3 rd year toxicology core facts:
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3 rd 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):. - PowerPoint PPT PresentationTRANSCRIPT
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3rd Year Toxicology Core Facts:
Zohair A. Al Aseri MD, FRCPC EM & CCMChairman and Assistant Professor , DEMCollege of Medicine King Saud UniversityConsultant Emergency Medicine and Intensivist King Saud University, Medical City
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1-Following drugs can cause Bradycardia (PACED):
Propranolol (beta-blockers), poppies (opiates), propoxyphene, physostigmineAnticholinesterase drugs, antiarrhythmicsClonidine, calcium channel blockersEthanol or other alcohol,Digoxin, digitalis
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Following drugs can cause Tachycardia (FAST):
Free base or other forms of cocaine, Anticholinergics, antihistamines, antipsychotics, amphetamines, alcohol withdrawalSympathomimetics (cocaine, caffeine, amphetamines, PCP), solvent abuse, strychnineTheophylline, TCAs, thyroid hormones
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Hypothermia (COOLS) may be seen in poisoning with:
Carbon monoxideOpioidsOral hypoglycemics, insulinLiquor (alcohols)Sedative-hypnotics
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Hyperthermia (NASA) may seen in poisoning with:
Neuroleptic malignant syndrome, nicotineAntihistamines, alcohol withdrawalSalicylates, sympathomimetics, serotonin syndromeAnticholinergics, antidepressants, antipsychotics
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Hypotesion (CRASH) may seen in poisoning with:
Clonidine, calcium channel blockersRodenticides (containing arsenic, cyanide)Antidepressants, aminophylline, antihypertensivesSedative-hypnoticsHeroin or other opiates
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Hypertension (CT SCAN) may occur after poisoning with:
CocaineThyroid supplementsSympathomimeticsCaffeineAnticholinergics, amphetaminesNicotine
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Poisoning with following may lead to an elevated anion gap:
Methanol, metformin, massive overdosesEthylene glycolTolueneAlcoholic ketoacidosisLactic acidosisAcetaminophen (large overdoses)Cyanide, carbon monoxide, colchicineIsoniazid, iron, ibuprofenDiabetic ketoacidosisGeneralized seizure-producing toxinsAcetylsalicylic acid or other salicylatesParaldehyde, phenformin
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Cholinergic toxidrome
(caused by organophosphorus, carbamate, pilocarpine) is characterised by:
Diarrhea, diaphoresisUrinationMiosisBradycardia, bronchosecretionsEmesisLacrimationLethargicSalivation
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Nicotinic toxidrome (recalled by days of the week) is characterised by:
Monday: MiosisTuesday: TachycardiaWednesday: WeaknessThursday: TremorsFriday: FasciculationsSaturday: SeizuresSunday: Somnolent
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Toxins accessible to haemodialysis:
UremiaSalicylatesTheophyllineAlcohols (isopropanol, methanol), Ethylene glycolBoric acid, barbituratesLithium
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Paracetamol (Acetaminophen),
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Q; Acetaminophen (paracetamol) can undergo all of the following biotransformation reactions EXCEPT
a. Deaminationb. N-oxidationc. Glucuronidationd. Sulphatione. Glutathione conjugation
Answer a
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N-acetyl-p-benzoquinonimine (NAPQI) is the toxic metabolic product of:
a. Acetyl-salisylic acidb. Acetamiophen (paracetamol)c. Mefanemic Acidd. Ibuprofen
Answer b
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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. 2 Hours from time of ingestionb. 4 Hours from time of ingestionc. 8 Hours from time of ingestiond. 24 Hours from time of ingestion
Answer b
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Salicylic acid (aspirin)
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Opioids
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ANTIDOTEAntidote Indication (agent)n-acetylcysteineEthanol/fomepizole (4-MP)Oxygen/hyperbaricsNaloxone/nalmefenePhysostigmineAtropine/pralidoxime (2-PAM)Methylene blueNitritesDeferoxamineDimercaprol (BAL)Succimer (DMSA)Fab fragmentsGlucagonSodium bicarbonateCalcium/insulin/dextroseDextrose, glucagon, octreotide
AcetaminophenMethanol/ethylene glycolCarbon monoxideOpioidsAnticholinergicsOrganophosphatesMethemoglobinemiaCyanideIronArsenicLead, mercuryDigoxin, colchicine, crotalidsBeta-blockersTricyclic antidepressantsCalcium channel antagonistsOral hypoglycemic