Whats in Grandma's medicine cabinet
To NAC or not to NAC
"It's for my glaucoma"
I ate a poppyseed bagel this morning
The hangover cure
100
Grandma looks sleepy.
HR 50 & BP 80/55. Blood Sugar 70.
Grandma took too much of what medication?
Beta Blocker
Overdoses present "Low and Slow" with hypotension and bradycardia.
beta-adrenergic receptor antagonism inhibits both glycogenolysis and gluconeogenesis
100
The neurotransmitter NAC helps replenish?
Glutathione
Several proposed MOA: NAC is a derivative of the cysteine. It gets absorbed in the GI tract sent to the liver, and converted to cysteine. The liver uses cysteine to produce glutathione
100
cannabinoid hyperemesis syndrome can be alleviated by doing THIS common everyday activity.
Taking a hot shower
100
Presenting to the ED by EMS. He tachycardic, hypertensive, and diaphoretic. Pupils are equal and dilated.
What is this patient in love with and most likely took?
Hes in love with coca.
Cocaine ingestion
100
What Toxic alcohol is known to cause KETOSIS without ACIDOSIS
Isopropyl Alcohol
200
33% of patients present with THIS when their QRS is prolonged >100ms after a acute TCA ingestion
Seizure
Txt: Give Diazepam for seizure control
Phenytoin is contraindicated due to further sodium channel blockade
200
The 4hr Acetaminophen level threshold for NAC administration.
150 µg/mL
200
Most common presenting symptom of children with toxic Marijuana Edible overdose?
Seizure
200
Pt smoked phencyclidine (PCP) earlier that day. HR130, BP 150/86 mm Hg. On physical exam, he is diaphoretic, with vertical nystagmus and equal pupils, and appears acutely agitated.
Acute txt for this patient?
Common laboratory finding in PCP overdoses?
Benzodiazepine
Rhabdomyolysis and Elevated Creatine Kinase
200
Ingestion of what can cause visual symptoms described as (snowstorm)
Methanol
300
Abdominal XRAY of a 2 year old boy who has N/V and is drowsy appearing
Txt ?
*ADD $100 if you can name two other radiopaque compounds
Deferoxamine
Iron-chelating agent that significantly reduces mortality.
chloral hydrate, calcium carbonate, compounds with iodine, acetazolamide, busulfan, and potassium
300
Name of the Nomogram used to prognosticate possible liver toxicity in Acetaminophen overdose.
What is the only scenario in which this Nomogram can be properly utilized?
Rumack-Matthew Nomogram
SA Single acute ingestion.
300
Common medications that produce a false positive for tetrahydrocannabino (THC) ?
NSAIDs, PPI, promethazine, drinabinol
300
Name (3) out of the 6 common synthetic opioids that do not cross-react with standard opioid screens and can yield a false-negative test results?
1.meperidine
2.buprenorphine
3.propoxyphene
4.methadone
5.fentanyl
6. tramadol
Due to these compounds being structurally different
300
5-year-old boy brought in for possible ingestion. He was playing in the garage when his mother found him with an opened bottle of antifreeze.
What renal/urine abnormalities would you expect in this type of ingestion?
Calcium oxalate crystals in urine
400
2 year old boy ingested handful of Ibuprofen tablets while Grandpa watched the football game. Pop estimates ~8 (100mg) tablets are missing. The boy weighs 15kg.
Treatment route and dosage?
Reassurance
Symptomatic overdoses occur with ingestions of > 100 mg/kg.
400
What phase and in what time frame of Acetaminophen toxicity does Multi-organ failure, coma and death occur?
PHASE III
3-4 days.
400
Cannabis Withdrawal Symptoms per (DSM5):
HINT: theres (7). Name at least 3
EXTRA $100 if you can name all 7
1. irritability, anger, aggression
2. nervousness or ANX
3. sleep difficulty
4. decreased appetite or weight loss
5. restlessness
6. depressed mood
7. physical symptoms causing discomfort: gastral intestinal sx's
400
What metabolite is screened for cocaine usage in UDS?
Benzoylecgonine
400
Most common dysrhythmia caused by "holiday heart” that occurs with heavy drinking?
Atrial-Fib
Ventricular Tachycardia can also be seen but is unusual and more rare than atrial dysrhythmias
500
Which of the following medications will treat the underlying cause of her symptoms?
Sodium bicarbonate
TCA overdose.
Terminal R wave (>3mm) in aVR
R to S ratio > 0.7 in aVR
QRS prolongation.
50ml of Sodium Bicarb raises pH by 0.1
500
What is the 21 hour IV protocol for Acetaminophen toxicity overdose?
*DOUBLE YOUR POINTS if you can tell me the Oral protocol and $50 if you can say which is more effective?
IV
Loading dose of 150mg/kg (max 15g) over 1 hour, followed by 50mg/kg over 4 hours, followed by 100mg/kg over 16 hours
ORAL
Loading dose 140mg/kg PO followed by...
70mg/kg PO every 4 hours for a total of 17 doses.
500
Traces of cannabis were discovered in pipes recovered from who's home in Stratford-upon-Avon?
William Shakespear
500
Heroin's metabolite 6-monoacetylmorphine (6-MAM) can be detected in a UDS. Much like heroin, however, 6-MAM has a short half-life making rapid detection difficult. What is the half life?
(30–40 min)
500
Therapeutic range when using ethanol for toxic alcohol ingestion
100-150 mg/dL