Pharm L5, T1 Toxicology.txt

When is toxicology actute, subacute or chronic?

What are the three primary determinants of toxicity?

What is the order from most effective to least effective routes of exosure?

Genetically, if a drug is a fast or slow acetylator, what will be the outcome?

Is a higher or lower V_d needed for effective hemodialysis of toxicity?

What is the cutoff time for gastric lavage?

Drug that absorbs chemical toxicity?

Drug that will acidify urine?

Drug that will alkalanize urine?

Drug that is cathartic for toxicology?

Drug that is an osmotic diuretic?

What are the 5 metal chelators?

Naloxone function?

Glucagon function?

Pyridoxine function?

Fomepizole function?

Cause: Food-borne toxin
Symptom: paralysis of muscles, double vision, vomitting
Treatment: emesis, lavage depending on time

Cause: B. cereus or Salmonella
symptom: 2-4 hr. after eating, GI inflammation, fever, dehydration
treatment: fluid intake, anti-emetic

Cause: miscellaneous substance, improper handling of chemicals
Symptoms: irritation, delirium, coma
treatment: flush skin, milk, eggs, antacids

Cause: Cholinesterase-inhibiting insecticides
symptoms: SLUD (salivation, lacrimation, urination, defecation), headaches, slow pulse, cyanosis, coma
treatments: flush skin, Atropine, 2-PAM

Atropine function?

2-PAM effects

Cause: Cholinesterase-inhibiting insecticides
symptoms: SLUD (salivation, lacrimation, urination, defecation), headaches, slow pulse, cyanosis, coma
treatments: flush skin, Atropine, 2-PAM contraindicates

cause: rodenticide, antagonis of glycine
symptom: convulsion, death from respiratory failure
treatment: IV Diazepam or NMJ blockers

Role of glycine

cause: herbicide, (2,4-D) acid + (2,4,5-T) acid = (TCDD)

cause: herbicides, uncouple oxidative phosphorylation = increased metabolic rate & temp

Cause: herbicide, redox recycling and ROS

Cause: CCl₄, methylene chloride, chloroethylene, trichloroethylene, ROS lipid peroxidation = cell death
Symptoms: liver toxicity, CNS depressant
treatment: flush skin, remove contaminated clothing

Cause: metabolic conversion to formaldehyde & formic acid
symptoms: visual problems, metabolis acidosis, resp. problems, death
Treat: 50% ethanol IV, Fomepizol, Sodium Bicarb

Role of Fomepizole

Role of Disulfiram

What are the mg levels of alcohol for acute, moderate, severe and coma poisoning?

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

Cause: rubbing alcohol
Symptoms: CNS depression, rage
Treatment: lavage

Symptom: depression, kidney damage due to calcium oxalate crystals that precipitate
treatment: ethanol IV, Fomepizol

symptoms: pulmonary irritation, CNS depression
treatment: emesis & gastric lavage w/o tracheal intubation

symptoms: CNS stimulation & depression (high doses), kidney & liver damage, cardiac arrhythmias
treatment: lavage if aspiration can be prevented, Diazepam w/ convulsions

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

Symptoms: GI inflammation/necrosis, hypovolemic shock after hemorrhage
treatment: dilute w/ water, analgesic pain relievers, milk of magnesia

symptoms: irritation, inflammation & tissue damage, penetrate more than strong acids, hypovolemic shock death
treatment: dilute w/ water

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

Cause: paint chips
Symptoms:
- 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

symptom: GI, inflammation, necrosis, hemorrhage, hypotension, metabolic acidosis, shock
Treatment: Chelate w/ Deferoxamine (oral)

Symptoms: irritation, abdominal pain, ARTN, shock, Stomatitis (bleeding gums), Erethism (emotional instability)
Treatment: milk, raw eggs, charcoal, chelate w/ IV Dimercapol

Most common metal chelated by penicillamine?

Main metal chelated by deferoxamine?

Main metal chelated by succimer?

Main two metals chelated by edetate?

4 metals chelated by dimercaprol?

T/F dimercaprol should be given orally?

Role of methemoglobin inducing agents

role of Carboxyhemoglobin producing agents

Role of Cytochrome oxidase inhibitors

symptoms: chocolate-colored blood, hypotension, cyanosis, convulsions, coma
treatment: methylene blue (convert methemoglobin back to hemoglobin), Oxygen administration

Symptoms:headache, dizziness, stupor, Carboxyhemoglobin is cherry red
Treatment:administer oxygen

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

Role of Rhodanese (sodium thiosulfate)

symptom: dyspnea, weakness, TB disposition, heart failure/respiratory failure
treatment: symptomatic & supportive

symptoms: dyspnea, resp. impairment, bronchogenic carcinoma/pleural mesothelioma
treatment: symptoms and support

symptoms: lung cancer risk

What drug is always used for convulsions and seizures?

How do emetics and Lavage come into play with mineral acid, strong base, mineral spirits and convulsion?

What organ is damaged by acetaminophen toxicity?

What toxicity is present from a fire extinguisher, halogenated hydrocarbons and liver damage?

What toxicity is from antifreeze?

Main oral chelator of lead?

chocolate colored blood toxicity

Cherry-red blood toxicity

bitter almond taste toxicity