1. TCA overdosesymptoms

-hyperthermia-anticholionergic effects: dilatedpupils, intestinal ileus-seizures-QRS prolongation-->ventricular arrhythmia-death: hypotension

2. Managment of pt withTCA overdose

-ABCs-Sodium bicarbonate --improves hypotension, longQRS, ventricle arrhythmia

3. EKG finding inhyperkalemia

-peaked T waves-long PR and QRS intervals-sine wave

4. antidotes ofanticholinesterasetoxicity (insecticides,physostigmine,donepezil)

atropine and pralidoxime

5. Most reliableindication of opioidtoxicity

*dec respiratory rate-miosis may or may not be seen

6. opioid intoxicationsymptoms

*decreased respiratory rate-hypotension, hypothermia, decbowel sounds, miosis

7. treatment of betablocker intoxication

-hypotension: IV fluids-bradycardia: Atropine-seizures: benzodiazepines(lorazepam)-IV glucagon, IV calcium salts,Vasopressor (epinephrine), highdose insulin and glucoseinfusions, Lipid emulsion therapy

8. Beta Blockerintoxicationsymptoms

bradycardia and hypotension

9. Benzodiazepineintoxicationsymptoms

drowsiness, slurred speech,unsteady gait

10. Treatment ofbenzodiazepineintoxication

Flumazenil

11. treatment of acuteopioid intoxication

naloxone- goal of inc respiratoryrate

12. Most importantfeature of TCAoverdose

-QRS prolongation: bestpredictor of seizures andventricular arrythmia

13. How do you decidewhether to administerthe antidote inacetaminophenpoisoning?

-draw serum acetaminophen levelsAFTER FOUR HOURS of overdose- Can administer N-acetylcysteinew/in 8 hrs of ingestion-four hours after ingestion isminimum to predict hepatotoxiceffects of acetaminophen overdose

14. cyanosis and pink hueto skin

Carbon monoxide poisoning

15. cyanosis and bluishskin color

Methemoglobinuria-due to antibiotics (trimethoprim,sulfonamides and dapsone),aniline dyes, nitrates-blue baby syndrome: infant drinksnitrates in water-tx: O2 + methylene blue

16. Symptoms of carbonmonoxide poisoning

-Headaches, N/V, abdominaldiscomfort, confusion, coma-pink hue to skin

17. Diagnosis of carbonmonoxide poisoning

-h/o smoke inhalation, furnaces-get carboxyhemoglobin levels

18. Treatment of carbonmonoxide poisoning

hyperbaric oxygen administration

19. Burning of rubber orplastic can result inwhat kind ofpoinoning?

cyanide poisoning (v automobiles,furnaces with carbon monxide)

20. Ethylene glycol vmethanol poisoningsymptoms

BOTH: substitutes for ethanol,metab anion gap acidosis, incosmolar gapmethanol: optic disc hyperemia,vision lossethylene: hypocalcemia, calciumoxalate deposits in kidney-hematuria, renal failure

21. Symptoms of aspirinoverdose

-anion gap metab acidosis, respalk-tinnitis, fever, hyperventilation

22. Opioid withdrawalsymptoms

anxiety, insomnia, flu-like symp,piloerection, fever, rhinorrhea,lacrimation, yawning, nausea,stomach cramps, diarrhea,mydriasis

23. Treatment ofmoderate to severesymptoms of opioidwithdrawal

-clonidine, buprenorphine,methadone

24. Treatment od mildsymptoms of opioidwithdrawal

antiemetics, muscle relaxants,NSAIDs

AC(E) USMLE Step 2 PoisoningStudy online at quizlet.com/_dn9i1

25. ethanol andsedativewithdrawal vsopioidwithdrawalfeatures

-NO SEIZURES in opioid withdrawal

26. Management ofpt who ingestedstronglyalkalinesubstance

-hospitalize, IV hydration, serialabdominal and chest XRs-endoscopy: assess esophageal damage-perforation? Gastrografin study

27. complicationsof ingestinglye/alkalinesubstance

-immediate esophageal damage -liquefactive necrosis of esophageal wallleading to perforation and mediastinitis

28. Symptoms ofingesting analkaline orcausticsubstance

dysphagia, severe pain, heavy salivationand mouth burns-necrosis of tissue lining the GI tract-perforation of the stomach or esophaguscan occur causing peronitis ormediastinitis

29. Drugs thatcauseNeurolepticMalignantSyndrome

dopaminergic antagonists, espciallytypical neuroleptics such as haloperidol

30. symptoms ofneurolepticmalignantsyndrome

-hyperthermia (fever), muscle rigidity,autonomic instability and mental statuschanges-elevated CK, leukocytosis

31. Symptoms ofethylene glycolpoisoning

-hypocalcemia, calcium oxalte depositionin kidneys--> flank pain, hematuria,oligouria, renal failure-anion gap metabolic acidosis

32. treatment ofethylene glycolpoisoning

-Fomepizole or ethanol (ADH inhibition)-Sodium bicarbonate to alleviate acidosis-hemodialysis if end organ damage

