5/5/2016

ToxicologySTEP2/3DrugsStep2&3Medbullets.com

Search

Step1
Cards

Step2&3

Derm

Endo

ENT

QBank
GI

Gyn

Cases
Heme

ID

Videos
Neuro

Nutri

Posts
OB

Onc

Ophtho

Ortho

Author:DamianApollo

TopHighYieldTopics

ToxicologyDrugIntroduction

Analgesics

Antibiotics
Antivirals
CardiovascularMedications
EndocrineMedications

Treatment

Pulm

Poison(s)
MetallicPoisoning

ObstetricMedications

Renal

Rheum

Feedback

Anatomy

Drugs

Notes

Iron

Usedforaluminumpoisoninginrenal
failure
Usedinironoverloadwithrepeat
transfusions(thalssemia)
Ironoverload,hemochromatosis

Prussianblue

Cesium
Thallium

Usedinthecaseofaradioactiveincident

Penicillamine

Copper(Wilson's
disease)

Watersolubleformofpenicillin
Avoidinpatientswhohavepenicillin
allergy
Chelatescopper

EDTA

Lead

Canchelateanddepletecalciumions

Dimercaprol(BAL)

Arsenic
Lead
Mercury

UsedinconjunctionwithEDTAforlead
poisoning

Succimer

Arsenic
Lead
Mercury

Usedmorecommonlyinchildren

Deferoxamine

Toxicology

PulmonaryMedications

Psych

About

Immunosuppressants

PsychiatricMedications

Peds

Messages

Toxicologymedicationscanbebrokendownintothefollowingcategories
metallicpoisoning
gaspoisoning
prescriptiondrugsoverdose
illegaldrugsoverdose
householdsubstanceoverdose

AnesthesiologyMedications

OncologyMedications

Colleagues

19

Topicupdatedon03/22/1611:59am

DrugsbySpecialty

GastrointestinalMedications

Groups

Signin

Joinnow

Toxicology

STEP2/3Drugs

ENTMedications

Deferasirox

GasPoisoning
100%O2(consider
hyperbaricO2)

Carbonmonoxide
(CO)

CObindswithmuchgreateraffinitythan
O2

Cyanide

Cyanidefoundinrodenticides"gopher
goitter",releasedinburningofplastics
andwool,andplantssuchascassava
Cyanidebindscytochromecofthe
electrontransportchain(ETC)arresting
cellularrespiration
Nitritescreatemethemoglobin(Fe3+)
intentionallytocompeteforandbind
cyanidesoitdoesnotgettotheETC

Amylandsodium
nitrite

Sodiumthiosulfate
Hydroxycobalamin

PrescriptionDrugOverdose
http://www.medbullets.com/step23drugs/21613/toxicology

1/5

5/5/2016

ToxicologySTEP2/3DrugsStep2&3Medbullets.com

Acetaminophen

Nacetylcysteine

Step1
Cards

Step2&3

Derm

Endo

ENT

QBank
GI

Gyn

Cases

Search

Videos

Sodiumbicarbonate
Heme ID Neuro Nutri

STEP2/3Drugs

Posts

Groups

Salicylates
OB Tricyclic
Onc Ophtho Ortho
antidepressants
(TCA)

Bestifgivenwith810hours
Alsoamucolytic

Joinnow

Signin

FirstsignofODishyperventilationand
Messages
About
Feedback
respiratoryalkalosis
Peds Donotgivewithphysostigmine
Psych Pulm Renal Rheum Anatomy Drugs
FirstcheckanEKGforQRSprolongation,
thentreatwithsodiumbicarbonateinTCA
overdose
Colleagues

DrugsbySpecialty
TopHighYieldTopics
Analgesics

Radioactiveiodine
(I131)

GiventopreventtheuptakeofI131

Amphetamines
(basic)

Eliminatesamphetaminesbyacidifying
urinewhichresultsinacharged
amphetaminemoleculewhichisexcreted

