepam
• Gag / cough reflex • MAO inhibitors or ethanol
→ Indirect estimate of patient’s ability to maintain a clear airway • Mefenamic acid
• Proper positioning
→ Supine, chin-lift, jaw-thrust (position tongue away fr airway)

Reviewer 4 PREPARED BY: Suarez, Rina; tables by Tran, Amanda 1 of 7

 PHARMA REVIEWER 4: Toxicology 2 of 7

Table 2. Treatment plans for convulsions → Emotional stability of patient for long term management
CONDITION PHARMACOLOGIC MANAGEMENT • Current medications
Conventional Diazepam • Past medical history: existing liver, heart, lung diseases
Therapy 5mg or 0.3mg/kg dose repeated every 2-5min
• Any home remedies given: immediate treatment that may
Max dose: 20mg
improve or complicate patient’s condition
Uncontrolled Phenytoin
seizures (adult) 15-20mg/kg loading dose (rate not to exceed Table 4. Poisons with delayed manifestations
*if still uncontrolled 50mg/min) followed by maintenance dose of TIME DELAYED SINCE
POISON
or responsive 100mg po or IV every 6-8hrs POST-INGESTION
Uncontrolled Phenytoin Ethylene glycol 6 hours
seizures (pedia) 15-20mg/kg not to exceed 1mg/kg/min with a Salicylates 12 hours
maintenance dose 5-7mg/kg/day (divided doses) Paracetamol 36 hours
Unresponsive to Pyridoxine Paraquat 48 hours
conventional 80-120mg/kg/dose or 5gm/IV
Methanol 48 hours
therapy
Thyroxine 4 weeks
INH toxicity Pyridoxine
5-10 grams increments until cessation of seizure
(2) PHYSICAL EXAMINATION
(6) TREAT METABOLIC ABNORMALITIES PHYSICAL FINDINGS POSSIBLE CAUSES
Table 3. Treatment for metabolic abnormalities Needle tracks, Bruises, Drugs given in IV
METABOLIC CAUSATIVE TREATMENT Lacerations
CONDITIONS AGENT Cutaneous bullae Barbiturates
Hypokalemia • Alkalinizing agents Infusion of KCL sol’n Carbon monoxide
(NaHCO3) 40 meq/hour not to exceed Diaphoresis Amphetamine
• Bronchodilators 60 meq/liter Salicylate
• Corticosteroids Organophosphate
• Diuretics Jaundice Paracetamol / hepatotoxic agents
Hyperkalemia • ACE inhibitors (1) D50-50 + 10 units Dry skin + Hyperpyrexia Atropine + Other anticholinergics
• B-blockers regular insulin Flushing Anticholinergics
• Glycosides K enters intracellular Alcohol
• Carbon monoxide compartment Cyanide
• Cyanide (2) NaHCO3
• Oral potassium 1 meq/kg/dose
(3) 10% calcium
HYPOVENTIALTION HYPERVENTILATION
• K+ sparing DQs COMBAT COMETS
diuretics gluconate
5-10ml/slow IV Digitalis Carbamates
- Under cardiac Quinidine Organophosphates
monitoring; stabilize Sedatives Methanol
membrane + prevent Clonidine Ethylene glycol
AP Opioids Theophylline
Hypothermia • Alcohol Metals Salicylates
• Carbon monoxide Beta-blockers
• Barbiturates Aromatic hydrocarbons
• Opioids TCAD/Theophylline
• Sedative-
hypnotics BRADYCARDIA TACHYCARDIA
• Gen anesthetics PAC3ED I C2OPE2 FA3S2T
• Phenothiazines Propranolol + other B-blockers Iron
• TCAD Anticholinesterases Carbon monoxide, Cyanide
Hyperthermia • Antihistamines Cooling measures Clonidine, Ca+ channel Organophosphates
• Amphetamines blockers, Codeine + other Phenothiazine
• Anticholinergics opioids Ethylene glycol, Ethanol
• INH Ethanol Free-base cocaine
• Phenytoin Digitalis Anticholinergics, Antihistamines
• Salicylates Amphetamines
• Xanthines Sympathomimetics, Salicylate,
• Phenothiazines Solvents
• Sulfonamides Theophylline
Hypoglycemia • Oral hypoglycemic • 50-100ml D50-50
agents • In alcohol intoxication: HYPOTENSION HYPERTENSION
• High dose insulin → Thiamine 100mg CRASH landing on you ü CT SCAN
prior to glucose
Clonidine Cocaine
infusion to avoid
Wernicke’s
Reserpine & other anti-hpn Theophylline
encephalopathy Antidepressants Sympathomimetic
Sedative-hypnotics Caffeine
Heroin and other opiates Anticholinergics
IV. CLINICAL EVALUATION
Nicotine
(1) HISTORY
• Time of exposure: phase of biotransformation of the poison at MIOSIS MYDRIASIS
time of admission COPS A2SIA
• Mode of exposure: oral, inhalational, dermal Cholinergics, clonidine Antihistamines
• Intake of other substances: ask patient’s companions to Opiates, organophosphates Antidepressants
search the area poisoning took place Phenothiazines, pilocarpine Sympathomimetics
• Circumstances prior to poisoning Sedative-hypnotics Isoniazid
Anticholinergics
→ e.g. spraying in field suggests pesticide poisoning
 PHARMA REVIEWER 4: Toxicology 3 of 7

