Toxicology Exam

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Toxicology Exam
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  1. Name the category of drugs:

    -Procainamide/NAPA (active metabolite)
    - quinidine
    - digoxin
    - lidocaine
    antiarrhythmics
  2. Name the category of drugs:

    -atenolol
    -bisoprolol
    -labetalol
    -metoprolol
    -propranolol
    Beta Blocker: High Blood Pressure/Angina/Migrain
  3. Name the category of drugs:

    -Diltiazem
    -verapamil
    Calcium Channel Blocker: HBP/Angina/Migrain/Heart Rhythm
  4. Name the category of drugs:

    -lisinopril
    angiotensin converting enzyme (ACE)-inhibitor: HBP
  5. Name the category of drugs:

    -losartan
    -valsartan
    angiotensin II receptor antagonist: HBP
  6. Name the category of drugs:

    -theophylline
    -caffeine
    antiasthmatics
  7. Name the category of drugs:

    -carbamazepine/tegretol
    -oxcarbamazepine
    -phenobarbital
    -phentoin/dilantin
    -primidone/mysoline
    -valproic acid/depakene
    -gabapentin
    -lamotrigine
    anticonvulsants
  8. Name the category of drugs:

    -carisoprodol
    -cyclobenzaprine
    muscle relaxant
  9. Name the category of drugs:

    -rosiglitazon
    -metformin
    anti-diabetic
  10. Name the category of drugs:

    -metoclopramide
    -ondansetron
    -promethazine
    anti-emetic
  11. Name the category of drugs:

    -imiprimine
    -desiprimine
    -amitryptyline
    -nortryptyline
    -doxepin
    tricyclic antidepressants
  12. Name the category of drugs:

    -buproprion
    -venlafaxine
    -amoxapine
    -fluoxetine (prozac)
    -sertraline
    -paroxetine
    -trazadone
    -citalopram
    antidepressants
  13. Name the category of drugs:

    -olanzapine
    -clozapine
    -lithium
    -quetiapine
    -haloperidol
    -risperidone
    antipsychotics
  14. Name the category of drugs:

    -methotrexate
    antineoplastic
  15. Name the category of drugs:

    -cyclosporine
    -tacrolimus
    -sirolimus
    immunosuppressants
  16. Name the category of drugs:

    -acetaminophen/tylenol
    -salicylate/aspirin
    analgesics: pain killer
  17. Name the category of drugs:

    -ibuprofen
    -meloxicam
    -naproxen
    NSAID
  18. Name the category of drugs:

    -gentamicin
    -amikacin
    -tobramycin
    -vancomycin
    -amoxicillin
    -oflaxacin
    antibiotics
  19. Name the category of drugs:

    -morphine
    -codeine
    opiates
  20. Name the category of drugs:

    -heroin
    -oxycodone
    -oxymorphone
    -hydrocodone
    -hydromorphone
    -buprenophine
    semi-opioids
  21. Name the category of drugs:

    -fentanyl
    -propoxyphene
    -meperidine
    -methadone
    synthetic opioids
  22. Name the category of drugs:

    -nalbuphine
    -naloxone
    -naltrexone
    opioid antagonists
  23. Name the category of drugs:

    -benzoylecgonine
    cocaine
  24. Name the category of drugs:

    -clonazepam
    -flurazepam
    -alprazolam
    -triazolam
    -midazolam
    -diazepam
    -temazepam
    -oxazepam
    -lorazepam
    -chlordiazepoxide
    -7-aminoflunitrazepam
    -nitrazepam
    benzodiazepines: sedative/hypnotic
  25. Name the category of drugs:

    -ephedrine
    -pseudoephedrine
    -phenypropanolamine
    -phentermine
    -methylphenidate
    -amphetamines
    -methamphetamine
    -MDA
    -MDMA
    -MDEA
    sympathomimetic amines: CNS stimulants
  26. Name the category of drugs:

    -amobarbital
    -pentobarbital
    -secobarbital
    -butalbital
    -phenobarbital
    barbituates: CNS depressants
  27. What is the generic name and its use?