Anticholinesterases
Organophosphates
Sarin(nervegas)

Removedcontaminatedclothingifpatient
wasexposedtoinsectisides
Atropineasananticholinergicand
combatstheexcessAch
Pralidoximeifgiveninatimelymanner
regeneratesacetylcholinesterase
reversingthecondition(timingiscritical)

Antimuscarinic
Anticholinergic
agents
Atropineoverdose

DonotgiveifpatientmayhaveTCAOD
asitmayleadtoheartblockorasystole
Tertiaryaminethatcancrosstheblood
brainbarrierandreverseanticholinergic
effectsintheCNS

Opioids

Precipitateswithdrawalsymptomsin
chronicopioidusers
Useinpatientswithrespiratory
depression
OpioidwithdrawalwillNOTkillapatientit
isjustunpleasant

Flumazenil

Benzodiazepines

Maycauseseizuresinaddicted
benzodiazepineusers
Rarelyusedwithbenzodiazepine
overdoseunlessconcernedforrespiratory
depression
Otherwiseletthepatient"sleepoff"the
benzodiazepines

Glucagon

blockers

IMglucagonbesttoreversebetablocker
overdose

blockers
(propranolol,
esmolol)

Theophylline

ODsymptomsaredueto2activation:
hypotension,tachycardia,hypokalemia,
hyperglycemia

Digitalisantibody,
lidocaine,Mg2+

Digitalis

VisualandGIsymptomsclassicallyseen
inoverdose

Methemoglobin

IroninthehememoleculeisFe3+which
cannotbindoxygenuntilitisreducedto
Fe2+bytreatment

Potassiumiodide

AnesthesiologyMedications
Antibiotics
Antivirals

Ammoniumchloride
(NH4Cl,acidic)

CardiovascularMedications
EndocrineMedications
ENTMedications
GastrointestinalMedications

Atropine

Immunosuppressants
ObstetricMedications
OncologyMedications
Toxicology

Pralidoxime

PsychiatricMedications
PulmonaryMedications

Physostigmine

Naloxone/naltrexone

Methyleneblue
VitaminC
http://www.medbullets.com/step23drugs/21613/toxicology

2/5

5/5/2016

ToxicologySTEP2/3DrugsStep2&3Medbullets.com

Aminocaproicacid

tPA
Streptokinase

VitaminK
Warfarin

Bridgewithheparinaswarfarincan
depleteproteinCandSfirst
(anticoagulants)leadingtoaninitial
prothromboticstate

Heparin

Protamineisahighlypositivelycharged
peptidewhichstronglybindstothe
negativelychargedheparin

Plasmainfusion

Protamine

HouseholdSubstanceOverdose
EthanolIVinfusion
Fomepizole

Causticfluid

Antifreeze
(ethyleneglycol)
Methanol

Thinkantifreezewheningestedsubstance
issaidtobesweetandindividualappears
"drunkwithoutthetypicalsmellofalcohol"

