1. 3rd 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

2. 1-Following drugs can cause Bradycardia (PACED):
Propranolol (beta-blockers), poppies (opiates), propoxyphene, physostigmine Anticholinesterase drugs, antiarrhythmics
Clonidine, calcium channel blockers Ethanol or other alcohol,
Digoxin, digitalis

3. Following drugs can cause Tachycardia (FAST):
Free base or other forms of cocaine, Anticholinergics, antihistamines, antipsychotics, amphetamines, alcohol withdrawal Sympathomimetics (cocaine, caffeine, amphetamines, PCP), solvent abuse, strychnine Theophylline, TCAs, thyroid hormones

4. Hypothermia (COOLS) may be seen in poisoning with:
Carbon monoxide Opioids Oral hypoglycemics, insulin Liquor (alcohols) Sedative-hypnotics

5. Hyperthermia (NASA) may seen in poisoning with:
Neuroleptic malignant syndrome, nicotine Antihistamines, alcohol withdrawal Salicylates, sympathomimetics, serotonin syndrome Anticholinergics, antidepressants, antipsychotics

6. Hypotesion (CRASH) may seen in poisoning with:
Clonidine, calcium channel blockers Rodenticides (containing arsenic, cyanide) Antidepressants, aminophylline, antihypertensives Sedative-hypnotics Heroin or other opiates

7. Hypertension (CT SCAN) may occur after poisoning with:
Cocaine Thyroid supplements Sympathomimetics Caffeine Anticholinergics, amphetamines Nicotine

8. Poisoning with following may lead to an elevated anion gap:
Methanol, metformin, massive overdoses Ethylene glycol Toluene Alcoholic ketoacidosis Lactic acidosis Acetaminophen (large overdoses) Cyanide, carbon monoxide, colchicine Isoniazid, iron, ibuprofen Diabetic ketoacidosis Generalized seizure-producing toxins Acetylsalicylic acid or other salicylates Paraldehyde, phenformin

9. Cholinergic toxidrome (caused by organophosphorus, carbamate, pilocarpine) is characterised by:
Diarrhea, diaphoresis Urination Miosis Bradycardia, bronchosecretions Emesis Lacrimation Lethargic Salivation

10. Nicotinic toxidrome (recalled by days of the week) is characterised by:
Monday: Miosis Tuesday: Tachycardia Wednesday: Weakness Thursday: Tremors Friday: Fasciculations Saturday: Seizures Sunday: Somnolent

11. Toxins accessible to haemodialysis:
Uremia
Salicylates
Theophylline
Alcohols (isopropanol, methanol), Ethylene glycol
Boric acid, barbiturates
Lithium

12. Paracetamol (Acetaminophen),

13. Q; Acetaminophen (paracetamol) can undergo all of the following biotransformation reactions EXCEPT
a. Deamination
b. N-oxidation
c. Glucuronidation
d. Sulphation
e. Glutathione conjugation
Answer a

14. N-acetyl-p-benzoquinonimine (NAPQI) is the toxic metabolic product of:
a. Acetyl-salisylic acid
b. Acetamiophen (paracetamol)
c. Mefanemic Acid
d. Ibuprofen
Answer b

15. Q. N-Acetyl cystiene (NAC) is used as antidote for acetaminophen
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 ingestion
b. 4 Hours from time of ingestion
c. 8 Hours from time of ingestion
d. 24 Hours from time of ingestion
Answer b

16. Salicylic acid (aspirin)

17. Opioids

18. ANTIDOTE Antidote Indication (agent)
n-acetylcysteine Ethanol/fomepizole (4-MP) Oxygen/hyperbarics Naloxone/nalmefene Physostigmine Atropine/pralidoxime (2-PAM) Methylene blue Nitrites Deferoxamine Dimercaprol (BAL) Succimer (DMSA) Fab fragments Glucagon Sodium bicarbonate Calcium/insulin/dextrose Dextrose, glucagon, octreotide
Acetaminophen Methanol/ethylene glycol Carbon monoxide Opioids Anticholinergics Organophosphates Methemoglobinemia Cyanide Iron Arsenic Lead, mercury Digoxin, colchicine, crotalids Beta-blockers Tricyclic antidepressants Calcium channel antagonists Oral hypoglycemic