Transcript 3rd Year Toxicology Core Facts:

3rd Year Toxicology Core Facts:
Zohair A. Al Aseri MD, FRCPC EM & CCM
Chairman and Assistant Professor , DEM
College of Medicine King Saud University
Consultant Emergency Medicine and Intensivist
King Saud University, Medical City
1-Following drugs can cause Bradycardia
(PACED):
Propranolol (beta-blockers), poppies (opiates),
propoxyphene, physostigmine
Anticholinesterase drugs, antiarrhythmics
Clonidine, calcium channel blockers
Ethanol or other alcohol,
Digoxin, digitalis
Following drugs can cause Tachycardia
(FAST):
Free base or other forms of cocaine,
Anticholinergics, antihistamines, antipsychotics,
amphetamines, alcohol withdrawal
Sympathomimetics (cocaine, caffeine, amphetamines,
PCP), solvent abuse, strychnine
Theophylline, TCAs, thyroid hormones
Hypothermia (COOLS) may be seen in
poisoning with:
Carbon monoxide
Opioids
Oral hypoglycemics, insulin
Liquor (alcohols)
Sedative-hypnotics
Hyperthermia (NASA) may seen in
poisoning with:
Neuroleptic malignant syndrome, nicotine
Antihistamines, alcohol withdrawal
Salicylates, sympathomimetics, serotonin
syndrome
Anticholinergics, antidepressants, antipsychotics
Hypotesion (CRASH) may seen in
poisoning with:
Clonidine, calcium channel blockers
Rodenticides (containing arsenic, cyanide)
Antidepressants, aminophylline, antihypertensives
Sedative-hypnotics
Heroin or other opiates
Hypertension (CT SCAN) may occur
after poisoning with:
Cocaine
Thyroid supplements
Sympathomimetics
Caffeine
Anticholinergics, amphetamines
Nicotine
Poisoning with following may lead to
an elevated anion gap:
Methanol, metformin, massive overdoses
Ethylene glycol
Toluene
Alcoholic ketoacidosis
Lactic acidosis
Acetaminophen (large overdoses)
Cyanide, carbon monoxide, colchicine
Isoniazid, iron, ibuprofen
Diabetic ketoacidosis
Generalized seizure-producing toxins
Acetylsalicylic acid or other salicylates
Paraldehyde, phenformin
Cholinergic toxidrome
(caused by organophosphorus, carbamate,
pilocarpine) is characterised by:
Diarrhea, diaphoresis
Urination
Miosis
Bradycardia, bronchosecretions
Emesis
Lacrimation
Lethargic
Salivation
Nicotinic toxidrome (recalled by days of the
week) is characterised by:
Monday: Miosis
Tuesday: Tachycardia
Wednesday: Weakness
Thursday: Tremors
Friday: Fasciculations
Saturday: Seizures
Sunday: Somnolent
Toxins accessible to haemodialysis:
Uremia
Salicylates
Theophylline
Alcohols (isopropanol,
methanol), Ethylene glycol
Boric acid, barbiturates
Lithium
Paracetamol (Acetaminophen),
Q; Acetaminophen (paracetamol) can undergo
all of the following biotransformation reactions
EXCEPT
a.
b.
c.
d.
e.
Answer a
Deamination
N-oxidation
Glucuronidation
Sulphation
Glutathione conjugation
N-acetyl-p-benzoquinonimine (NAPQI)
is the toxic metabolic product of:
a.
b.
c.
d.
Acetyl-salisylic acid
Acetamiophen (paracetamol)
Mefanemic Acid
Ibuprofen
Answer b
Q..N-Acetyl cystiene (NAC) is used as antidote
for acetaminophen. The decision to use is ideally
based on Acetaminophen blood levels measured
at:
a.
b.
c.
d.
2 Hours from time of ingestion
4 Hours from time of ingestion
8 Hours from time of ingestion
24 Hours from time of ingestion
Answer b
Salicylic acid (aspirin)
Opioids
ANTIDOTE
Antidote
n-acetylcysteine
Ethanol/fomepizole (4-MP)
Oxygen/hyperbarics
Naloxone/nalmefene
Physostigmine
Atropine/pralidoxime (2-PAM)
Methylene blue
Nitrites
Deferoxamine
Dimercaprol (BAL)
Succimer (DMSA)
Fab fragments
Glucagon
Sodium bicarbonate
Calcium/insulin/dextrose
Dextrose, glucagon, octreotide
Indication (agent)
Acetaminophen
Methanol/ethylene glycol
Carbon monoxide
Opioids
Anticholinergics
Organophosphates
Methemoglobinemia
Cyanide
Iron
Arsenic
Lead, mercury
Digoxin, colchicine, crotalids
Beta-blockers
Tricyclic antidepressants
Calcium channel antagonists
Oral hypoglycemic