Pharm L5, T1 Toxicology.txt

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Pharm L5, T1 Toxicology.txt
2011-09-21 15:02:01
Pharm L5 T1 Toxicology

Pharm L5, T1 Toxicology
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  1. When is toxicology actute, subacute or chronic?
    • acute: occurs over 1-2 days
    • subacute: repeated exposures during 3 month period
    • chronic: repeated exposures >3months
  2. What are the three primary determinants of toxicity?
    • Dose/dose rate
    • duration of exposure (Concentration x time)
    • route of exposure
  3. What is the order from most effective to least effective routes of exosure?
    IV > Inhaled > IM > SC > oral > topical
  4. Genetically, if a drug is a fast or slow acetylator, what will be the outcome?
    • fast: liver toxicity
    • slow: neural toxicity
  5. Is a higher or lower Vd needed for effective hemodialysis of toxicity?
    Low Vd
  6. What is the cutoff time for gastric lavage?
    4 hours
  7. Drug that absorbs chemical toxicity?
  8. Drug that will acidify urine?
    Ammonium chloride
  9. Drug that will alkalanize urine?
    Sodium bicarbonate
  10. Drug that is cathartic for toxicology?
    Magnesium sulfate
  11. Drug that is an osmotic diuretic?
  12. What are the 5 metal chelators?
    • Deferoxamine
    • Dimercaprol
    • Edetate
    • Penicillamine
    • Succimer (children)
  13. Naloxone function?
    block opiods
  14. Glucagon function?
    inhibit beta-blockers
  15. Pyridoxine function?
    Isoniazid toxicity
  16. Fomepizole function?
    Ethylene glycol toxicity
  17. Cause: Food-borne toxin
    Symptom: paralysis of muscles, double vision, vomitting
    Treatment: emesis, lavage depending on time
    Botulinus Toxin
  18. Cause: B. cereus or Salmonella
    symptom: 2-4 hr. after eating, GI inflammation, fever, dehydration
    treatment: fluid intake, anti-emetic
    Bacterial food poisoning
  19. Cause: miscellaneous substance, improper handling of chemicals
    Symptoms: irritation, delirium, coma
    treatment: flush skin, milk, eggs, antacids
    Bleach toxicity
  20. Cause: Cholinesterase-inhibiting insecticides
    symptoms: SLUD (salivation, lacrimation, urination, defecation), headaches, slow pulse, cyanosis, coma
    flush skin, Atropine, 2-PAM
    Organophosphate poisoning
  21. Atropine function?
    block cholinergic effects
  22. 2-PAM effects
    reactivate Cholinesterase enzyme
  23. Cause: Cholinesterase-inhibiting insecticides
    symptoms: SLUD (salivation, lacrimation, urination, defecation), headaches, slow pulse, cyanosis, coma
    treatments: flush skin, Atropine, 2-PAM contraindicates
  24. cause: rodenticide, antagonis of glycine
    symptom: convulsion, death from respiratory failure
    treatment: IV Diazepam or NMJ blockers
    Strychine poisoning
  25. Role of glycine
    inhibitory transmitter to motorneurons and interneurons
  26. cause: herbicide, (2,4-D) acid + (2,4,5-T) acid = (TCDD)
    Chlorophenoxy compounds
  27. cause: herbicides, uncouple oxidative phosphorylation = increased metabolic rate & temp
  28. Cause: herbicide, redox recycling and ROS
  29. Cause: CCl4, methylene chloride, chloroethylene, trichloroethylene, ROS lipid peroxidation = cell death
    Symptoms: liver toxicity, CNS depressant
    treatment: flush skin, remove contaminated clothing
    Halogenated hydrocarbons
  30. Cause: metabolic conversion to formaldehyde & formic acid
    symptoms: visual problems, metabolis acidosis, resp. problems, death
    Treat: 50% ethanol IV, Fomepizol, Sodium Bicarb
    • Methanol poisoning
  31. Role of Fomepizole
    alcohol dehydrogenase inhibitor
  32. Role of Disulfiram
    • ***discourage alcohol use
    • inhibits acetaldehyde dehydrogenase so acetaldehyde stays in body causing nausea and vomiting
  33. What are the mg levels of alcohol for acute, moderate, severe and coma poisoning?
    • acute: 50-150 mg
    • moderate: 150-300 mg
    • severe: 300-500 mg
    • coma: >500 mg`
  34. symptom: CNS stimulation b/c of inhibited GABA pathway followed by CNS depression at high doses.
