1.

TCA overdose
symptoms
-hyperthermia
-anticholionergic effects: dilated
pupils, intestinal ileus
-seizures
-QRS prolongation-->
ventricular arrhythmia
-death: hypotension
2. Managment of pt with
TCA overdose
-ABCs
-Sodium bicarbonate
--improves hypotension, long
QRS, ventricle arrhythmia
3. EKG finding in
hyperkalemia
-peaked T waves
-long PR and QRS intervals
-sine wave
4. antidotes of
anticholinesterase
toxicity (insecticides,
physostigmine,
donepezil)
atropine and pralidoxime
5. Most reliable
indication of opioid
toxicity
*dec respiratory rate
-miosis may or may not be seen
6. opioid intoxication
symptoms
*decreased respiratory rate
-hypotension, hypothermia, dec
bowel sounds, miosis
7. treatment of beta
blocker intoxication
-hypotension: IV fluids
-bradycardia: Atropine
-seizures: benzodiazepines
(lorazepam)
-IV glucagon, IV calcium salts,
Vasopressor (epinephrine), high
dose insulin and glucose
infusions, Lipid emulsion therapy
8. Beta Blocker
intoxication
symptoms
bradycardia and hypotension
9. Benzodiazepine
intoxication
symptoms
drowsiness, slurred speech,
unsteady gait
10. Treatment of
benzodiazepine
intoxication
Flumazenil
11. treatment of acute
opioid intoxication
naloxone- goal of inc respiratory
rate
12. Most important
feature of TCA
overdose
-QRS prolongation: best
predictor of seizures and
ventricular arrythmia
13. How do you decide
whether to administer
the antidote in
acetaminophen
poisoning?
-draw serum acetaminophen levels
AFTER FOUR HOURS of overdose
- Can administer N-acetylcysteine
w/in 8 hrs of ingestion
-four hours after ingestion is
minimum to predict hepatotoxic
effects of acetaminophen overdose
14. cyanosis and pink hue
to skin
Carbon monoxide poisoning
15. cyanosis and bluish
skin color
Methemoglobinuria
-due to antibiotics (trimethoprim,
sulfonamides and dapsone),
aniline dyes, nitrates
-blue baby syndrome: infant drinks
nitrates in water
-tx: O2 + methylene blue
16. Symptoms of carbon
monoxide poisoning
-Headaches, N/V, abdominal
discomfort, confusion, coma
-pink hue to skin
17. Diagnosis of carbon
monoxide poisoning
-h/o smoke inhalation, furnaces
-get carboxyhemoglobin levels
18. Treatment of carbon
monoxide poisoning
hyperbaric oxygen administration
19. Burning of rubber or
plastic can result in
what kind of
poinoning?
cyanide poisoning (v automobiles,
furnaces with carbon monxide)
20. Ethylene glycol v
methanol poisoning
symptoms
BOTH: substitutes for ethanol,
metab anion gap acidosis, inc
osmolar gap
methanol: optic disc hyperemia,
vision loss
ethylene: hypocalcemia, calcium
oxalate deposits in kidney-
hematuria, renal failure
21. Symptoms of aspirin
overdose
-anion gap metab acidosis, resp
alk
-tinnitis, fever, hyperventilation
22. Opioid withdrawal
symptoms
anxiety, insomnia, flu-like symp,
piloerection, fever, rhinorrhea,
lacrimation, yawning, nausea,
stomach cramps, diarrhea,
mydriasis
23. Treatment of
moderate to severe
symptoms of opioid
withdrawal
-clonidine, buprenorphine,
methadone
24. Treatment od mild
symptoms of opioid
withdrawal
antiemetics, muscle relaxants,
NSAIDs
AC(E) USMLE Step 2 Poisoning
Study online at quizlet.com/_dn9i1
25. ethanol and
sedative
withdrawal vs
opioid
withdrawal
features
-NO SEIZURES in opioid withdrawal
26. Management of
pt who ingested
strongly
alkaline
substance
-hospitalize, IV hydration, serial
abdominal and chest XRs
-endoscopy: assess esophageal damage
-perforation? Gastrografin study
27. complications
of ingesting
lye/alkaline
substance
-immediate esophageal damage -
liquefactive necrosis of esophageal wall
leading to perforation and mediastinitis
28. Symptoms of
ingesting an
alkaline or
caustic
substance
dysphagia, severe pain, heavy salivation
and mouth burns
-necrosis of tissue lining the GI tract
-perforation of the stomach or esophagus
can occur causing peronitis or
mediastinitis
29. Drugs that
cause
Neuroleptic