Perform
endoscopy
Irrigationx15mins
forocular
exposure

Donottrytoinducevomitinginpatient
Couldperhapsusesmallamountof
diluent

Other
Antivenin

Rattlesnakebite

IronPoisoning
Mostdeathsduetoironpoisoning(ingestionofirontablets)occurinchildrenbetween1224
monthsofage
Symptomsoccurwithin30mintoseveralhours
abdominalpain,diarrhea,vomiting
cyanosis,drowsiness,hyperventilationresultingfromacidosis
Deathcanresultinsixhours,butanapparentrecoverymayhappenfrom612hourswithdeath
ensuinginthenext12hours
Ifnottreatedearly,damagetothestomachcanleadtopyloricstenosisorgastricscarring
Earlytreatmentwithdeferoxaminecanreducemortalitysignificantlyfrom45%to1%
Mechanismofactionofironrelateddamage
ironoverdoseresultsintheperoxidationofmembranelipidsleadingtocelldeath
MethanolandEthyleneGlycolToxicity
Eacharecompetitivesubstratesforalcoholdehydrogenase
(ADH)
Methanol
metabolizedbyADHtoformaldehydefollowedby
aldehydedehydrogenasetoformformicacidwhichis
toxictotheopticnerve
earlytoxicityofformicacidismetabolicacidosisby
formicaciditself
formicacidalsobindstocytochromeoxidase
blockingoxidativephosphorylation
resultinginlacticacidosiswhichisthelatterandleadingcauseofthemetabolic
acidosis
signsandsymptomsappearwithin1224hoursafteringestion
CNSdepression
methanolactssimilarlyasethanolasaCNSdepressant
metabolicacidosis
visualchanges
blindnessoccurswithaslittleas30mLanddeathat100mLingestion
Ethyleneglycol
colorless,odorless,sweettastingliquid
toxicityderivesfromthehepaticoxidationofethyleneglycoltooxalicacid
http://www.medbullets.com/step23drugs/21613/toxicology

3/5

5/5/2016

ToxicologySTEP2/3DrugsStep2&3Medbullets.com

degradedbysamepathwayasmethanol
theglycolicacidproducedbyaldehydedehydrogenaseisconvertedinoxalic
acid
oxalicacidbindscalciumandformscalciumoxalatecrystalsthatdamagetheheart,
brain,lungs,kidneys
signsandsymptomsdevelopinstagesafteringestion
firststage:0.512hours
strongerinebriantthanmethanolandethanolcausingmilddepressionofCNS
resultinginseizuresandcoma
patientsappear"drunkwithoutsmellinglikealcohol"
within412hours,calciumoxalatecrystalsdepositinthebraincausingCNS
toxicity,cerebraledema,meningismus(nuchalrigidity,photophobia,headache
withoutinfectionorinflammation)
hypocalcemiaoccursduetobindingofcalciumbyoxalicacidandcancause
prolongedQT,arrhythmias,myocardialdepression
secondstage:1224hours
tachypneaoccurstooffsetthemetabolicacidosisduetothetoxicmetabolites
produced
multiorganfailure(CHF,lunginjury,myositis)duetowidespreadcrystal
deposition
NOTE:mostdeathsoccurinthesecondstage
thirdstage:2472hours
acuteanuricrenalfailurefromcrystaldepositionbutfullrecoveryoccurswithin
weekstomonths
Treatment
IVethanol
competitivesubstrateforADHandhasgreateraffinityforADHthanmethanoland
ethyleneglycol
fomepizole
inhibitsADHpreventingproductionoftoxicmetabolites
Miscellaneous
Whenbehavioralchangesarerecognizedinadolescentsscreenforsubstanceuse

RATECONTENT

AVERAGE5.0of2
RATINGS

Qbank(13Questions)
Question: 1

of13

NextQuestion

TAG
(M3.PH.3)Afiveyearoldgirlcomestotheemergencydepartmentcrying,holdingherstomachandcoughingup
pinkishsputum.Herfatherfranticallyreportstoyouthatshe"swallowedsomething"athomeabouttwohoursago.
Afterappropriateairwayandhemodynamicstabilization,youwouldnextperformesophagogastroduodenoscopy
(EGD)ifthefathertellsyouthatthepatienthadingested: ReviewTopic
1.
2.
3.
4.
5.

Ironpills
Cyanide
Anticholinergics
Acetaminophen
Draincleaner

PREFERREDRESPONSE

Evidence&ReferencesShowReferences

TopicComments

Subscribestatus:

On

Off

Pleaselogintoaddcomment.

http://www.medbullets.com/step23drugs/21613/toxicology

4/5

5/5/2016

ToxicologySTEP2/3DrugsStep2&3Medbullets.com

http://www.medbullets.com/step23drugs/21613/toxicology

5/5