    -Darvon
    • a. Propoxyphene
    • b. analgesic
  28. What is the generic name and its use?

    -Dolophine
    • a. methadone
    • b. analgesic
  29. What is the generic name and its use?

    -Demerol
    • a. meperidine
    • b. analgesic
  30. What is the generic name and its use?

    -Valium
    • a. diazepam
    • b. tranquilizer
  31. What is the generic name and its use?

    -Tylenol
    • a. acetaminophen
    • b. analgesic
  32. What is the generic name and its use?

    -Benzedrine
    • a. amphetamine
    • b. stimulant
  33. What is the generic name and its use?

    -Desoxyn
    • a. methamphetamine
    • b. stimulant
  34. What is the generic name and its use?

    -Sudafed
    • a. pseudoephedrine
    • b. decongestant
  35. What is the generic name and its use?

    -Temaril
    • a. trimeprazine
    • b. antihistamine
  36. What is the generic name and its use?

    -Vesprin
    • a. triflupromazine
    • b. tranquilizer
  37. What is the generic name and its use?

    -throazine
    • a. chlorpromazine
    • b. tranquilizer
  38. What is the generic name and its use?

    -Tofranil
    • a. imipramine
    • b. antidepressant
  39. What is the generic name and its use?

    -Stelazine
    • a. trifluoperazine
    • b. tranquilizer
  40. What is the generic name and its use?

    -Quaalude
    • a. methaqualone
    • b. hypnotic
  41. What is the generic name and its use?

    -Miltown
    • a. meprobamate
    • b. tranquilizer
  42. What is the generic name and its use?

    -Elavil
    • a. amitriptyline
    • b. antidepressant
  43. What is the generic name and its use?

    -Sinequan
    • a. doxepin
    • b. antidepressant
  44. What is the generic name and its use?

    -Aventyl
    • a. nortriptyline
    • b. antidepressant
  45. What is the generic name and its use?

    -Seconal
    • a. secobarbital
    • b. hypnotic
  46. What is the generic name and its use?

    -Dilantin
    • a. phenytoin
    • b. anticonvulsant
  47. What is the generic name and its use?

    -Luminal
    • a. phenobarbital
    • b. hypnotic
  48. What is the generic name and its use?

    -Doriden
    • a. glutethimide
    • b. hypnotic
  49. What is the generic name and its use?

    -Nembutal
    • a. pentobarbital
    • b. hypnotic
  50. What is the generic name and its use?

    -Alurate
    • a. aprobarbital
    • b. hypnotic
  51. What is the generic name and its use?

    -Valmid
    • a. ethinamate
    • b. hypnotic
  52. What is the generic name and its use?

    -Amytal
    • a. amobarbital
    • b. hypnotic
  53. What is the generic name and its use?

    -Valium
    • a. diazepam
    • b. tranquilizer
  54. What is the generic name and its use?

    -Butisol
    • a. butabarbital
    • b. hypnotic
  55. What are the effects of cocaine and how long do they last?
    a. Energetic, alert, talkative, sensitive to light, sound, and touch. Less desire for food or sleep. Constricts blood vessels, increases temp., heart rate, and blood pressure

