Safe Prescribing — Flashcards

Flashcard 81: A patient with known bipolar disorder presents to hospital with a coarse tremor, hyperreflexia and confusion. Shortly after admission they experience a seizure which progresses to a coma? Toxicity of what medication has most likely caused this? _____

Answer: Lithium

Flashcard 82: Ethylene glycol poisoning is suspected based on clinical presentation and a _____ metabolic acidosis with an increased osmolal gap.

Answer: high anion-gap

Extra: Key findings include: - CNS depression (initial phase) - High anion gap metabolic acidosis (HAGMA) - Increased osmolal gap - Envelope/Needle-shaped calcium oxalate crystals in urine. - Treatment: Fomepizole (DOC) or Ethanol; Dialysis for severe cases.

Flashcard 83: An ABG performed on a patient with salicylate poisoning will show mixed respiratory alkalosis & metabolic acidosis. What causes the respiratory alkalosis? _____

Answer: Early stimulation of the respiratory centre

Flashcard 84: Why should opioid overdose patients be monitored closely after naloxone administration?\n_____

Answer: Naloxone has a shorter half-life than most opioids (risk of re-sedation)

Extra: The duration of action of Naloxone is approximately 30-90 minutes, whereas many opioids (like morphine or methadone) have a much longer half-life. Patients may appear to recover but then lapse back into respiratory depression as the naloxone wears off, requiring repeat doses or an infusion.

Flashcard 85: The most characteristic early clinical feature of salicylate poisoning is _____

Answer: tinnitus

Extra: Salicylate poisoning (aspirin) typically presents with: 1. CNS: Tinnitus, vertigo, respiratory center stimulation. 2. Acid-Base: Early respiratory alkalosis followed by an elevated anion gap metabolic acidosis (Mixed Disorder). 3. GI: Nausea, vomiting, and gastric irritation. Treatment includes urine alkalinization with sodium bicarbonate.

Flashcard 86: A 21 year old has recently started their second year of university. They have had a headache since moving into a new student house but now presents with altered mental status and pink mucosae. What is the most likely treatment for this patient? _____

Answer: 100% Oxygen via non-rebreathe mask (minimum 6 hours) - Carbon monoxide poisoning

Flashcard 87: The management of agitation & neuromuscular excitability in serotonin syndrome involves _____

Answer: benzodiazepines

Flashcard 88: Digoxin level blood test should be performed _____ after administration

Answer: 6 hours

Flashcard 89: The initial management of suspected serotonin syndrome involves _____ and supportive care (IV fluids)

Answer: stopping serotonergic drugs

Flashcard 90: _____ and widened QRS (>100ms) are found in patients with TCA toxicity?

Answer: Prolonged QTc interval