33. danger oftypicalantipsychoticmedication andcoldtemperature

-Fluphenazine (more potent than haldol)and other "typical" antipsychotics inhibitautonomic thermoregulation, can getextreme hhypothermia with prolongedexposure to cold-all patients taking antiipsychotic meds areadvised to avoid prolonged exposure toextreme temperatures

34. Symptoms inthe first 6-12hours ofalcoholcessation

-anxiety, insomnia, tremors, diaphoresis

35. Symptoms inthe first 48 hrsof alcoholcessation

-Hallucinations and withdrawal seizures-tachycardia, HTN,agitation, seizures

36. Symptoms within4-7 days of alcoholcessation

Delirium Tremens - HTN, agitation,tachycardia, delirium, possible death,autonomic instability-mortality rate 5%

37. Treatment ofalcoholwithdrawal

Benzodiazepines -eg chlordiazepoxide(Librium); CNS depressants that willlimit the effects of alcohol withdrawalhallucinations- haloperidol-thiamine, folate, multivitaminreplacement

38. Organophosphatepoisoningsymptoms

-inhibits acetylcholinesterase leading tocholinergic excess: bradycardia, miosis,rhonchi, muscle fasciculations,salivation, lacrimation, urination,defecation

39. Treatment oforganophosphatepoisoning

atropine, pralidoxime

40. Symptoms of Betablocker overdose

asthma exacerbation (wheezing),bradycardia, AV block, hypotension,potential cardiogenic shock

41. Treatment of betablocker overdose

-hypotension: IV fluids-bradycardia: Atropine-seizures: benzodiazepines (lorazepam)-IV glucagon, IV calcium salts,Vasopressor (epinephrine), high doseinsulin and glucose infusions, Lipidemulsion therapy

42. treatment of TCAoverdose

-Sodium bicarbonate narrows the QRScomplex (thus preventing ventriculararrhythmia) by increasing theextracellular sodium conc

43. Treatment ofneurolepticmalignantsyndrome

-dantrolene (muscle relaxant)-bromocriptine (dopamine agonist)-amantadine (antiviral withdopaminergic properties)

44. Benzodiazepineoverdose v opioidoverdose

benzos: NO severe respiratorydepression, NO pupillary constriction(usually but not always in opioidoverdose)

45. Benzodiazepineoverdose v alcoholand phenytoinintoxication

no nystagmus in benzos

46. Phenytoin toxicitysymptoms

horzontal nystagmus, cerebellar ataxia,confusion

47. Symptoms ofdiphenhydramineoverdose

-anti-histamine effects: drowsiness,confusion-anticholinergic effects: dry mouth,dilated pupils, blurred vision, reducedbowel sounds, urinary retention

48. Treatment ofdiphenhydramineoverdose

physostigmine, a cholinesteraseinhibitor

49. Management ofWarfarin inducedbleeding

-Fresh frozen plasma - immediatelyreverses action of warfarin-Vitamin K - takes 8-12 d to be effective

50. urgent reversal ofheparin

protamine sulfate

51. Vit A def night blindness, dry skin

52. Vit B1/thiaminedef

-beriberi: polyneuritis, dilatedcardiomyoppathy, high output CHF,edema-Wernicke-Korsakoff syndrome

53. Vitamin B2 def angular stomatitis, cheilosis, cornealvascularization

54. Vit B3/niacin def pellagra: diarrhea, dermatitis, dementia

55. Vit B5 def dermatitis, enteritis, alopecia, adrenalinsufficiency

56. Vit B6 def convulsions, hyperirritability; requiredduring INH treatment

57. VitB12/cobalamindef

macrocytic, megalobalstic anmeia,neuro symp, glossitis

58. Vit C def scurvy: swollen gums, bruising, anemia,poor wound healing

59. Vit D def rickets (in children - bending bones);osteomalacia in adults (soft bones);hypocalcemic tetany

60. Vit E def inc fragility of RBCs

61. Vit K def neonatal hemorrhage, inc PT and PTT;NOMRAL Bleeding time

62. Biotin def dermatitis, enteritiscaused by raw egg ingestion, orantibiotic use

63. folic acid def -Most common vit def in US-sprue, macrocytic, megaloblasticanemia, without neuroologic symp

64. Magnesium def -lead to def Ca2+ and K-weakness, muscle cramps,hypocalcemic tetany, CNShyperirritability, tremors,choreoathetoid movement

65. Selenium def Keshan disease (cardiomyopathy)

66. iron intoxicationsymptoms

five phases: 30 min- 6 hours after ingestion: GIphase (N/V, hematemesis, melena, abdpain)-6-24 hrs later: asx-72 hrs; shock, metabolic acidosis-12-96 hrs: hepatotoxicity-iron tox>350

67. Tx of NeurolepticMalignantSyndrome

-fever, muscle rigidity, auto instability,AMS-dantrolene (muscle relxant)+bromociptine (dopa agonist)+amantidine (antiviral with dopaproperties)