    b. A few minutes to a few hours
  56. How do large amounts of cocaine effect the user?
    causes vertigo, tremors, muscle twitches, irritability and depression.
  57. what are the symptoms of chronic use of cocaine?
    Anxiety, insomnia, and hypersensitivity.
  58. What are the symptoms of cardiotoxicity of cocaine?
    Arrhythmias, hypertension, seizures, and MI.
  59. What stimulant is highly addictive, readily crosses the placenta, and causes severe behavioral and developmental abnormalities?
    cocaine
  60. What is the window of detection for cocaine?
    24 hours
  61. What is the window of detection for benzolecgonine?
    72 hours
  62. How long can cocaine and its byproducts remain in the system of chronic users?
    Up to 3 weeks due to tissue storage.
  63. What are the clinical uses of cocaine?
    Anesthetic and vasoconstrictor used in dental or nasal surgeries.
  64. What other drug has similar effects to cocaine when used in higher doses?
    Ritalin
  65. What drug is known as the "new cocaine" or "Vitamin-R", used to work or party harder?
    Ritalin
  66. By which route is cocaine rapidly absorbed?
    Smoking.
  67. High long does the high or euphoria from cocaine last?
    Up to one hour.
  68. What route does 80% of cocaine enter the blood?
    Intranasal
  69. What route does 46% of cocaine enter the blood?
    Smoking.
  70. This stimulant was created in 1887 to be used as a nasal decongestant, used in 1937 to treat narcolepsy, in WWII for combat fatigue, and abused in the 50's by students as a study aid and truck drivers on long hauls.
    Amphetamines.
  71. What are the routes of administration for amphetamines?
    Smoking, inhalation, swallowing or IV.
  72. What neurotransmitters are affected by amphetamines?
    Increases the release of norepinephrine and dopamine from storage sites.
  73. What are the effects of amphetamines?
    • -excite the CNS
    • -increase energy
    • -increase confidence and well being
    • -feel stronger
    • -decrease apetite
    • -increase sweat
  74. What route of transmission will intensify the effects of amphetamines, causing a flash or rush?
    IV
  75. How does physical exertion affect the user when on amphetamines?
    Increases the hazards of the stimulant use due to their effects on cardiovascular and temperature regulation; FRY.
  76. What effects do large doses of amphetamines cause?
    • -chest pains and heart palpitations
    • -Increased blood pressure, stroke
    • -irregular heart beat
    • -increased heart rate
    • -decreased appetite
    • -hyperactivity
  77. What are the effects of chronic amphetamine use?
    • -teeth grinding
    • -touching and/or picking of face and extremities
    • -paranoia
    • -violence
  78. What are fatalities from amphetamines usually due to?
    Convulsions, coma, or circulatory collapse.
  79. How and when are amphetamines detected?
    Amphetamines (basic) are pH dependent, excreting best in acidic urine in 3-4 days.
  80. What are the clinical uses of amphetamines?
    • -obesity
    • -parkinson's
    • -narcolepsy
    • -ADD
    • -some cold meds
  81. What route are amphetamines taken to stimulate the CNS?
    Orally, by injection, or snorting.
  82. What form of amphetamine is increasingly being smoked these days?
    methamphetamine
  83. What barbiturate was created in 1903 and used as a CNS depressant?
    Barbital
  84. What barbiturate was created in 1912 and used as an anticonvulsant?
    phenobarbital
  85. Which barbiturate is short acting and what is its half-life?
    • -Secobarbital
    • -T1/2 = 15-20hrs
  86. Which barbiturate is intermediate acting and what is its half-life?
    • -Butabarbital
    • -T1/2 = 20-50hrs
  87. Which barbiturate is long acting and what is its half-life?
    • -Phenobarbital
    • -T1/2 = 80-120hrs
  88. How are barbiturates administered?
    Oral, injection, or IV.
  89. What type of sedative enhances the inhibitory effects on neural transmission?
    barbiturates
  90. What are the effects of barbiturates?
    • -unsteady gait
    • -drowsiness
    • -speech problems
  91. Which barbiturate is short acting and used as a suicide agent? What are its effects?
    • -secobarbital