    * Increased heat & zero-order kinetics
    treatment: hemodialysis if >500 mg, Diazepam if convulsions/seizures
  35. Cause: rubbing alcohol
    Symptoms: CNS depression, rage
    Treatment: lavage
    Isopropyl alcohol (Isopropanol) poisoning
  36. Symptom: depression, kidney damage due to calcium oxalate crystals that precipitate
    treatment: ethanol IV, Fomepizol
    Ethylene glycol poisoning
  37. symptoms: pulmonary irritation, CNS depression
    treatment: emesis & gastric lavage w/o tracheal intubation
    Petroleum distillates
  38. symptoms: CNS stimulation & depression (high doses), kidney & liver damage, cardiac arrhythmias
    treatment: lavage if aspiration can be prevented, Diazepam w/ convulsions
    Aromatic hydrocarbons (benzene, toluene, xylene)
  39. symptoms: GI tract irritation, muscle weakness b/c of Ca chelation, renal tubular damage b/c of Ca precipitation
    Treatment: precipitate drug in GI w/ Ca (milk, antacids, etc.), calcium gluconate IV
    Oxalic acid toxicity
  40. Symptoms: GI inflammation/necrosis, hypovolemic shock after hemorrhage
    treatment: dilute w/ water, analgesic pain relievers, milk of magnesia
    mineral acids (hydrochloric, sulfuric, acetic, perchloric)
  41. symptoms: irritation, inflammation & tissue damage, penetrate more than strong acids, hypovolemic shock death
    treatment: dilute w/ water
    Strong Alkali (hydroxides in soap, cleansers, drain cleaners)
  42. cause: bind to sulhydryl groups on enzymes and inhibit cellular metabolism
    symptoms: GI disturbance, convulsions, arrhythmias, kidney damage, nephritis, dermatitis, cirrhosis, personality changes
    treatments: lavage or emesis, dimercarprol or penicillamine
    arsenic or arsine
  43. Cause: paint chips
    - acute: GI irritation, kidney damage
    - chronic: line on gums, erythrocyte strippling, aminolevulinic acid accumulation
    - CNS effects: behavior disturbances, loss of
    developed skills, coma
    Treatment: prevent, chelate using Dimercapol, Succimer (oral children), Penicillamine
    - neuromuscular effects: weakness, paralysis
    Lead poisoning:
  44. symptom: GI, inflammation, necrosis, hemorrhage, hypotension, metabolic acidosis, shock
    Treatment: Chelate w/ Deferoxamine (oral)
    Iron poisoning
  45. Symptoms: irritation, abdominal pain, ARTN, shock, Stomatitis (bleeding gums), Erethism (emotional instability)
    Treatment: milk, raw eggs, charcoal, chelate w/ IV Dimercapol
    Mercury Salt poisoning
  46. Most common metal chelated by penicillamine?
    Copper (wilson's disease)
  47. Main metal chelated by deferoxamine?
  48. Main metal chelated by succimer?
  49. Main two metals chelated by edetate?
    Zing & Lead
  50. 4 metals chelated by dimercaprol?
    gold, arsenic, lead, mercury
  51. T/F dimercaprol should be given orally?
    F, should be given parenterally b/c it is easily absorbed in GI tract
  52. Role of methemoglobin inducing agents
    oxidize hemoglobin to methemoglobin so oxygen is not carried
  53. role of Carboxyhemoglobin producing agents
    Carbon monoxide
  54. Role of Cytochrome oxidase inhibitors
    Hydrogen cyanide
  55. symptoms: chocolate-colored blood, hypotension, cyanosis, convulsions, coma
    treatment: methylene blue (convert methemoglobin back to hemoglobin), Oxygen administration
    Nitrite toxicity
  56. Symptoms:headache, dizziness, stupor, Carboxyhemoglobin is cherry red
    Treatment:administer oxygen
    carbon monoxide poisoning
  57. Cause: complex with ferric iron and inhibit oxygen utilization
    symptoms:dizzy, headache, hypotension, unconscious, convulsions, resp. failure
    treatment: Sodium Nitrite, amyl nitrite or sodium thiosulfate, Rhodanese, oxygen treatment
    Cyanide poisoning
  58. Role of Rhodanese (sodium thiosulfate)
    Excrete cyanide as SCN- out of kidney
  59. symptom: dyspnea, weakness, TB disposition, heart failure/respiratory failure
    treatment: symptomatic & supportive
    Free crystalline silica
  60. symptoms: dyspnea, resp. impairment, bronchogenic carcinoma/pleural mesothelioma
    treatment: symptoms and support
    asbestos toxicity
  61. symptoms: lung cancer risk
    Radon toxicity
  62. What drug is always used for convulsions and seizures?
  63. How do emetics and Lavage come into play with mineral acid, strong base, mineral spirits and convulsion?
    Don't do emetics or gastric lavage
  64. What organ is damaged by acetaminophen toxicity?
  65. What toxicity is present from a fire extinguisher, halogenated hydrocarbons and liver damage?
    CCl4, chloroethylene, trichloroethylene, tetrachloroethylene
  66. What toxicity is from antifreeze?
    ethylene glycol
  67. Main oral chelator of lead?
  68. chocolate colored blood toxicity
  69. Cherry-red blood toxicity
    Carbon monoxide
  70. bitter almond taste toxicity
    Cyanide poisoning