68. Tx of AV blockcaused by Betablocker intox

-atropine and IV fluids-glucagon

69. TCA overdose txpathophys

Sodium bicarbonate-alkalinize serum, TCA then lessprotein bound, dec bioavailability-Na+ reverses the sodium channelblocking effects of TCA

70. Bleomycin SE pulmonary fibrosis

71. cyclophosphamideSE

hemorrhagic cystitis

72. isoniazid SE vitamin B6 def, lupus like syndrome,liver toxicity

73. cyclosporine SE renal toxicity

74. ACE I SE cough, angioedema

75. demeclocycline SE diabetes insipidus

76. lithium SE diabetes insipidus, thyroid dysfunction

77. methoxyflurane SE diabetes insipidus

78. sulfa drugs SE allergy, kernicterus in neonates

79. halothane SE liver necrosis

80. phenytoin SE lateral gaze nystagmus, ataxia,hirsutism, folate deficiency, teratogen(cranio-facial abnorm), gumhypertrophy

81. vincristine SE peripheral neuropathy

82. amiodarone SE thyroid dysfunction, pulmonary toxicity

83. valproic acid SE neural tube defects in offspring

84. thioridazine SE -typical antipsychotic-retinal deposits, cardiac toxicity

85. vancomycin SE red man syndrome

86. quinolones SE cartilage damage-teratogen

87. quinine SE cinchonism (tinnitus, vertigo)

88. morphine SE sphincter of Oddi spasm

89. Clindamycin SE pseudomembranouscolitis

90. chloramphenicol SE gray babysyndrome, aplasticanemia

91. doxorubicin SE cardiomyopathy

92. bulsulfan SE pulmonary fibrosis

93. monoamine oxidase inhibitors SE tyramine crisis(after wine, cheese)

94. hydralazine SE lupus like syndrome

95. procainamide SE lupus like syndrome

96. minoxidil SE hirsutism

97. aminoglycosides SE ototoxicity, renaltoxicity

98. chlorpropamide SE -old sulfonylurea(its use no longerrecommended)-SIADH

99. didanosine SE pancreatitis,peripheralneuropathy

100. halogen anesthesia SE malignanthyperthermia

101. succinylcholine SE malignanthyperthermia, CI inhyperkalemia

102. Zidovudine SE bone marrowsupression

103. acetazolamide SE metabolic acidosis

104. HMG Co reductase inhibitors SE (simvastatin)-muscle and livertoxicity

105. ethambutol SE optic neuritis

106. metronidazole SE disulfiram reactionwith alcohol

107. cisplatin SE nephrotoxicity

108. methyldopa SE hemolytic anemia(coombs testpositive)

109. SE alpha 1 antagonists (terazosin,prazosin)

-first doseorthostatichypotension

110. antidepressant that causesdepression

methyldopa

111. antidote for cholinesteraseinhibitors (insect repellant,donepezil, rivastigmine,pyridostigmine)

-atropine,pralidoxime

112. antidote forquinidine or TCAs

sodium bicarbonate (cardio-protective)

113. antidote fordigoxin

normalize potassium and otherelectrolytes

114. antidote formethanol/ethyleneglycol

-stabilize with Sodium bicarb,benzodiazepine (anticonvulsant)-ethanol, fomepizole

115. antidote forbenzodiazepines(diazepam,alprazolam)

flumazenil

116. antidote for betablockers

glucagon

117. antidote for lead EDTA-use succimer for children

118. antidote forcopper or gold

penicillamine

119. antidote foropioids

naloxone

120. antidote formuscarinicblockers (exscopolamine, oratropine,ipratropium)

-physostigmine (cholinesteraseinhibitor)

121. aspirin and nasalpolyps

do not give aspirin to pts with nasalpolyps bc hypersensitivity reactionsinvolving an asthmatic attack

122. Drug inducedlupus

-sx: fever, myalgias, arthralgias,arthritis, erythematous rash insun exposed skin-drugs: procainamide, hydralazine,minocycline, diltiazem, penicillamine,isoniazid, quinidine, anti-TNF alphatherapy (infliximab and etanercept),INF-alfa, methyldopa, chlorpromazine

123. Metronidazole SE -inhibits acetaldehyde dehydrogenase:"disulfiram-like reaction" if taken withalcohol!!

124. how doesacetominophencause liver toxicity

-metabolizes to form mercapturic acid-needs conjugated to glutathione forexcretion-depletion of glutathione, mercapturicmetabolites bind to hepatocytes-->liver failure

125. metformintoxicity

-lactic acidosis-GI problems, nausea, diarrhea,anorexia, abd pain

126. salicylatepoisoning sx

tinnitis, fever, vertigo-anion gap metab acidosis + respalkalosis

127. amitriptyline overdose sx -TCA-3 Cs: coma, convulsions, cardiotoxicity

128. barbiturate overdose severe CNS depression, resp depression

129. hypertensive crisis -tyramine interacts with antidepressants of MAOI class-hypertensive crisis: very high BP, headache, epistaxis