Toxicology

Substance Use Disorders

Mechanism Medication Indications
Adenosine antagonists Caffeine Stimulant
NN [Ganglionic] agonists Nicotine Stimulant
NDRI Cocaine Stimulant
  Amphetamine
MDMA [Ecstasy]
Stimulant
Hallucinogen
5-HT2 agonists Lysergic acid diethylamide (LSD) Hallucinogen
NMDA antagonists Ketamine
Phencyclidine (PCP) [Angel dust]
Hallucinogen
Cannabinoid agonists Cannabis [Marijuana] Hallucinogen
- Psilocybin Hallucinogen
GABAA agonists Alcohol Depressant
GABAB agonists γ-Hydroxybutyrate (GHB) Depressant
μ-opioid agonists Heroin Depressant

Treatment of Substance Use Disorders

Subtance Toxicity Withdrawal Cessation
Nicotine - - Nicotine
Varenicline
Bupropion
Cocaine Benzodiazepines - -
Phencyclidine (PCP) Benzodiazepines - -
Benzodiazepines Flumazenil Benzodiazepines -
Alcohol - Benzodiazepines Disulfiram
Naltrexone
Opioids Naloxone Opioids
Clonidine
Guanfacine
Methadone
Buprenorphine

Antidotes for Toxins

Toxin Antidotes
Acetaminophen N-acetylcysteine
Anticholinesterases
Organophosphates
Atropine
Pralidoxime
Anticholinergics Physostigmine
Botulism Antitoxin
β antagonists Glucagon
Ca channel blockers Calcium
Cocaine Benzodiazepines
Phencyclidine (PCP) Benzodiazepines
Barbiturates NaHCO3
Benzodiazepines Flumazenil
Methanol
Propylene glycol
Ethylene glycol
Fomepizole
Ethanol
Opioids Naloxone
Valproate L-carnitine
Salicylate
TCAs
NaHCO3
Sulfonylureas Octreotide
Digitalis Anti-digitalis
K & Mg
Warfarin FFP / PCC
Vitamin K
Heparin Protamine sulfate
Factor 10a inhibitors FFP / PCC
Andexanet alfa
tPAs Cryoprecipitate
Antifibrinolytics
Arsenic [As]
Mercury [Hg]
Gold [Au]
Succimer
Dimercaprol
Iron [Fe] Deferasirox
Deferoxamine
Deferiprone
Copper [Cu] Penicillamin
Trientine
Lead [Pb] Succimer
Dimercaprol
EDTA
Lithium [Li] Hemodialysis
Carbon monoxide [CO] 100% O2
Hyperbaric O2
Cyanide Hydroxocobalamin
Thiosulfate
Nitrites
Methemoglobin Methylene blue
Vitamin C

Comparison Between CO Poisoning and Methemoglobinemia

Disorder SpO2 SaO2 PaO2
CO Poisoning - -
Methemoglobinemia -

Presentation of Lead Poisoning {LEAD}

  • Lead [Burton] line
  • Encephalopathy
  • Erythrocyte basophilic stippling
  • Abdominal colic
  • Anemia :: sideroblastic anemia
  • Drops :: wrist & foot drop

Management of Lead Poisoning

Level (μg/dL) Management
5 ~ 45 Observation
45 ~ 70 Succimer
> 70 Dimercaprol
EDTA

CAGE Questions for Alcohol Use {CAGE}

  • Cut down
  • Anger
  • Guilty
  • Eye-opener

Clinical Effects of Blood Alcohol Concentration (BAC)

BAC (mg/dL) Effects
20 ~ 50 ↓ Fine motor coordination
50 ~ 100 ↓ Judgment
↓ Coordination
100 ~ 150 Gait disturbance
150 ~ 250 Lethargy
300 Coma
400 Respiratory depression

Timeline of Alcohol Withdrawal Symptoms

  • Tremors
  • Hallucinosis
  • Seizure & Sleep deprivation
  • Delirium tremens

Presentation of Fetal Alcohol Syndrome (FAS)

  • Intrauterine growth retardation (IUGR)
  • Short palpebral fissure
  • Midfacial hypoplasia
  • Smooth philtum
  • Thin vermilion border
  • Microcephaly
  • Mental retardation

Presentation of Digitalis Toxicity

  • Hyperkalemia
  • Blurry vision
  • Yellow halos
  • Bradycardia
  • ECG changes
    • AV blocks
    • Scooped ST segment
    • Bidirectional VT
  • GI symptoms