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Toxicological Jeopardy

Toxicological Jeopardy. Toxic Tidbits. Picture That. Street Drugs And Salicylates. Antidotes And Anecdotes. Name That Toxidrome. 100. 100. 100. 100. 100. 200. 200. 200. 200. 200. 300. 300. 300. 300. 300. 400. 400. 400. 400. 400. 500. 500. 500. 500. 500. 750. 750.

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Toxicological Jeopardy

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  1. Toxicological Jeopardy

  2. Toxic Tidbits Picture That Street Drugs And Salicylates Antidotes And Anecdotes Name That Toxidrome 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 750 750 750 750 750 Final Jeopardy

  3. Toxic Tidbits Acute Lithium toxicity is characterized by which of the following? • Seizures, hypotension, arrhythmias • Rotary nystagmus, Agitation, hypertension • GI symptoms, tremor, hyprerreflexia • Hypoglycemia, tremor, AMS Toxic Tidbits $100 (1 of 1)

  4. Toxic Tidbits Overdose of which of the following is most likely to result in a metabolic acidosis? • Captopril • Furosemide • Acetaminophen • Metformin Toxic Tidbits $200 (1 of 1)

  5. Toxic Tidbits Alkaline diuresis enhances the excretion of all of the following substances Except? • Phenobarbital • Chlorpropamide • Salicylate • Pentobarbital Toxic Tidbits $300 (1 of 2)

  6. Pentobarbital • All the other substances except pentobarbital can be enhanced by urinary alkalinization • Increasing the ionized form of weak acids increases their water solubility, therefore, more eliminated in urine rather than distributing to tissues HA H + + A - Toxic Tidbits $300 (2 of 2)

  7. Toxic Tidbits After an overdose of captopril, which of the following electrolyte disturbances Is most likely to occur? • Hypokalemia • Hypocalcemia • Hypercalcemia • Hyperkalemia Toxic Tidbits $300 (1 of 2)

  8. Angiotensinogen Substance P Renin PG synthesis Bradykinin Angiotensin I X X ACE I Angiotensin II NE release Inactive Peptide Vasodilation ADH Aldosterone Peripheral Vascular Resistance H2O Resorption Na+ Resorption K+ Excretion H2O Resorption Na+ Resorption Vasoconstriction Blood Pressure Blood Pressure Toxic Tidbits $300 (2 of 2)

  9. Toxic Tidbits Serotonin Syndrome is most likely to occur with combination of which of the following? • Prozac and Ambien • Lexapro and Demerol • Linezolid and Etomidate • Lithium and Valproic Acid Toxic Tidbits $400 (1 of 1)

  10. Toxic Tidbits A 3 y/o female presents with a BG level of 14mg/dl. Labs show an elevated prolactin, GH, insulin and C peptide, UDS (-) What was the child exposed to? • Rosiglitazone • Metformin • Glyburide • insulin Toxic Tidbits $500 (1 of 2)

  11. Sulfonylurea Mechanism sulfonylurea Ca KATP Sulfonylurea receptor I K+ I I I Pancreatic  cell insulin Toxic Tidbits $500 (2 of 2)

  12. Toxic Tidbits (+) anion gap, (-) osmol gap, (+) ketones is seen with which of the Following? • Alcoholic Ketoacidosis • Ethylene Glycol • Isopropanol • Methanol Toxic Tidbits $750 (1 of 1)

  13. Antidotes And Anecdotes A 48 year old male develops chest pain, dyspnea and cyanosis shortly after the administration of Benzocaine. Which of the following should be administered? A) Nitroglycerin B) Methylene Blue C) Physiostygmine D) Narcan Antidotes And Anecdotes $100 (1 of 2)

  14. Medications Amyl nitrite Benzocaine Dapsone Lidocaine NTG Nitroprusside Phenacetin Phenazopyridine Prilocaine Quinones Sulfonamides Chemical Agents Anline dyes Butyl nitrite Chlorobenzene Fires Nitrates Isobutyl nitrite Napthalene Nitrophenol Nitrous gases Silver nitrate Trinitrotoluene Antidotes And Anecdotes Antidotes And Anecdotes $100 (2 of 2)

  15. Antidotes And Anecdotes A 16 year old male ingested 20 (200mg) INH tablets prior to ED arrival. He is actively seizing, what course of action should be taken? • Administer IV valium 5mg • Administer IV pyridoxine 2 grams • Administer IV PHB 20mg/kg IV • Administer IV pyrodoxine 4 grams Antidotes And Anecdotes $200 (1 of 2)

  16. MECHANISM OF INH TOXICITY GLUTAMIC ACID DECARBOXYLASE GLUTAMIC ACID GABA PYRIDOXAL 5` PHOSPHATE INH INHIBITS INH INACTIVATES PYRIDOXINE PHOSPHOKINASE INH ENHANCES URINARY ELIMINATION PYRIDOXINE Antidotes And Anecdotes $200 (2 of 2)

  17. Antidotes And Anecdotes Which of the following is NOT a mechanism by which N-acetylcysteine works to prevent APAP induced hepatotoxicity? • Precursor for Glutathione synthesis • A substrate for sulfonation • Directly Binds NAPQUI • Increase CYP2E1 activity Antidotes And Anecdotes $300 (1 of 2)