    • -pulmonary ventilation decreases, cerebral hypoxia, BO and body temp decrease, depresses cardiac and respiratory centers of the brain
  92. When are barbiturates detected?
    Depending on the barbiturate, 30hrs to several weeks.
  93. What are the clinical uses of barbiturates?
    • -decrease restlessness
    • -induce sleep
    • -treat convulsive disorders
    • -treat hyperbilirubinemia in newborns
    • -decrease O2 consumption in severe brain damage to induce coma during brain swelling
    • -anesthesia or sedation
  94. What large family of drugs act as depressants and are used as sedatives and anticonvulsants?
    Barbiturates
  95. What are the most commonly used barbiturates?
    Secobarbital, pentobarbital, and amobarbital.
  96. What is the duration of action of barbiturates?
    15 minutes to a day or two
  97. WHat CNC depressants were synthesized in the 50's and introduced as Diazepam in the 60's and less hazardous than barbiturates?
    Benzodiazepines
  98. Name seven widely used benzodiazepines in the US:
    • -diazepam
    • -oxazepam
    • -lorazepam
    • -flurazepam
    • -alprazolam
    • -temazepam
    • -chlordiazepoxide.
  99. Name the group of sedatives that is lipid soluble, readily penetrates the blood-brain barrier and is stored in fatty tissue.
    Benzodiazepines
  100. What are the administration routes of benzodiazepines?
    Oral, intramuscular, IV, suppositories.
  101. What are the actions of benzodiazepines?
    Enhances the inhibitory effect on neurotransmission.
  102. What are the effects of benzodiazepines?
    • -drowsiness
    • -sedation
    • -fatigue
    • -mental depression
    • -loss of coordination
  103. What are the effects of benzodiazepines at high dosage or prolonged use?
    • -affects speech
    • -reflexes
    • -decreases blood pressure
    • -confusion
  104. What is the effect of chronic use of benzodiazepines?
    • -physical dependence
    • -withdrawal: insomnia, agitation, muscle tension, psychosis, hallucinations, and seizures
  105. What are the signs of a benzodiazepine over-dose?
    • -irritability
    • -aggressive behavior
    • -excitement followed by CNS/respiratory depression
    • -hypotension
    • -coma
  106. When can benzodiazepines be detected?
    • -T1/2 of parent drug = 5-150hrs
    • -T/12 of metabolite = 250hrs
    • -due to longer half lives and lipophilcity, benzos may be detected months after use.
  107. What are the clinical uses of benzodiazepines?
    • -anxiety
    • -sleeping agents
    • -anticonvulsants
    • -muscle relaxants
    • - preanesthetic to supplement, induce and maintain anesthesia
  108. What is the treatment for a benzodiazepine overdose?
    Flumazenil
  109. What is a common metabolite of benzodiazepines?
    Oxazepam
  110. What are the effects of tricyclic antidepressants?
    • -mood elevator
    • -increases physical activity and alertness
    • -improves appetite and sleep patterns
    • -reduces morbid preoccupation
  111. Name drugs that are considered tricyclic antidepressants:
    • -amitriptyline
    • -nortriptyline
    • -imipramine
    • -desipramine
    • -doxepin
  112. What are signs/symptoms of tricyclic antidepressant overdose?
    • -CNS and cardio toxicity
    • -high fever
    • -convulsions
    • -cardiac arrhythmias
    • -comas
  113. What treatment is used against tricyclic antidepressants?
    • -Charcoal to prevent further absorption and monitor cardiac activity.
    • -convulsions controlled with diazepam and dilantin.
    • -Sodium bicarbonate and Magnesium used to resolve metabolic acidosis and cardiovascular complications.
  114. What specimens are collected for analysis of an overdose?
    • -Urine or gastric contents are collected for a qualitative analysis.
    • -Serum is collected for quantification
  115. What do blood gases look like during a depressant and opiate OD?
    Increased pCO2 and decreased pH—Resp. acidosis
  116. What do blood gases look like during a ethylene glycol and methanol OD?
    Decreased pCO2 and decreased pH—Comp. Metabolic acidosis
  117. What do blood gases look like during an ASA OD?
    Decreased pCO2 and increased pH—Resp. Alkalosis
  118. What toxins cause an increase in both anion and osmolal gaps?
