OTC'S
ALCOHOLS
PRESCRIPTION DRUGZ
VARIOUS OTHER TOXINS
SHROOMZ, BRAH
HEAVY METAL
100

WHAT IS THE TOXIC INGESTION DOSE FOR ACETAMINOPHEN?

>150 MG/KG (>7.5 GRAMS IN ADULTS)


100

WHAT IS THE TRIAD OF WERNICKE'S ENCEPHALOPATHY AND WHAT IS THE TREATMENT?

MENTAL STATUS CHANGE

OPHTHALMOPLEGIA

ATAXIA

TREATED WITH THIAMINE

KORSAKOFF'S PSYCHOSIS IS AMNESIA AND CONFABULATION

100

WHAT ARE THE CLOTTING FACTORS THAT WARFARIN BLOCKS?

II, VII, IX, X

100

GIVE 2 INDICATIONS FOR HYPERBARIC THERAPY FOR CARBON MONOXIDE POISONING?

CARBOXYHEMOGLOBIN LEVEL >25%

MENTAL STATUS CHANGE, SEIZURE, COMA

DYSRHYTHMIA, CARDIAC ISCHEMIA, SYNCOPE

HYPOTENSION

PREGNANCY WITH COHB>20% OR SIGNS OF FETAL DISTRESS

ABNORMAL CEREBELLAR EXAM

100

MOST MUSHROOM INGESTIONS WITH SYMPTOM ONSET OF <2 HOURS HAVE BENING COURSE, T/F

TRUE

MOST TOXIC MUSHROOMS HAVE A DELAYED ONSET OF INITIAL GI SYMPTOMS (>6 HOURS)

100

THIS HEAVY METAL WILL CAUSE ENCEPHALOPATHY, COMA, SEIZURES, PERIPHERAL NEUROPATHY (WRIST DROP), ANEMIA, NEPHROPATHY, BELLY PAIN

LEAD

200

WHAT IS THE ANTIDOTE FOR ACETAMINOPHEN AND WITHIN WHAT TIMEFRAME IS IT MOST BENEFICIAL?

N-ACETYLCYSTEINE

WITHIN 8 HOURS OF INGESTION


200

WHAT IS THE TREATMENT FOR ETHYLENE GLYCOL POISONING AND WHAT IS ITS TOXIC METABOLITE?

FOMEPIZOLE, ETHANOL (STOPS ALCOHOL DEHYDROGENASE FROM CONVERTING ETHYLENE GLYCOL TO TOXIC METABOLITES)

HEMODIALYSIS IF RENAL INSUFFICIENT, SEVERELY ACIDOTIC OR ETHYLENE GLYCOL LEVEL >50MG/DL

WILL RAISE ANION AND OSMOLAR GAPS

WILL NOT CAUSE KETOSIS

200

HOW DO YOU TREAT WARFARIN TOXICITY?

MAY GIVE ORAL VITAMIN K FOR NO OR MILD BLEEDING

GIVE 10MG OF VITAMIN K IV FOR SEVERE BLEEDING

FFP OR PROTHROMBIN COMPLEX CONCENTRATES (KCENTRA) FOR SEVERE BLEEDING

200

THIS TOXIC GAS SMELLS LIKE BITTER ALMONDS

CYANIDE

FIRES INVOLVING PLASTICS, NITROPRUSSIDE INFUSIONS, APRICOT PITS

200

WHAT ORGAN SYSTEM DOES THIS MUSHROOM EFFECT?

KIDNEYS

ORELLANINE (CORTINARIUS SPP.)

CAUSES RENAL FAILURE

TREATED WITH DIALYSIS AND POSSIBLE TRANSPLANT

200

THIS HEAVY METAL TOXICITY DEPENDS ON THE FORM AND ROUTE OF EXPOSURE

MERCURY

ELEMENTAL MERCURY - NO ABOSRBED IN GI TRACT, TOXICITY IS FROM INHALATION

INORGANIC MERCURY - GI SYMPTOMS, RENAL DYSFUNCTION

ORGANIC MERCURY - NEUROLOGIC MANIFESTATIONS

300

WHAT IS THE TOXIC METABOLITE OF ACETAMINOPHEN?

NAPQI

FORMED VIA P450 PATHWAY

300

THIS ALCOHOL CAUSES A STRONG ACETONE SMELL

ISOPROPANOLOL (RUBBING ALCOHOL)

CONVERTED TO ACETONE

LESS TOXIC THAN ETHYLENE GLYCOL OR METHANOL

CAUSES GASTRITIS, CNS DEPRESSION, HYPOTENSION (INDICATION FOR DIALYSIS)

WILL RAISE OSMOLAR GAP AND CAUSE KETOSIS

WILL NOT RAISE ANION GAP

300

WHAT TOXIDROME WOULD BE CAUSED BY AN MAOI OVERDOSE?