Malignant
Syndrome
dopaminergic antagonists, espcially
typical neuroleptics such as haloperidol
30. symptoms of
neuroleptic
malignant
syndrome
-hyperthermia (fever), muscle rigidity,
autonomic instability and mental status
changes
-elevated CK, leukocytosis
31. Symptoms of
ethylene glycol
poisoning
-hypocalcemia, calcium oxalte deposition
in kidneys--> flank pain, hematuria,
oligouria, renal failure
-anion gap metabolic acidosis
32. treatment of
ethylene glycol
poisoning
-Fomepizole or ethanol (ADH inhibition)
-Sodium bicarbonate to alleviate acidosis
-hemodialysis if end organ damage
33. danger of
typical
antipsychotic
medication and
cold
temperature
-Fluphenazine (more potent than haldol)
and other "typical" antipsychotics inhibit
autonomic thermoregulation, can get
extreme hhypothermia with prolonged
exposure to cold
-all patients taking antiipsychotic meds are
advised to avoid prolonged exposure to
extreme temperatures
34. Symptoms in
the first 6-12
hours of
alcohol
cessation
-anxiety, insomnia, tremors, diaphoresis
35. Symptoms in
the first 48 hrs
of alcohol
cessation
-Hallucinations and withdrawal seizures
-tachycardia, HTN,agitation, seizures
36. Symptoms within
4-7 days of alcohol
cessation
Delirium Tremens - HTN, agitation,
tachycardia, delirium, possible death,
autonomic instability
-mortality rate 5%
37. Treatment of
alcohol
withdrawal
Benzodiazepines -eg chlordiazepoxide
(Librium); CNS depressants that will
limit the effects of alcohol withdrawal
hallucinations- haloperidol
-thiamine, folate, multivitamin
replacement
38. Organophosphate
poisoning
symptoms
-inhibits acetylcholinesterase leading to
cholinergic excess: bradycardia, miosis,
rhonchi, muscle fasciculations,
salivation, lacrimation, urination,
defecation
39. Treatment of
organophosphate
poisoning
atropine, pralidoxime
40. Symptoms of Beta
blocker overdose
asthma exacerbation (wheezing),
bradycardia, AV block, hypotension,
potential cardiogenic shock
41. Treatment of beta
blocker overdose
-hypotension: IV fluids
-bradycardia: Atropine
-seizures: benzodiazepines (lorazepam)
-IV glucagon, IV calcium salts,
Vasopressor (epinephrine), high dose
insulin and glucose infusions, Lipid
emulsion therapy
42. treatment of TCA
overdose
-Sodium bicarbonate narrows the QRS
complex (thus preventing ventricular
arrhythmia) by increasing the
extracellular sodium conc
43. Treatment of
neuroleptic
malignant
syndrome
-dantrolene (muscle relaxant)
-bromocriptine (dopamine agonist)
-amantadine (antiviral with
dopaminergic properties)
44. Benzodiazepine
overdose v opioid
overdose
benzos: NO severe respiratory
depression, NO pupillary constriction
(usually but not always in opioid
overdose)
45. Benzodiazepine
overdose v alcohol
and phenytoin
intoxication
no nystagmus in benzos
46. Phenytoin toxicity
symptoms
horzontal nystagmus, cerebellar ataxia,
confusion
47. Symptoms of
diphenhydramine
overdose
-anti-histamine effects: drowsiness,
confusion
-anticholinergic effects: dry mouth,
dilated pupils, blurred vision, reduced
bowel sounds, urinary retention
48. Treatment of
diphenhydramine
overdose
physostigmine, a cholinesterase
inhibitor
49. Management of
Warfarin induced
bleeding
-Fresh frozen plasma - immediately
reverses action of warfarin
-Vitamin K - takes 8-12 d to be effective
50. urgent reversal of
heparin
protamine sulfate
51. Vit A def night blindness, dry skin
52. Vit B1/thiamine
def
-beriberi: polyneuritis, dilated
cardiomyoppathy, high output CHF,
edema
-Wernicke-Korsakoff syndrome
53. Vitamin B2 def angular stomatitis, cheilosis, corneal
vascularization
54. Vit B3/niacin def pellagra: diarrhea, dermatitis, dementia
55. Vit B5 def dermatitis, enteritis, alopecia, adrenal
insufficiency
56. Vit B6 def convulsions, hyperirritability; required
during INH treatment
57. Vit
B12/cobalamin
def
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, enteritis