BREATH ODOR DRUG → NOT effectively adsorbed by charcoal: 

Bitter almonds Cyanide ▪ Alcohol
Fruity odor DKA ▪ Cyanide
Isopropanol ▪ Iron
Oil of wintergreen Methylsalicylate ▪ Lithium
Rotten eggs “sulfur smell” Sulfur dioxide ▪ Petroleum distillates
Hydrogen sulfide
Substances effectively adsorbed by activated charcoal
Pears Chloral hydrate •
• Aspirin • Digitalis Salicylates
Garlic Arsenic • Amphetamines • Furosemide • Strychnine
Organophosphate • Antidepressants • Glibenclamide • Tetracyclines
Mothballs Camphor • Antiepileptics • Glipizide • Theophylline
• Antihistamines • Indomethacin • Arsenic
TOXIDROMES : signs and symptoms when taken collectively • Atropine • Kerosene • Antimony
can characterize a certain toxicant • Barbiturates • Phenothiazines • Iodine
• Benzodiazepines • Malathion • Silver
CHOLINERGICS (ORGANOPHOSPHATES/CARBAMATES) • B-blockers • NSAIDs • Phosphorus
Cholin’s D2UM2BELS • Chloroquine • Paracetamol • Potassium
Diarrhea/diaphoresis • Cimetidine • Phenol • Permanganate
Urination • Dapsone • Quinine • Tin
Miosis/muscle fasciculations • Mercury chloride
Bradycardia Substances with enterohepatic recirculation
Emesis
Lacrimation • Multiple doses of activated charcoal lavage (every 6-8 hours)
Salivation → Caution: danger of intestinal impaction; dose reduced to half
→ Prevent impaction: activated charcoal lavage followed by
ANTICHOLINERGICS/ANTIDEPRESSANTS sodium sulfate and cathartics
Hot as a hare: hyperthermia → Contraindicated in caustics and petroleum distillates
Dry as a bone: dry mucosa • Aspirin • Phenobarbital
Red as a beet: flushed skin • Carbamazepine • Phenytoin
Blind as a bat: dilated pupils • Cyclosporin • Piroxicam
Mad as hatter: confusion/delirium • Digoxin • Salicylate
• Glutethimide • Theophylline
SYMPATHOMIMETICS (COCAINE/AMPHETAMINES) • Meprobamate • TCAD
Cocaine MyTHHS • Methamphetamine • Organochlorines
Mydriasis • Paracetamol • Pesticides
Tachycardia • Phencyclidine • Anti-coagulants
Hypertension • Phenothiazine
Hyperthermia
Seizures A patient has massive aspirin ingestion. What should be done? 
A. Gastric lavage
NARCOTICS/OPIATES B. Activated charcoal
“Mio and Brady, make Hipo-hipo sa Kama” C. Whole bowel irrigation
Miosis D. All of the above Answer: D
Bradycardia
Hypotension VI. EXCRETION OF ABSORBED SUBSTANCES
Hypoventilation (1) FORCED DIURESIS
Coma • Less frequently indicated since many drugs metabolize in liver
• Causative Agent: Barbiturates, amphetamines, salicylates
V. ELIMINATION OF THE POISON • 20% Mannitol
• External decontamination → Test dose of 200mg/kg for 10min for urine output of 1 ml/min