SYMPATHOMIMETIC LIKE TOXIDROME

MAOI BLOCK BREAKDOWN OF CATECHOLAMINES

AGED MEATS/CHEESES, ETOH, FAVA BEANS CAN CAUSE TYRAMINE REACTION (DANGEROUS INCREASE IN BLOOD PRESSURE)

TREAT SUPPORTIVELY, BENZOS

AVOID BETA BLOCKERS FOR HTN OR TACHYCARDIA


300

HOW DO YOU TREAT CYANIDE POISONING

IV HYDROXOCOBALAMIN

CYANOKIT

-INHALED AMYL NITRITE, IV SODIUM NITRITE AND IV SODIUM THIOSULFATE

-THESE INDUCE METHEMOGLOBINEMIA, WHICH WILL BIND CYANIDE AND STOP TOXICITY

300

NAME A SYMPTOM OF POISONING FROM THIS MUSHROOM

SEIZURES

HEPATIC TOXICITY

GYROMITRA SPECIES

TOXIN IS SIMILAR TO INH TOXICITY (SEIZURES ARE TREATED WITH PYRIDOXINE)

300

WHAT IS THE ANTIDOTE FOR LEAD POISONING?

SUCCIMER

EDTA

DIMERCAPROL

400

WHAT IS THE ANTIDOTE FOR IRON POISONING?

DEFEROXAMINE CHELATION

"VIN ROSE COLORED" URINE AFTER ADMINISTERING DEFEROXAMINE

CHARCOAL DOES NOT BIND IRON

400
THIS ALCOHOL CAUSES "SNOW STORM" BLURRY VISION

METHANOL

WINDSHIELD WASHER FLUID, SHELLACS, HILLBILLIES MAKING BAD BOOZE

BLURRED VISION FROM OPTIC DISC HYPEREMIA

400

NAME 2 SYMPTOMS OF SEROTONIN SYNDROME

INCREASED MUSCLE TONE/RIGIDITY, GREATER IN LOWER THAN UPPER EXTREMITIES

HYPERTHERMIA, AUTONOMIC DYSFUNCTION

CAUSATIVE AGENTS: MEPERIDINE, MAOI, DEXTROMETHORPHAN, SSRI, TCAs, COCAINE

TREATMENT: CYPROHEPTADINE (ANTISEROTONERGIC AGENT)

400

THIS DRUG OF ABUSE CAUSES ROTARY NYSTAGMUS

PHENYLCYCLIDINE (PCP)

400

WHAT IS THIS MUSHROOM CALLED?

DEATHCAP 

CAUSE OF MOST MUSHROOM DEATHS IN U.S.

HEPATOTOXICITY - COAGULOPATHY, ENCEPHALOPATHY

TREAT WITH ACTIVATED CHARCOAL, NAC

500

WHAT ARE SOME EARLY SYMPTOMS OF IRON POISONING?

GI TOXICITY: BELLY PAIN, DIARRHEA, VOMITING, GI BLEEDING

VASODILATION --> HYPOTENSION

SHOCK AND LACTIC ACIDOSIS FROM UNCOUPLING OF OXIDATIVE PHOSPHORYLATION

COAGULOPATHY

HEPATIC AND LIVER FAILURE

500

WHAT IS THE TOXIC METABOLITE OF METHANOL AND HOW DO YOU TREAT IT?

FORMIC ACID

TREATED WITH FOMEPIZOLE, ETOH, HEMODIALYSIS

DIALYSIS INDICATED IN RENAL INSUFFICIENCY, METHANOL LEVEL >25MG/DL, SEVERE ACIDOSIS, VISUAL SYMPTOMS

INCREASES ANION AND OSMOLAR GAP

DOES NOT CAUSE KETOSIS

500

WHAT ARE 2 SYMPTOMS OF TCA OVERDOSE?

DYSRHYTHMIAS, HTN, SEIZURES


500

WHAT IS THE TREATMENT OF CHOICE FOR DYSRHYTHMIAS FOR SOMEONE WHO "HUFFS" "BAGS" OR "SNIFFS" HYDROCARBONS?

BETA BLOCKERS

SUDDEN VENTRICULAR DYSRHYTHMIAS CAN BE CAUSED BY CARDIAC SENSITIZATION TO ENDOGENOUS CATECHOLAMINES

600

ARE IRON PILLS RADIOPAQUE?

YES

600
OVER WHAT QRS INTERVAL WOULD YOU TREAT FOR TCA OVERDOSE AND WHAT MEDICATION WOULD YOU GIVE?

>100MS

SODIUM BICARB

3% SALINE AND LIDOCAINE FOR REFRACTORY CASES

NOREPI FOR REFRACTORY HYPOTENSION

LIPID THERAPY FOR SEVERE AND REFRACTORY CASES

600

HOW TO DO YOU TREAT A CUTANEOUS HYDROGEN FLUORIDE EXPOSURE?

CALCIUM GLUCONATE GEL APPLIED TOPICALLY, AN INTRADERMAL INFILTRATION OR ARTERIAL INFUSION

STRONGLY BINDS CALCIUM AND MAGNESIUM

700

NAME 3 COMMON THINGS YOU CAN BUY OVER THE COUNTER THAT HAVE SALICYLATES IN THEM

ASPIRIN, OIL OF WINTERGREEN, BISMUTH SUBSALICYLATE (PEPTO)

700

HOW DO YOU TREAT A BETA BLOCKER OVERDOSE?

