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CEN TOX CEN 2: QUESTIONS & ANSWERS
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CEN TOX CEN 2: QUESTIONS & ANSWERSFor a patient with beta-blocker toxicity, you should prepare for which
intervention? Correct Ans - Transcutaneous pacer insertion
Patients with beta-blocker toxicity may require transcutaneous pacing to treat
bradycardia caused by the toxicity.
Hemodialysis has limited usefulness in patients with beta-blocker toxicity.
In addition to calcium gluconate, which drugs may be administered to treat
calcium channel blocker toxicity?
A.Sodium bicarbonate and amiodarone (Cordarone)
B. Flumazenil (Romazicon) and naloxone (Narcan)
C. N-acetylcysteine (Mucomyst) and Atropine
D. Insulin (Humalog) and glucagon (GlucaGen) Correct Ans - Several
antidotes may be used to treat calcium channel blocker toxicity, including
calcium gluconate or chloride, insulin (Humalog), and glucagon (GlucaGen).
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs
and symptoms of withdrawal from which drug? Correct Ans - Heroin
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs
and symptoms of withdrawal from heroin, an illicit opiate that is a central
nervous system depressant.
For a patient with benzodiazepine toxicity, which intervention is appropriate
for enhancing drug elimination?
A. Gastric lavage
B. Activated charcoal administration
C. Hemodialysis
D. Charcoal hemoperfusion Correct Ans - Administer activated
charcoal promptly and safely to enhance benzodiazepine elimination.
When a blood sample is drawn at the appropriate time, the serum level of
which drug reflects the degree of acute toxicity?
A. Ibuprofen (Motrin)
B. Acetaminophen (Tylenol)
,C. Morphine (MS Contin)
D. Phencyclidine hydrochloride (PCP) Correct Ans - When the initial
blood sample is drawn at least 4 hours after acute acetaminophen (Tylenol)
ingestion, the serum level can be plotted on the Rumack-Matthew nomogram
to assess the peak acetaminophen level and determine the risk of hepatoxicity.
Quantitative drug levels of ibuprofen (Motrin), morphine (MS Contin), and
phencyclidine hydrochloride (PCP) are not usually available or helpful except
for documenting ingestion.
With an overdose, which category of drugs produces coronary artery spasms?
Correct Ans - Central nervous system stimulants
One of the cardiac effects of central nervous system stimulant toxicity is
coronary artery spasms.
Which antidysrhythmic is most appropriate for treating ventricular
dysrhythmias caused by tricyclic antidepressant toxicity?
A. Amiodarone (Cordarone)
B. Procainamide (Pronestyl)
C. Quinidine (Quinidex)
D. Digoxin (Lanoxin) Correct Ans - Amiodarone (Cordarone) is the
most appropriate antidysrhythmic for treating ventricular dysrhythmias
caused by tricyclic antidepressant toxicity.
Procainamide (Pronestyl) and quinidine (Quinidex) are contraindicated in
tricyclic antidepressant toxicity because of the potential for QRS widening.
Digoxin (Lanoxin) is not an antidysrhythmic. It controls the heart rate by
blocking the sodium-potassium pump.
A patient is admitted after taking an overdose of alprazolam (Xanax). Which
antidote should you expect to administer to this patient?
A. Flumazenil (Romazicon)
B. Naloxone (Narcan)
C. Calcium gluconate
D. Cyproheptadine (Periactin) Correct Ans - Alprazolam (Xanax) is a
benzodiazepine, and flumazenil (Romazicon) is the antidote for a
benzodiazepine overdose.
,Naloxone (Narcan) is the antidote for opiate toxicity.
Calcium gluconate is one of several antidotes for calcium channel blocker
toxicity.
Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin
syndrome in toxicity due to an overdose of a selective serotonin reuptake
inhibitor.
Acetaminophen (Tylenol) toxicity may occur with lower acetaminophen doses
in patients with which disorder?
A. Cardiomyopathy
B. Asthma
C. Alcohol abuse
D. Disseminated intravascular coagulation Correct Ans -
Acetaminophen toxicity may occur with lower acetaminophen doses in
patients with alcohol abuse, malnutrition, or preexisting hepatic dysfunction
and in those who take isoniazid (INH), anticonvulsant medications (such as
phenytoin [Dilantin] or carbamazepine [Tegretol]), or other cytochrome P450
oxidizers.
Cardiomyopathy, asthma, and disseminated intravascular coagulation do not
affect acetaminophen levels.
Family members bring a geriatric patient with confusion and delirium to the
emergency department. They report that her symptoms have progressed over
the past few days since she started using BENGAY for her arthritis. Which
medication is a likely cause of these symptoms?
A. Acetaminophen (Tylenol) B. Salicylate C. Iron D. Digoxin (Lanoxin)
Correct Ans - BENGAY contains salicylate, and chronic salicylate poisoning
can cause confusion and delirium in geriatric patients.
Other possible causes include sepsis, pneumonia, and anticholinergic
ingestion.
Acetaminophen (Tylenol), iron, and digoxin (Lanoxin) toxicity are not likely to
cause confusion and delirium.
, An overdose of which nonsteroidal anti-inflammatory drug can cause
seizures?
A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D.
Piroxicam (Feldene) Correct Ans - An overdose of piroxicam (Feldene)
or mefenamic acid (Ponstel) or the ingestion of a large amount of naproxen
(Aleve) or ketoprofen (Orudis) can cause seizures.
Ketorolac (Toradol) can cause renal failure.
Celecoxib (Celebrex) and indomethacin (Indocin) toxicity can cause
gastrointestinal effects and drowsiness.
Which effect occurs in calcium channel blocker toxicity? Correct Ans -
Hyperglycemia
The signs and symptoms of calcium channel blocker toxicity include
hyperglycemia due to inhibited insulin release, bradycardia, hypotension,
atrioventricular block (not atrial fibrillation), confusion, nausea, vomiting, and
metabolic acidosis. Seizures are an effect of beta-blocker toxicity.
Which drug can cause a sense of omnipotence, excitement, hyperalertness,
hyperactivity, or hypersexuality? Correct Ans - Amphetamine
(Adderall)
Amphetamine is a central nervous system stimulant that can cause a sense of
omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality.
An antihypertensive drug, clonidine (Catapres) is an alpha2 agonist that
causes central nervous system depression.
Methaqualone (Quaalude) leads to central nervous system depression and
may cause hypertonicity, hyperreflexia, or clonus.
With a toxic ingestion, the tricyclic antidepressant amitriptyline (Elavil)
produces central nervous system depression.
Which drug can cause pinpoint pupils, amnesia, and hypotension? Correct
Ans - Dextromethorphan (Robitussin)
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