→ Discard patient’s clothing+ thoroughly bathe/shower → Good kidney function: mannitol 75-100ml (adult) or
→ Eye contamination: copious irrigation of eyes with free-flowing 0.5-1gm/kg/dose (pediatric) every 6hours
water for 30 minutes → Duration: does not exceed 48 hours
→ Avoid neutralizing solutions: may cause injury d/t exothermic • Furosemide
heat reaction + liberation of CO2 esp. in caustic poisoning
→ 1 mg/kg/dose in cases of pulmonary edema
• Empty the stomach
→ Induction of emesis (2) ALKALINIZATION THERAPY
▪ For 1-hour post-ingestion • Causative Agent: Salicylates, barbiturates, INH
▪ Considered when: no absolute contraindications, amounts • Therapeutic goals:
ingested lead to toxicity, definite treatment will be delayed
→ Ionize weak acids
→ Gastric lavage
→ Inhibit passive renal tubular reabsorption of non-ionized
▪ For 6-12 hours post-ingestion
molecules, thus enhancing excretion
▪ Took drugs which delay gastric emptying or slow release
• 8.4% NaHCO3 1meq/kg/dose or 1mg/kg/dose
preparation which can form a large bezoar in stomach like
theophylline • Target urine pH: > 7.5
• Limit GI absorption of poison: Activated charcoal / bowel
(3) ACIDIFICATION THERAPY
irrigation
• Causative Agents: Amphetamines, Phenytoin, Theophylline
→ Drugs/chemicals bind to surfaces of charcoal particles
• Ascorbic acid: 1gm (adult) / 20mg/kg (pedia) IV every 6 hrs
→ 10:1 (charcoal: poison)
• Ammonium chloride: 4gm every 2 hours or 75mg/kg/day
→ Adults: 10-100g activated charcoal in 200 ml water
every 6 hours
→ Children: 1g/kg or 30-50g in 100 ml water
• Target urine pH: < 5.5
→ Patient in Trendelenburg or left lateral decubitus
 PHARMA REVIEWER 4: Toxicology 4 of 7

(4) HEMOPERFUSION A 5-year-old presents at the ER with a diagnosis of lead poisoning.

• Indications: The oral agent that reduces blood lead concentration is: 
→ Life threatening poisoning A. EDTA
→ Electrolyte, acid and base disturbances B. Atropine
→ Dialyzable toxins with poor body clearance C. Succimer
D. Deferoxamine Answer: C
→ Increased plasma toxin concentration
→ Underlying hepatic or renal diseases
(2) ACCELERATED DETOXIFICATION
• Adsorbent: ACTIVATED CHARCOAL
• Thiosulfate: enhances rapid detoxification of cyanide to
• Effective in poisoning secondary to barbiturates, carbamazepine
thiocyanate
and theophylline
→ Disopyramide (3) REDUCTION IN CONVERSION TO MORE TOXIC
→ Glutethimide COMPOUNDS
→ Meprobamate • Ethanol: Inhibits conversion of methanol and ethyl glycol to
→ Phenobarbital more toxic substances by alcohol dehydrogenase
→ Salicylates • NAC (N-acetylcysteine): Prevents conversion of paracetamol
→ Theophylline to NAPQI

