{"id":5374,"date":"2011-09-06T15:55:33","date_gmt":"2011-09-06T15:55:33","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5374.htm\/"},"modified":"2021-08-07T14:44:20","modified_gmt":"2021-08-07T18:44:20","slug":"general-toxicology-random-drugs","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/general-toxicology-random-drugs.htm\/","title":{"rendered":"*General Principles and Random Drugs"},"content":{"rendered":"
“All things are poison and nothing is without poison.\u00a0 Solely the dose determines that a thing is without poison.”<\/p>\n
–Paracelsus<\/p>\n
<\/p>\n
Vaults of Erowid<\/a><\/p>\n www.lycaeum.org<\/a><\/p>\n www.householdproducts.nlm.nih.gov<\/a><\/p>\n www.ansci.cornell.edu\/plants<\/a><\/p>\n www.dartmouth.edu\/~toxmetal<\/a><\/p>\n www.toxed.com<\/a><\/p>\n www.microdex.com\/products\/poisondex<\/a><\/p>\n www.clinicalpharmacology-ip.com<\/a><\/p>\n <\/p>\n <\/p>\n PHAILS<\/p>\n P<\/strong>esticides;<\/p>\n H<\/strong>ydrocarbons;<\/p>\n A<\/strong>cids and a<\/strong>lkali;<\/p>\n I<\/strong>ron;<\/p>\n L<\/strong>ithium; and<\/p>\n S<\/strong>olvents<\/p>\n <\/p>\n ABCD<\/p>\n A<\/strong>ntimalarials (quinine) and a<\/strong>minophylline (theophylline);<\/p>\n B<\/strong>arbiturates (Phenobarbital) and b<\/strong>eta-blockers (nadolol);<\/p>\n C<\/strong>arbamazepine<\/p>\n D<\/strong>apsone<\/p>\n and D<\/strong>ilantin (Phenytoin)<\/p>\n Valproate<\/p>\n Theophylline<\/p>\n <\/p>\n Small Molecule, Low Protein Binding, Water Soluble<\/p>\n I STUMBLE<\/strong><\/p>\n I<\/strong>sopropyl Alcohol<\/p>\n S<\/strong>alicylates<\/p>\n T<\/strong>heophylline (caffeine)<\/p>\n U<\/strong>remia<\/p>\n M<\/strong>ethanol<\/p>\n B<\/strong>arbiturates, beta-blockers (water soluble, such as atenolol)<\/p>\n L<\/strong>ithium<\/p>\n E<\/strong>thylene glycol<\/p>\n <\/p>\n s<\/p>\n P<\/strong>ropranolol or other beta-blockers, poppies (opiates), propafenone, phenylpropanolamine<\/p>\n A<\/strong>nticholinesterase drugs<\/p>\n C<\/strong>lonidine, calcium-channel blockers<\/p>\n E<\/strong>thanol or other alcohols<\/p>\n D<\/strong>igoxin<\/p>\n <\/p>\n F<\/strong>ree base or other forms of cocaine<\/p>\n A<\/strong>nticholinergics, antihistamines, amphetamines<\/p>\n S<\/strong>ympathomimetics (cocaine, amphetamines), solvent abuse<\/p>\n T<\/strong>heophylline<\/p>\n \u00a0<\/strong><\/p>\n C<\/strong>arbon monoxide<\/p>\n O<\/strong>piates<\/p>\n O<\/strong>ral hypoglycemics, insulin<\/p>\n L<\/strong>iquor<\/p>\n S<\/strong>edative-hypnotics<\/p>\n \u00a0<\/strong><\/p>\n N<\/strong>euroleptic malignant syndrome, nicotine<\/p>\n A<\/strong>ntihistamines<\/p>\n S<\/strong>alicylates, sympathomimetics<\/p>\n A<\/strong>nticholinergics, antidepressants<\/p>\n \u00a0<\/strong><\/p>\n C<\/strong>lonidine, calcium-channel blockers<\/p>\n R<\/strong>eserpine or other antihypertensive agents<\/p>\n A<\/strong>ntidepressants, aminophylline<\/p>\n S<\/strong>edative-hypnotics<\/p>\n H<\/strong>eroin or other opiates<\/p>\n \u00a0<\/strong><\/p>\n C<\/strong>ocaine<\/p>\n T<\/strong>hyroid supplements<\/p>\n S<\/strong>ympathomimetics<\/p>\n C<\/strong>affeine<\/p>\n A<\/strong>nticholinergics, amphetamines<\/p>\n N<\/strong>icotine<\/p>\n \u00a0<\/strong><\/p>\n P<\/strong>CP, paraquat, pneumonitis (chemical)<\/p>\n A<\/strong>SA and other salicylates<\/p>\n N<\/strong>on-cardiogenic pulmonary edema<\/p>\n T<\/strong>oxin-induced metabolic acidosis<\/p>\n \u00a0<\/strong><\/p>\n S<\/strong>edative-hypnotics (including GHB)<\/p>\n L<\/strong>iquor<\/p>\n O<\/strong>piates, sedative-hypnotics<\/p>\n W<\/strong>eed (marijuana)<\/p>\n <\/p>\n C<\/strong>holinergics, clonidine<\/p>\n