Toxicology

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Author:
manjinder
ID:
146819
Filename:
Toxicology
Updated:
2012-04-10 18:35:23
Tags:
Toxic
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Description:
Toxic substances
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  1. AChE inhibitors
    Edrophonium, physostigmine, neostigmine, pyridostigmine, donepezil, tacrine, rivastigmine, galantamine, Organophosphates (echothiophate, malathion, parathion, sarin, VX)
    • DUMBBELSS= PANS + sweating + skel muscle
    • miosis, salivation, sweats, GI cramps, diarrhea, muscle twitches --> seizures, coma, respiratory failure

    Antidotes: respiratory support: atropine + pralidoxime (for irreversible (organophosphates) AChE inhibitors)
  2. Atropine & Muscarinic blockers
    homatropine, cyclopentolate, tropicamide (ophthalmology), ipratropium, scopolamine, benztropine, trihexyphenidyl, biperiden, (parkinsonism) glycopyrrolate, dicyclomine (GI)
    • SANS + block sweating (hyperthermia)
    • inc HR, inc BP, hyperthermia (hot,dry skin), delirium, hallucinations, mydriasis

    Antidote: physostigmine (crosses BBB)
  3. Carbon Monoxide
    N/V, dyspnea w/ hyperventilation, mydriasis, vertigo, dec BP, syncope, inc HR, arrhythmias

    Antidote: hyperbaric O2
  4. Salicylates (ASA)
    confusion, lethargy, hyperventilation, hyperthermia, dehydration, ototoxicity (tinnitus), hypokalemia, acidosis, seizures, coma

    Antidotes: urinary alkalinization (NaHCO3) possible hemodialysis
  5. Arsenic
    wood preservatives, pesticides, ant poisons, drinking water, coal combustion
    • binds to hemoglobin and decreases erythrocyte glutathione levels, causing membrane fragility and resulting hemolysis.
    • Acute: gastroenteritis, garlic breath, "rice water" stools
    • Chronic: skin pigmentation (raindrop pattern- "milk and roses" complexion results from vasodilation and anemia), stocking glove neuropathy

    Antidotes: dimercaprol, penicillamine
  6. Iron
    • Acute: severe GI distress --> necrotizing gastroenteritis w/ hematemesis, bloody diarrhea,
    • Antidotes: deferoxamine IV
  7. Lead
    • inhibits ferrochelatase and ALA dehydratase --> dec heme synthesis...also inhibits rRNA degradation
    • multisystem effects: LEAD
    • Lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray
    • Encephalopathy (MR) and Erythrocyte basophilic stippling (aggregation of ribosome)
    • Abdominal colic and sideroblastic anemia
    • Drops- wrist and foot drop (neuropathy).

    • Rx:
    • Dimercaprol and EDTA are 1st line of Rx
    • Succimer for kids only used in mild to moderate lead poisoning. Not used as 1st line when encephalopathy.
  8. Mercury
    • salts in amalgams, batteries, dyes, fireworks, photography
    • Vapor inhalation: chest pain, dyspnea, pneumonitis
    • Inorganic salt ingestion: gastroenteritis, tubular necrosis
    • chronic: CNS effects, ataxia, paresthesias, auditory and visual loss

    Antidotes: Succimer PO or Dimercaprol (IM)
  9. Theophylline, beta agonists
    Esmolol (b1 specific)
  10. Mathanol or ethylene glycol
    ethanol, fomepizole
  11. BZs (BZ1,2), zolpidem (BZ1), zaleplon (BZ1)
    Flumazenil (block BZ1 and BZ2)
  12. Copper (wilson's disease), iron, lead, mercury
    penicillamine
  13. Heparin
    Protamine
  14. Warfarin and coumarin anticoagulants
    Vit K
  15. Acetaminophen
    N-acetylcysteine (replenishes glutathione)
  16. Amphetamines (basic)
    NH4Cl (acidify urine)
  17. b-blockers
    glucagon
  18. digitalis
    stop dig, normalize K+, Lidocaine, Anti-dig Fab fragments, Mg2+
  19. cyanide
    nitrite, hydroxocobalamin, thiosulfate
  20. methemoglobin
    methylene blue, vit C
  21. TCAs
    NaHCO3 (plasma alkalinization)
  22. tPA, streptokinase, urokinase
    Aminocaproic acid

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