(5) DIALYSIS (4) COMPETITIVE INHIBITION AT RECEPTOR SITES

• Useful for short-term dialysis in severe salicylate toxicity, • Naloxone: blocks receptor sites in CNS (except spinal column)
ethylene glycol or methanol ingestion • Atropine: blocks muscarinic receptor sites from Ach
→ Ammanita phalloides
→ Antifreeze (5) BYPASSING EFFECTS OF THE POISON
→ Heavy metals in soluble compounds • Oxygen: Synergistic action with sodium thiosulfate and sodium
→ Heavy metals, after therapy with chelating agents nitrite in cyanide toxicity
→ Methanol • Pyridoxine in INH toxicity
• Hemodialysis is more effective than peritoneal dialysis in the
elimination of methanol, ethylene glycol, lithium, isopropanol (6) ANTIBODIES INTERACTING WITH POISONS
• Digi Fab: Digoxin-specific antibodies reverses binding of
DIALYSIS: DEPENDENT ON PATIENTS CONDITION digitalis compounds to cardiac receptors
• Alcohols • Calcium • Meprobamate
• Ammonia • Chloral hydrate • Paraldehyde *NOTE: see table of antidotes in page 7
• Amphetamines • Fluorides • Potassium
• Aniline • Iodides • Salicylates VIII. SUPPORTIVE THERAPY
• Barbiturates • Isopropanol • Strychnine • IVF: Given for maintenance and replacement of fluid losses
• Bromide • INH • Thiocyanate • When alkaline and acid therapy are employed, frequent blood
• Boric acid • Lithium • Quinidine and urine pH determination should be done
• Quinine • Intensive nursing care to avoid:
DIALYSIS: NOT INDICATED → Aspiration
• Antidepressants • Digitalis → Development of decubitus ulcers
• Belladona compounds • Diphenoxylate • Treat metabolic disturbances, electrolyte imbalance,
• Chlordiazepoxide • Glutethimide hypoglycemia, hypothermia, hyperthermia
• Dextropropoxyphene • Heroin and other opiates
•
• Monitor vital signs, input and output
Benzodiazepines • Synthetic anticholinergics
Table 6. Poisons and their neutralizing agents
VII. ANTIDOTES SUBSTANCE NEUTRALIZING AGENT
Caustic ingestion Eggwhite albumin
(1) INERT COMPLEX FORMATION
Phosphorus Eggwhite albumin
• Chelating agents
Iron Sodium bicarbonate
→ Used in heavy metal poisoning
Cyanide Sodium bicarbonate
→ Formation of a stable complex with a 5 or 6 membered ring
Iodine Starch
and incorporation of a sulfide bond
Nicotine Potassium permanganate (1:10,000)
CHELATING AGENTS Quinine Potassium permanganate (1:10,000)
DMPS 2.3 diercapto-1-propane sulfonate Strychnine Potassium permanganate (1:10,000)
BAL British anti-Lewisite
EDTA Disodiumedetate Table 7. Approx. duration of detectability of drugs in urine with acute intoxication
PEN Penicillamine DRUG APPROXIMATE DURATION
NAPA N-acetyl penicillamine Amphetamine 48 hours
DTPA Diethylene triaminoneopiate pentaacetic- Methamphetamine 48 hours
N-N-N-N-N acid Short-acting barbiturates 24 hours
DMSA Dimercaptosuccinic acid AKA Succimer Intermediate-acting 48-72 hours
barbiturates
Table 5. Chelators of choice for selected metals  Long-acting barbiturates >7 days
2ND Benzodiazepines 3 days
METAL IST CHOICE CONTRAINDICATED
CHOICE Cocaine metabolites 2-3 days
Arsenic DMSA, DMPS BAL Methadone 3 days
Lead DMSA, PEN EDTA BAL Codeine 48 hours
Methylmercury DMPS, DMSA NAPA BAL Propoxyphene 6-48 hours
Cadmium EDTA DMSA BAL Cannabinoids 10 days
Copper PEN DTPA, BAL Methaqualone > 7 days
DMSA
Phencyclidine >8 days
 PHARMA REVIEWER 4: Toxicology 5 of 7