  18. Antidotes And Anecdotes $300 (2 of 2)

  19. Antidotes And Anecdotes Which of the following is not a component of the cyanide antidote kit? • Amyl nitrate • Amyl nitrite • Sodium nitrite • Sodium thiosulfate Antidotes And Anecdotes $400 (1 of 2)

  20. Antidotes And Anecdotes $400 (2 of 2)

  21. Antidotes And Anecdotes Side effects of administration of Deferoxamine include which of the Following? A) Hypotension B) ARDS C) Increased risk or Yersinia Infections D All of the above Antidotes And Anecdotes $500 (1 of 2)

  22. Deferoxamine Challenge Dose Administered Antidotes And Anecdotes $500 (2 of 2)

  23. Antidotes And Anecdotes How many vials of Digibind should be given to a 70kg male with acute digoxin Toxicity and a level of 7ng/mL? A) 4 vials B) 5 vials C) 6 vials D) 10 vials Antidotes And Anecdotes $750 (1 of 2)

  24. Inhibition of Na-K-ATPase heart skeletal muscle rise in Nai+ and Cai++ baroceptors [Nai+] rise in Nai+ and Cai++ [Ko+] automoticity [Cai++] firing hyperkalemia premature beatsescape rhythmsV-tach, V-fib vagal tone bradycardia, AV blocks, asystole contractility

  25. Picture That Name the toxin Picture That $100 (1 of 4)

  26. Picture That Name the toxin Picture That $100 (2 of 4)

  27. Picture That Name the toxin Picture That $100 (3 of 4)

  28. Jimson Weed(datura stramonium) • Anticholinergic Plants • Atropa belladonna (deadly nightshade) • Cestrum nocturnum (night blooming jessamine) • Datura suaveolens (angel’s trumpet) • Datura stramonium (jimson weed) • Hyoscyamus niger (black henbane) • Lantana camara (red sage) • Solanum carolinensis (wild tomato) • Solanum dulcamara (bittersweet) • Solanum pseudocapsicum (Jerusalem cherry) • Solanum tuberosum (potato) • Arctium lappa (burdock root) Picture That $100 (4 of 4)

  29. Picture That Name the toxin Picture That $200 (1 of 5)

  30. Picture That Name the toxin Picture That $200 (2 of 5)

  31. Picture That Name the toxin Picture That $200 (3 of 5)

  32. Picture That Name the toxin Picture That $200 (4 of 5)

  33. Picture That Name the toxin Picture That $200 (5 of 5)

  34. Picture That Picture That $300 (1 of 3)

  35. Picture That Ingestion/exposure to the previously pictured plant is most likely to result in? • Hyponatremia • Contact Dermatitis • Arrhythmias • Flatulence Picture That $300 (2 of 3)

  36. Picture That Picture That $400 (1 of 2)

  37. Picture That Which of the following should be administered to the patient after an unknown overdose with the previous EKG? • Physiostigmine • Calcium Salts • Glucagon • Sodium Bicarbonate Picture That $400 (2 of 2)

  38. Picture That Picture That $500 (1 of 2)

  39. Picture That Which toxin is found in the pictured mushroom? • Ibotenic acid • Psilocybin • Gyromitrin • muscarine Picture That $500 (2 of 2)

  40. Picture That Picture That $750 (1 of 2)

  41. Picture That What is the name of the toxin found in the pictured fish? • Cigutoxin • Domoic acid • Tetrodotoxin • Scrombroid Picture That $750 (2 of 2)

  42. Salicylates The minimal toxic dose (mg/kg) of salicylates is? • 100 • 50 • 25 • 150 Salicylates $100 (1 of 2)

  43. Salicylates: Toxic Dose • Therapeutic Range: 10–15 mg/kg • Mild Toxicity: 150 mg/kg • Moderate Toxicity: 150-300 mg/kg • Severe Toxicity: > 300 mg/kg Salicylates $100 (2 of 2)

  44. Street Drugs An 18 year old female presents to the Emergency Department obtunded. She is intubated but self extubates shortly after. She is now awake, alert and appropriate. Which of the following may be responsible? • GHB • Gamma-butyrolactone • 1,4-butanediol • All of the above may be responsible Street Drugs $200 (1of 3)

  45. GHB dehydrogenase GABA transaminase GABA transaminase Succinic semialdehyde reductase Tissue lactonases Nonenzymatic hydrolysis B-oxidation GABAB Receptor Trans-4-hydroxycrotonic acid GHB-receptor Street Drugs $200 (2of 3)

  46. Alcohol Dehydrogenase HO NAD NADH NAD Aldehyde dehydrogenase NADH B-oxidation Trans-4-hydroxycrotonic acid GHB-receptor GABAB Receptor Street Drugs $200 (3of 3)

  47. Salicylates As a salicylate poisoned patient becomes more acidotic, more salicylate will exist in the ____ form and the volume of distribtuion ____. • Ionized, decreases • Unionized, increases • Unionized, decreases • Ionized, increases Salicylates $300 (1 of 3)

  48. Salicylates $300 (2 of 3)

  49. Volume of distribution (Vd) • Apparent volume the drug is dissolved in • Measured in Liters or Liters/Kg • not a real volume Salicylates $300 (3 of 3)

  50. Salicylates Hyperthermia, occuring in salicylate toxicity, is secondary to? • Inhibition of the krebs cycle • Uncoupling of oxidative phosphorylation • Stimulation of lipid metabolism • Increasing capillary permeability Salicylates $500 (1 of 1)

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