    • -Ethanol
    • -Isopropanol
    • -Methanol
    • -Ethylene glycol
  119. What levels are tested int he liver during an overdose?
    AST, ALT, Bili, LDH, and GGT.
  120. What is the specimen of choice during a drug screening and why?
    • -Urine
    • -allows the greatest amount of toxins and breakdown products
    • -displays longest degree of positivity
    • -can be obtained in large quantities with minimal prep
    • -noninvasive
  121. What would you include in an emergency drug screen and why?
    • tricyclic antidepressants - delayed symptoms
    • cocaine and ethanol - most commonly used
  122. A patient has an emergency drug screen where they are positive for acetaminophen, what is the antidote?
    N-acetylcysteine
  123. A patient has an emergency drug screen where they are positive for Digoxin, what is the antidote?
    Digibind
  124. WHat is the treatment for theophylline?
    charcoal hemoperfusion
  125. What is the treatment for lithium?
    hemodialysis
  126. What would you find on a drug screening upon collection of gastric contents?
    large concentrations of unmetabolized drug
  127. What is the BEST specimen for quantitation?
    Blood
  128. What is the difference between using an immunoassay vs TLC to detect drugs?
    Immunoassays only detect major categories of abused drugs, whereas TLCs pick up abused and prescriptions. (toxi-lab can detect 150-200 drugs)
  129. What drugs cannot be detected at Rochester General's lab?
    LSD, GHB, and inhalants
  130. What test is performed for all positive results on drug screens?
    Gas Chromatography Mass Spec.
  131. What natural stimulant was chewed for thousands of years and is known to block the sense of fatigue? In modern times, it is cut with cornstarch, talcum, and/or sugar.
    Cocaine
  132. What is the administration of cocaine?
    • -Snort
    • -Smoked
    • -Melted and injected
    • -eaten or rubbed into mucous membranes
  133. How does cocaine effect the brain?
    Stimulates the area that regulates sensation of pleasure by binding the neurotransmitter, dopamine so it cannot be reabsorbed.
  134. What is a "comatose cocktail" and when is it used?
    Contains glucose/dextrose, thiame and naloxone (narcan) and is used to bring patients out of comas due to opiates.
  135. List methods of toxin removal:
    • 1. Syrup of Ipecac
    • 2. Gastric Lavage
    • 3. Whole Bowel Irrigation
    • 4. Cathartics (MgSO4)
    • 5. Activated Charcoal
    • 6. Hemodialysis
  136. WHat is the most common and frequently used method of toxin removal that binds oral and IV meds?
    Activated Charcaol
  137. What are the two main anatomical areas of the adrenal glands?
    The cortex and the medulla
  138. What are the subdivisions of the cortex?
    • -Zona glomerulosa
    • -Zona fasciculata
    • -Zona reticularis
  139. What products are synthesized in the cortex of the adrenal glands?
    • -glucocorticoids
    • -mineralcorticoids
    • -adrenal androgens
  140. What products are synthesized in the medulla of the adrenal glands?
    • catecholamines (from chromaffin cells)
    • -epinepherine
    • -norepinepherine
    • -dopamine
  141. The cortex consists of the zona glomerulus, zona fasciculata, and zona reticularis. Name the hormones synthesized by each one.
    • 1. zona glomerulus - mineral corticoids
    • 2. zona fasciculata - glucocorticoids
    • 3. zona reticularis - adrogens
  142. What are steroids defined by?
    Their backbone, cyclopentanoperhydrophenathrene
  143. What are steroids primarily synthesized by and where?
    Cholesterol in the adrenal glands and gonads
  144. What form is cholesterol acquired from circulation in?
    LDL
  145. What happens to excess cholesterol in the body?
    Its is esterified and stored.
  146. What is the major organ in the body where steroids are metabolized (neutralized)?
    The liver.
  147. What is the minor organ in the body where steroids are metabolized (neutralized)?
    Kidney and GI.
  148. What hormone is considered a major glucocorticoid that is an anti-inflammatory and immunosuppressive–responisible for the metabolism of carbohydrates, lipids and proteins?
    Cortisol