Table 8. Specimen time collection of blood/urine

REFERENCES
TIME TO DRAW
BLOOD POST-
VALUE AND TIME • Guiang, J. (2020). Toxicology. Dept of Pharmacology. UST-FMS.
DRUG TO REPEAT
INGESTION OR
COLLECTION
ADMINISTRATION END OF REVIEWER
2-4 hours Prepared by: Suarez, Rina; Tables by Tran, Amanda
Carbamazepine 2-4 hours TR: 4-10ug/ml
TX: >20ug/ml
2-4 hours
Digoxin 2-4 hours TR: 0.9-1.2ng/ml
TX: >1.5ng/ml
2-4 hours
Iron 2-4 hours
TX: >350ug/ml
2 hours
Isopropanol 0.5-1 hour
TX: >150mg/100ml
TR: 0.6-1.2mEq/L
Lithium 2-4 hours
TX: >1.2mEq/L
TR: 10-20ug/ml
TX: 200ug/ml (4th
Paracetamol 4th hour 
hour); 50ug/ml (12th
hour)
2-4 hours
Phenobarbital 1-2 hours TR: 15-40ug/ml
TX: >40ug/ml
2-4 hours
Phenytoin 1-2 hours TR: 10-20ug/ml
TX: >20ug/ml
2-4 hours
Salicylates 2-4 hours TR: 12-20ug/ml
TX: >30ug/ml
Ordinary tablet/syrup 1-2 hours
(1 hour) TR: 10-20ug/ml
Theophylline Sustained release TX: 20-35ug/ml “laging may sapat na liwanag para sa susunod na hakbang”
(12-36 hours) ALD: >35ug/ml
 PHARMACOLOGY

TOXICOLOGY SHIFT 4
REVIEWER 4
REVIEWER | MAY 2020

ANTIDOTE INDICATION MODE OF ACTION

NAC Paracetamol Restores depleted glutathione stores 

Protects against renal + hepatic failure

Atropine Organophosphate & carbamate insecticides Competitive inhibition of muscarinic receptors

Deferoxamine Iron Chelation of ferrous salts

Digoxin specific antibody fragments Severe digoxin poisoning Forms complexes with digoxin

Flumazenil Diazepam and other benzodiazepines Direct receptor antagonist

Folinic acid Folic acid antagonists: methotrexate, trimethoprim, Bypasses blocked folate metabolism; Stimulation of folate
pyrimethamine dependent one-carbon pool pathway for methanol metabolism

Heparin Ergotamine, aminocaproic acid Reverses hypercoagulable state

Naloxone Narcotics/opioids Competitive inhibition

Neostigmine Anticholinergics Anticholinesterase

Propranolol B-adrenoceptor stimulants, theophylline, thyroxine Non-selective B-blocking; Suppresses sympathetic

overactivity

Pyridoxine INH, Theophylline Reversal of acute pyridoxine deficiency

Protamine sulfate Heparin Neutralizes heparin

Sodium bicarbonate Iron Prevents conversion of ferrous to ferric

Starch Iodine Neutralizes iodine

Vitamin C Chemicals causing methemoglobinemia in patients Promotes conversion of methemoglobinemia in hemoglobin

wt G6PD deficiency

Vitamin K Anticoagulants Bypasses inhibition of vitamin K epoxide reductase enzyme

ANTIDOTE INDICATION COMMENTS

NAC (acetadone, Acetaminophen Best results be given within 8-10 hours of overdose
mucomyst) LAB: ALT, AST and acetaminophen level monitoring

Atropine  Organophosphates, carbamates Initial dose: 1-2mg (0.05mg/kg)/IV, no response double dose every 10-
15min. (wheezing and pulmonary secretions as endpoints)

Sodium bicarbonate TCA, quinidine 1-2meq/kg/IV bolus (careful in CHF)