O<\/strong>piates, organophosphates<\/p>\n P<\/strong>henothiazines, pilocarpine<\/p>\n S<\/strong>edative-hypnotics<\/p>\n \u00a0<\/strong><\/p>\n A<\/strong>ntihistamines<\/p>\n A<\/strong>ntidepressants<\/p>\n A<\/strong>tropine and other anticholinergics<\/p>\n S<\/strong>ympathomimetics<\/p>\n <\/p>\n (MOPS)<\/strong><\/p>\n M<\/strong>eprobamate, methadone<\/p>\n O<\/strong>piates, organophosphates<\/p>\n P<\/strong>henobarbital, propoxyphene, phenothiazines<\/p>\n S<\/strong>alicylates, smoke inhalation (including cocaine smoke), solvents<\/p>\n <\/p>\n ME DIE<\/strong><\/p>\n M<\/strong>ethanol<\/p>\n E<\/strong>thylene glycol<\/p>\n D<\/strong>iuretics (osmotic diuretics like mannitol)<\/p>\n I<\/strong>sopropyl alcohol<\/p>\n E<\/strong>thanol<\/p>\n Also acetone<\/strong><\/p>\n <\/p>\n Aspirin<\/p>\n Tramadol (Ultram\u00ae, Ultracet\u0099)<\/p>\n Tricyclic antidepressants<\/p>\n Bupropion (Wellbutrin\u00ae, Zyban\u00ae)<\/p>\n Diphenhydramine (Benadryl\u00ae)<\/p>\n Amphetamines\/Cocaine<\/p>\n Venlafaxine (Effexor\u00ae)<\/p>\n Leon from the Poison Review has this mnemonic:<\/strong><\/p>\n O \u2013 <\/strong>organophosphates C \u2013 <\/strong>cocaine, camphor <\/p>\n <\/p>\n Nitrites, Isopropyl alcohol:\u00a0 fruit like<\/strong><\/p>\n Phenols:\u00a0 disinfectant<\/strong><\/p>\n Cyanide:\u00a0 bitter almonds<\/strong><\/p>\n Chloral Hydrate:\u00a0 pear-like<\/strong><\/p>\n Arsine, phosphorous, tellerium, organophosphates:\u00a0 garlic<\/strong><\/p>\n Turpentine:\u00a0 violets<\/strong><\/p>\n Hydrogen Sulfide:\u00a0 rotten eggs<\/strong><\/p>\n Camphor, naphthalene:\u00a0 mothballs<\/strong><\/p>\n Phosgene:\u00a0 hay<\/strong><\/p>\n Methylsalicylate:\u00a0 wintergreen<\/strong><\/p>\n Brady+Vomiting=Digoxin<\/p>\n Also av or nodal block with atrial or ventricular irritability<\/p>\n Tachy+Vomiting=think theo<\/p>\n TROD seen with zines, haldol, reglan<\/p>\n T<\/strong>remor, torticollis, trismus<\/p>\n R<\/strong>igidity<\/p>\n O<\/strong>pisthotonos, Oculogyric Crisis<\/p>\n D<\/strong>ysphonia, dysphagia<\/p>\n AC only helps in tylenol overdose if given within 1 hour of ingestion (J Toxicol Clin Toxicol 2001;39(6):601)<\/p>\n Position Statement Am Acad Toxicol, no AC after 1 hour can be supported by evidence, only give in patients with intact or protected airway<\/p>\n<\/span>Mnemonics<\/span><\/h2>\n
Do not adsorb to charcoal<\/h4>\n
Repeat Dose Charcoal<\/h4>\n
Toxins Accessible To Hemodialysis<\/h4>\n
<\/span>Vital Sign\/PE Mnemonic<\/span><\/h3>\n
Bradycardia (PACED)<\/h4>\n
Tachycardia (FAST)<\/h4>\n
Hypothermia (COOLS)<\/h4>\n
Hyperthermia (NASA)<\/h4>\n
Hypotension (CRASH)<\/h4>\n
Hypertension (CT SCAN)<\/h4>\n
Rapid respiration (PANT)<\/h4>\n
Slow respiration (SLOW)<\/h4>\n
Miosis (COPS)<\/h4>\n
Mydriasis (AAAS)<\/h4>\n
Drugs Causing Pneumonitis Or Pulmonary Edema<\/h4>\n
Causes of high Osmal Gap<\/h4>\n
Drugs that cause Seizures<\/h4>\n
\nT<\/strong> \u2013 tricyclic antidepressants
\nI<\/strong> \u2013 isoniazid, insulin (hypoglycemia)
\nS<\/strong> \u2013 sympathomimetics, synthetic cannabinoids (Spice)<\/p>\n
\nA \u2013 <\/strong>amphetamines, anticholinergics, atypical antipsychotics
\nM<\/strong> \u2013 methylxanthines (theophylline, caffeine)
\nP<\/strong> \u2013 phencyclidine (PCP)
\nB<\/strong> \u2013 botanicals (e.g., water hemlock), bath salts, benzo withdrawal,\u00a0bupropion
\nE<\/strong> \u2013 ethanol withdrawal
\nL<\/strong> \u2013 lead, lindane
\nL \u2013 <\/strong>lithium, lidocaine<\/p>\nSmells of Toxicology (River’s)<\/strong><\/h4>\n
<\/span>Presentations<\/span><\/h2>\n
Extrapyramidal Toxidrome<\/h4>\n
<\/span>Activated Charcoal<\/span><\/h2>\n