CEN TOX CEN 2 QUESTIONS AND
ANSWERS
For a patient with beta-blocker toxicity, you should prepare for which intervention?
Correct answer- 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 answer- 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 answer- 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 answer- 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 answer- 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
answer- 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 answer- 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 answer- 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 answer- 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 answer-
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 answer- 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 answer- 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 answer- Amphetamine (Adderall)
ANSWERS
For a patient with beta-blocker toxicity, you should prepare for which intervention?
Correct answer- 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 answer- 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 answer- 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 answer- 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 answer- 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
answer- 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 answer- 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 answer- 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 answer- 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 answer-
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 answer- 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 answer- 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 answer- Amphetamine (Adderall)