Calcium Ca-channel blockers, fluoride 15mg/kg/IV

Deferoxamine Iron salts 15mg/kg/h IV (100mg of deferoxamine binds with 8.5mg of iron)

Digoxin antibodies Digoxin and related cardiac glycosides 1 vial binds 0,5mg digoxin

Esmolol Theophylline, caffeine, metaproterenol Infuse 25-50mcg/kg/min. IV

Ethanol Methanol, ethylene glycol Loading dose to give blood level at least 100mg/dl (42m/70kg)

Flumazenil Benzodiazepines 0.2mg/IV repeat up to max of 3mg

Avoid in patients with seizures, benz dependence, TCA overdose

Fomepizole Methanol, ethylene glycol 15mg/kg (repeat every 12hours)

Glucagon B-blockers 5-10mg/kg IV bolus

Hydroxocobalamin Cyanide 5grams/IV over 15min.

Naloxone Narcotic drugs, opioid derivatives 0.4-2mg/IV,IM,SQ

Oxygen Carbon monoxide  100% high flow non-rebreathing mask; (?) hyperbaric chamber

Physostigmine Anticholinergic drugs 0.5-1mg/IV

Pralidoxime  Organophosphate cholinesterase inhibitors 1g/IV repeated every 3-4 hrs or infusion 250-400mg/h (250mg pedia dose)

Reviewer 4 PREPARED BY: Suarez, Rina; tables by Tran, Amanda 6 of 7

 PHARMA REVIEWER 4: Toxicology 7 of 7

UNIVERSITY OF SANTO TOMAS

FACULTY OF MEDICINE AND SURGERY
D2022 Reviewer
Sample EXAMINATION
May 2020

Instructions:
1. There are 20 items in this questionnaire
2. CHOOSE THE BEST ANSWER.
3. Try to answer on your own (without the use of reviewers/transes)
4. Answers are given in a separate document.
5. God bless!

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MATCHING TYPE
Match the antidote to the following ingested poisons:
A. Glucagon
B. Flumazenil
C. N-acetylcysteine
D. Deferoxamine

1. _____ Ferrous sulfate

2. _____ Diazepam
3. _____ Propranolol
4. _____ Paracetamol

TRUE (A) OR FALSE (B)

The following measures should be done for a 50-year-old male with moderate to severe aspirin intoxication.
5. _____ Gastric lavage
6. _____ Repeated doses of atropine
7. _____ IV sodium bicarbonate
8. _____ Emergency hemodialysis for severe intoxication

MULTIPLE CHOICE
9. A patient developed seizures within 45 minutes after ingestion of isoniazid. She was given IV diazepam 3x but the
seizures persisted. The most appropriate drug to give is:
A. Lorazepam B. Phenobarbital C. Pyridoxine D. Vitamin B12

10. A 30-year-old female showed constricted pupils, and other signs and symptoms of poisoning. She was given atropine
sulfate to which she responded very well. The most likely poison is:
A. Organophosphate B. Iron C. Lead D. Carbon monoxide

11. Which of the following enhances elimination of amphetamine when there is an overdose?
A. Urinary acidification B. Chelation C. Gastric lavage D. Administration of laxative

12. Activated charcoal does NOT bind this substance and therefore not effective in removing it from the GIT
A. Carbamazepine B. Theophylline C. Digoxin D. Iron

13. A 40-year-old patient was diagnosed with copper poisoning. The most appropriate chelating agent is:
A. Dimercaptosuccinic acid B. Penicillamine C. Dimercaprol D. BAL

14. Exposure to toxic levels of mercury is ideally managed with this antidote.
A. Sodium-calcium EDTA B. N-acetylcysteine C. Dimercaprol (BAL) D. Succimer (DMSA)

15. A child who has accidentally swallowed iodine solution should be given:
A. Sodium thiosulfate B. Starch C. Ammonium chloride D. NSS

- END OF QUIZ-
GOD BLESS!