  149. What is the most potent hormone in the mineralocorticoid group?
    aldosterone
  150. What group of hormones regulate salt homeostasis?
    Mineralocorticoids (aldosterone)
  151. What hormone is exclusive to the zona glomerulosa?
    aldosterone
  152. List the hormones in the adrenal androgen group:
    • 1. Androgens - DHEA, androstenedione, testosterone
    • 2. progesterone
    • 3. estrogen
  153. Where and by what system are steroid hormones metabolized?
    In the liver through the cytochrome p450 system
  154. What hormone is metabolized to where 2% gets excreted unchanged in the urine and the rest is conjugated in the liver?
    Cortisol
  155. This hormone is reduced mostly to segments either in the  kidneys or the liver; the metabolites are then conjugated:
    androgens
  156. What two group of adrenal hormones are under the influence of adrenocorticotropic hormone (ACTH) secreted by the pituitary?
    Glucocorticoids and androgens
  157. What is adrenocorticotropic hormone regulated by?
    hypothalamic corticotropin releasing hormone (CRH)
  158. What is aldosterone regulated by?
    renin-angiotensin system
  159. Where is renin synthesized and secreted?
    The kidneys by juxtaglomerular epithelial cells
  160. Where is angiotensin synthesized and where does it circulate?
    Produced in the liver and circulates in the blood.
  161. What is the most common method of measuring adrenal hormones? What alternative methods of measurement and what samples?
    • 1. Immunoassay
    • 2. HPLC and Mass Spec.; urine, blood and saliva
  162. What is the primary cause for adrenal insufficiency described by the progressive dysfunction or destruction of the adrenal glands (all adrenal steroids are affected)?
    Addison's disease
  163. What are the signs/symptoms of adrenal insufficiency (Addison's disease)?
    • -fatigue, weakness
    • -weight loss
    • -GI disturbances
    • -post prandial hypoglycemia
    • -hyperkalemia
    • -hyperpigmentation of the skin
  164. What is the diagnosis for adrenal insufficiency (Addison's disease)?
    • -decreased basal cortisol
    • -increased basal ACTH
  165. What is the secondary cause for adrenal insufficiency? What is the tertiary?
    • 1. ACTH reduction
    • 2. CRH reduction
  166. What is the diagnosis for secondary and tertiary adrenal insufficiency?
    low ACTH or CRH, and low cortisol
  167. What test is used to determine between secondary and tertiary adrenal insufficiency?
    • -CRH stimulation test
    • -exogenous CRH is monitored, if ACTH goes up its tertiary, if not its secondary.
  168. What are characteristics of hypoaldosteronism?
    • -Addison's
    • -inadequate production of renin or angiotensin
    • -acquired by heparin therapy or post-surgery
    •       -Low NA
    •       -High K
    •       -Low Cl
    •       -acidosis
    •       -Low Blood Pressure
  169. What condition is described by a defect in one of the enzymes involved in cortisol synthesis?
    Congenital Adrenal Hyperplasia
  170. How does congenital adrenal hyperplasia affect the adrenal gland?
    Results in an increase in ACTH that stimulates the adrenal gland.
  171. What enzyme is deficient in 90% of Congenital Adrenal Hyperplasia cases?
    21-hydroxylase
  172. What condition is described by the impairment of sexual development in girls and pseudo-hermaphroditism in males and is diagnosed at puberty by hypokalemia, hypertension, and hypogonadism?
    Congenital Adrenal Hyperplasia
  173. What is Conn's disease (Hyperaldosteronism)?
    aldosterone producing adenoma
  174. What are the characteristics of Conn Syndrome?
    • -Tumor hyperplasia
    • -Hypernatremia, hypokalemia and metabolic alkalosis
    • -Hypertension 
    • -Low Renin and High aldosterone
  175. What hormones are affected during Primary Conn Syndrome?
    • -Low renin
    • -High aldosterone
  176. What are the characteristics of secondary Conn Syndrome?
    • -Stimulus outside of the adrenal gland activates the renin angiotensis system
    • -High renin and Low aldersterone
  177. What hormones are affected during Secondary Conn syndrome?
    • -High renin
    • -Low aldosterone

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