GLUCAGON

CALCIUM

PACING

EPINEPHRINE

INTRA-AORTIC BALLOON PUMP

INSULIN/GLUCOSE 

LIPID THERAPY

700

WHAT IS THE ANTIDOTE FOR ISONIAZID POISONING, AND WHAT SYMPTOM WILL IT LIKELY CAUSE?

PYRODXINE (B6)

SKEEZURES


800

DO SALICYLATES CAUSE RESPIRATORY ALKALOSIS, METABOLIC ACIDOSIS, OR BOTH

BOTH

RESPIRATORY ALKALOSIS FROM CENTRAL RESPIRATORY STIMULATION

METABOLIC ACIDOSIS FROM UNCOUPLING OF OXIDATIVE PHOSPHORYLATION


800

HOW DO YOU TREAT A CALCIUM CHANNEL BLOCKER OVERDOSE?

CALCIUM!

PRESSORS

INSULIN/GLUCOSE

INTRAAORTIC BALLOON PUMP

ATROPINE, PACING PROBABLY WON'T BE EFFECTIVE

800

NAME A TREATMENT FOR LITHIUM POISONING

IV FLUIDS

HEMODIALYSIS

INDICATIONS FOR DIALYSIS

-RENAL FAILURE

-INABILITY TO IV HYDRATE (CHF)

-CNS TOXICITY

-SYMPTOMATIC PATIENTS WITH LITHIUM LEVEL >4 IN ACUTE OVERDOSE

900

WHAT IS ONE SYMPTOM UNIQUE TO SALICYLATE OVERDOSE COMPARED TO OTHER MEDICATIONS?

TINNITUS

N/V, TINNITUS, RESP ALK, MET ACID, CEREBRAL EDEMA, SEIZURES


900

THIS BLOOD PRESSURE MEDICATION CAN MIMIC OPIATE OVERDOSE

CLONIDINE

SEDATION, HYPOTENSION, MIOSIS, BRADYCARDIA, RESPIRATORY DEPRESSION

HIGH DOSE NARCAN CAN REVERSE MENTAL STATUS DEPRESSION

FLUIDS

PRESSORS (NOREPI, PHENYLEPHRINE)


900

CHOCOLATE BROWN BLOOD IS INDICATIVE OF WHAT?

METHEMOGLOBINEMIA

NITRITES, NITRATES, DAPSONE, PHAZOPYRIDINE, BENZOCAINE CAN CAUSE OXIDATION OF IRON --> MET-HGB


1000

HOW DO YOU TREAT SALICYLATE OVERDOSE?

URINARY ALKALINIZATION (TO PH >7.5) WITH BICARB

HEMODIALYSIS INDICATIONS:

RENAL FAILURE

LUNG INJURY

MENTAL STATUS CHANGE

SALYCILATE LEVEL >100 IN ACUTE POISONING

SEVERE ACIDOSIS

RISING SALICYLATE LEVEL DESPITE URINE ALKALINIZATION

RISK OF VOLUME OVERLOAD

1000


FOXGLOVE

DIG PLANT


1000

IS PULSE OX RELIABLE IN METHEMOGLOBINEMIA?

NO

WILL READ ABOUT 85%

NEED CO-OX FOR ANALYSIS


1100

WHAT SYMPTOM IS UNIQUE TO DIGITALIS POISONING?

VISUAL ABERRATIONS (YELLOW-GREEN)


1100

METHYLENE BLUE IS THE TREATMENT FOR THIS

METHEMOGLOBINEMIA

1200

WHAT ARE INDICATIONS FOR DIGIFAB?

MALIGNANT DYSRHYTHMIAS

POTASSIUM >5

DIG LEVEL >15 ACUTELY OR >10 AFTER 6 HOURS

PACING IS CONTRAINDICATED DUE TO VENTRICULAR IRRITABILITY

CALCIUM IS ALSO CONTRAINDICATED ("STONE HEART THEORY", GIVING CALCIUM COULD CAUSE IRREVERSIBLE CONTRACTION OF THE MYOCARDIUM


1200

MEDICATIONS THAT CAUSE EXTRAPYRAMIDAL SYMPTOMS (HALDOL, DROPERIDOL, COMPAZINE) CAN CAUSE THIS CONDITION THAT IS A RARE CAUSE OF HYPERTHERMIA

NEUROLEPTIC MALIGNANT SYNDROME

MUSCLE TONE IS INCREASED, "STIFF AND HOT"

TREAT WITH COOLING MEASURES AND BENZOS

1300

A WASTE MANAGEMENT WORKER SUDDENLY LOSES CONSCIOUSNESS IN A SEWER, WHAT IS THE MOST LIKELY CAUSATIVE AGENT

HYDROGEN SULFIDE (H2S)

INHIBITS CYTOCHROME OXIDASE --> CELLULAR HYPOXIA