CEN TOXICOLOGY MIDTERM EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES| 2026
Anticholinergics [not producing fluids/blood to heart, lungs and brain] syndrome
(antihistamines, bronchodilators, cyclic antidepressants, SLEEP AIDS) - CORRECT
ANSWER>>> Hot as a hare (hyperthermia)
Red as a beet (flushed)
Dry as a bone [ANHYDROSIS (dry skin, urinary retention)
Blind as a bat (mydriasis)
Mad as a hatter (hallucinations, delirium, myoclonic jerking)
The antidote for anticholinergic toxicity is physostigmine salicylate. Physostigmine is the only
reversible acetylcholinesterase inhibitor capable of directly antagonizing the CNS manifestations
of anticholinergic toxicity; it is an uncharged tertiary amine that efficiently crosses the blood-
brain barrier
What does muscular rigidity cause - CORRECT ANSWER>>> rhabdomyolysis syndrome
due to a direct or indirect muscle injury. It results from the death of muscle fibers and release
of their contents into the bloodstream (myoglobin). This can lead to renal (kidney) failure.
sympathomimetic [fight or flight/shunt blood going to heart/brain/lungs] - CORRECT
ANSWER>>> MIMIC SYMPATHETIC
a drug that stimulates the sympathetic branch of the autonomic nervous system
Epinephrine, adrenaline
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,Organophosphate poisoning
Cholinergics {see, spit, pee, shit] used in pesticides b/c - CORRECT ANSWER>>> BUGS
DROWN with Cholinergic [producing fluids: saliva, urine, digestive enzymes]
Organophosphates are used as insecticides, medications, and nerve agents. Symptoms include
increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle
tremors, and confusion.
Cholinergics {see, spit, pee, shit] pathway - CORRECT ANSWER>>> muscarinic and nicotinic
receptors that use acetylcholine neurotransmitters
cholinergic cells that use which neurotransmitter - CORRECT ANSWER>>> Referring to
cells that use acetylcholine as their synaptic transmitter.
SLUDGE-BBB - CORRECT ANSWER>>> Muscarinic Cholinergic syndrome
Salvation
lacrimation
urination
defecation
gastric emesis
Bronchorrhea
bronchospasm
bradycardia
miosis
increased bowel sounds
Cholinergic Drug toxicity
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, antidote - CORRECT ANSWER>>> 2-PAM
Atropine
anticholinergic over dose examples - CORRECT ANSWER>>> Atropine
antihistamines [benadryl]
TCAs Tricyclic antidepressants (Amitriptyline)
Cyclobenzaprine (muscle relaxant)
extrapyramidal effects are? - CORRECT ANSWER>>> Extrapyramidal symptoms are most
commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. The
most common typical antipsychotics associated with EPS are haloperidol and fluphenazine.
drug-induced movement disorders that include acute and tardive symptoms
Saran Gas [nerve gas] - CORRECT ANSWER>>> Within seconds of exposure to sarin gas
(or liquid, which evaporates easily), we start to notice the immediate effects of acetylcholine
buildup. First, our smooth muscles and secretions go crazy. The nerves to those areas keep
firing, keep telling them to go
Saran Gas nerve gas antidote - CORRECT ANSWER>>> 2-PAM Cl
Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity; however, 2-
PAM Cl must be administered within minutes to a few hours (depending on the agent) following
exposure to be effective. There is also generally no benefit in giving more than three injections
of 2-PAM Cl.
nerve gas tx - CORRECT ANSWER>>> FIRST RESPONDERS AT THE SCENE
atropine until they stop pouring fluid out of their face
Pulmonary Edema Needs Positive Pressure Airway
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QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES| 2026
Anticholinergics [not producing fluids/blood to heart, lungs and brain] syndrome
(antihistamines, bronchodilators, cyclic antidepressants, SLEEP AIDS) - CORRECT
ANSWER>>> Hot as a hare (hyperthermia)
Red as a beet (flushed)
Dry as a bone [ANHYDROSIS (dry skin, urinary retention)
Blind as a bat (mydriasis)
Mad as a hatter (hallucinations, delirium, myoclonic jerking)
The antidote for anticholinergic toxicity is physostigmine salicylate. Physostigmine is the only
reversible acetylcholinesterase inhibitor capable of directly antagonizing the CNS manifestations
of anticholinergic toxicity; it is an uncharged tertiary amine that efficiently crosses the blood-
brain barrier
What does muscular rigidity cause - CORRECT ANSWER>>> rhabdomyolysis syndrome
due to a direct or indirect muscle injury. It results from the death of muscle fibers and release
of their contents into the bloodstream (myoglobin). This can lead to renal (kidney) failure.
sympathomimetic [fight or flight/shunt blood going to heart/brain/lungs] - CORRECT
ANSWER>>> MIMIC SYMPATHETIC
a drug that stimulates the sympathetic branch of the autonomic nervous system
Epinephrine, adrenaline
1|Page
,Organophosphate poisoning
Cholinergics {see, spit, pee, shit] used in pesticides b/c - CORRECT ANSWER>>> BUGS
DROWN with Cholinergic [producing fluids: saliva, urine, digestive enzymes]
Organophosphates are used as insecticides, medications, and nerve agents. Symptoms include
increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle
tremors, and confusion.
Cholinergics {see, spit, pee, shit] pathway - CORRECT ANSWER>>> muscarinic and nicotinic
receptors that use acetylcholine neurotransmitters
cholinergic cells that use which neurotransmitter - CORRECT ANSWER>>> Referring to
cells that use acetylcholine as their synaptic transmitter.
SLUDGE-BBB - CORRECT ANSWER>>> Muscarinic Cholinergic syndrome
Salvation
lacrimation
urination
defecation
gastric emesis
Bronchorrhea
bronchospasm
bradycardia
miosis
increased bowel sounds
Cholinergic Drug toxicity
2|Page
, antidote - CORRECT ANSWER>>> 2-PAM
Atropine
anticholinergic over dose examples - CORRECT ANSWER>>> Atropine
antihistamines [benadryl]
TCAs Tricyclic antidepressants (Amitriptyline)
Cyclobenzaprine (muscle relaxant)
extrapyramidal effects are? - CORRECT ANSWER>>> Extrapyramidal symptoms are most
commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. The
most common typical antipsychotics associated with EPS are haloperidol and fluphenazine.
drug-induced movement disorders that include acute and tardive symptoms
Saran Gas [nerve gas] - CORRECT ANSWER>>> Within seconds of exposure to sarin gas
(or liquid, which evaporates easily), we start to notice the immediate effects of acetylcholine
buildup. First, our smooth muscles and secretions go crazy. The nerves to those areas keep
firing, keep telling them to go
Saran Gas nerve gas antidote - CORRECT ANSWER>>> 2-PAM Cl
Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity; however, 2-
PAM Cl must be administered within minutes to a few hours (depending on the agent) following
exposure to be effective. There is also generally no benefit in giving more than three injections
of 2-PAM Cl.
nerve gas tx - CORRECT ANSWER>>> FIRST RESPONDERS AT THE SCENE
atropine until they stop pouring fluid out of their face
Pulmonary Edema Needs Positive Pressure Airway
3|Page