caused by raw egg ingestion, or
antibiotic use
63. folic acid def -Most common vit def in US
-sprue, macrocytic, megaloblastic
anemia, without neuroologic symp
64. Magnesium def -lead to def Ca2+ and K
-weakness, muscle cramps,
hypocalcemic tetany, CNS
hyperirritability, tremors,
choreoathetoid movement
65. Selenium def Keshan disease (cardiomyopathy)
66. iron intoxication
symptoms
five phases:
30 min- 6 hours after ingestion: GI
phase (N/V, hematemesis, melena, abd
pain)
-6-24 hrs later: asx
-72 hrs; shock, metabolic acidosis
-12-96 hrs: hepatotoxicity
-iron tox>350
67. Tx of Neuroleptic
Malignant
Syndrome
-fever, muscle rigidity, auto instability,
AMS
-dantrolene (muscle relxant)
+bromociptine (dopa agonist)
+amantidine (antiviral with dopa
properties)
68. Tx of AV block
caused by Beta
blocker intox
-atropine and IV fluids
-glucagon
69. TCA overdose tx
pathophys
Sodium bicarbonate
-alkalinize serum, TCA then less
protein bound, dec bioavailability
-Na+ reverses the sodium channel
blocking effects of TCA
70. Bleomycin SE pulmonary fibrosis
71. cyclophosphamide
SE
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), gum
hypertrophy
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 pseudomembranous
colitis
90. chloramphenicol SE gray baby
syndrome, aplastic
anemia
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, renal
toxicity
98. chlorpropamide SE -old sulfonylurea
(its use no longer
recommended)
-SIADH
99. didanosine SE pancreatitis,
peripheral
neuropathy
100. halogen anesthesia SE malignant
hyperthermia
101. succinylcholine SE malignant
hyperthermia, CI in
hyperkalemia
102. Zidovudine SE bone marrow
supression
103. acetazolamide SE metabolic acidosis
104. HMG Co reductase inhibitors SE (simvastatin)
-muscle and liver
toxicity
105. ethambutol SE optic neuritis
106. metronidazole SE disulfiram reaction
with alcohol
107. cisplatin SE nephrotoxicity
108. methyldopa SE hemolytic anemia
(coombs test
positive)
109. SE alpha 1 antagonists (terazosin,
prazosin)
-first dose
orthostatic
hypotension
110. antidepressant that causes
depression
methyldopa
111. antidote for cholinesterase
inhibitors (insect repellant,
donepezil, rivastigmine,
pyridostigmine)
-atropine,
pralidoxime
112. antidote for
quinidine or TCAs
sodium bicarbonate (cardio-protective)
113. antidote for
digoxin
normalize potassium and other
electrolytes
114. antidote for
methanol/ethylene
glycol
-stabilize with Sodium bicarb,
benzodiazepine (anticonvulsant)
-ethanol, fomepizole
115. antidote for
benzodiazepines
(diazepam,
alprazolam)
flumazenil
116. antidote for beta
blockers
glucagon
117. antidote for lead EDTA
-use succimer for children
118. antidote for
copper or gold
penicillamine
119. antidote for
opioids
naloxone
120. antidote for
muscarinic
blockers (ex
scopolamine, or
atropine,
ipratropium)
-physostigmine (cholinesterase
inhibitor)
121. aspirin and nasal
polyps
do not give aspirin to pts with nasal
polyps bc hypersensitivity reactions
involving an asthmatic attack
122. Drug induced
lupus
-sx: fever, myalgias, arthralgias,
arthritis, erythematous rash in
sun exposed skin
-drugs: procainamide, hydralazine,
minocycline, diltiazem, penicillamine,
isoniazid, quinidine, anti-TNF alpha
therapy (infliximab and etanercept),
INF-alfa, methyldopa, chlorpromazine
123. Metronidazole SE -inhibits acetaldehyde dehydrogenase:
"disulfiram-like reaction" if taken with
alcohol!!
124. how does
acetominophen
cause liver toxicity
-metabolizes to form mercapturic acid
-needs conjugated to glutathione for
excretion
-depletion of glutathione, mercapturic
metabolites bind to hepatocytes-->
liver failure
125. metformin
toxicity
-lactic acidosis
-GI problems, nausea, diarrhea,
anorexia, abd pain
126. salicylate
poisoning sx
tinnitis, fever, vertigo
-anion gap metab acidosis + resp
alkalosis
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