Unit 9 Toxicology

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Unit 9 Toxicology
2014-04-07 19:59:58
Clinical Toxicology Unit9 Final

Unit 9 Toxicology
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  1. Major toxic effects of Aminoglycosides (Tobramycin, Gentamicin, Amikacin,etc.)  (Vancomycin has same toxic effects)
    Rots kidneys (Intestinal Nephritis)

    Rots 8th Cranial Nerve (Ototoxicity – deafness, ringing of ears, loss of balance)
  2. Major toxic effects of Chloramphenicol (chloromyocetin)
    Rots stem cells in bone marrow.

    10% developed transient Aplastic Anemia, and of these, 20% became chronic.
  3. Major toxic effects of Lidocaine (Xylocaine - given to resist ventricular fibrillation)
    Bradycardia, Cardiovascular Callapse, Cardiac Arrest

    Signs of toxicity : Low Blood Pressure, Dizziness, Blurred Vision, Nausea
  4. Major toxic effects of Methotrexate
    Anti-rejection medication --> organ transplant success

    Blocks DNA and RNA synthesis

    Rots Liver, Bone Marrow, and Kidneys

    Isn’t a therapeutic range because that are many different uses.  Light labile and temperature sensitive.

    In agressive therapy, they give a lethal dose and then after four hours save them (a couple hours before they would die).  This would require a greater delusion.
  5. Major toxic effects of Theophylline
    Used to treat asthma and emphysema (blocks mucus production, relaxes bronchioles)

    This is the alcaloid in tea.  Similar to chocolate’s theobromine.

    Headache, tachycardia, dizziness, nausea, insomnia, irritability, convulsions, seizures, strokes
  6. Major toxic effects of Digoxin and Digitoxin (cardiac glycosides)
    It slows down and steadies the heart rate.

    Used to increase cardiac output for Congestive Heart Failure patients.

    Nausea and vomiting, blurred vision, pounding in ears (slower and more forceful pounding of the heart); AV-heart block = death
  7. Major toxic effects of Lithium
    Used to treat manic-depressive illness.

    Therapeutic range is just below toxic range.

    Muscle tremors, twitching, ataxia that can result in life-threatening seizures. Lithium replaces Potassium.
  8. Major toxic effects of Cyclosporine - A  (CYA)
    Anti-rejection drug.

    Rots everything if toxic, but reject organ if too low.  Dosage based upon trough level.

    50% bound to RBC so specimen is EDTA whole blood (one of the few on whole blood).
  9. Major toxic effects of Tacro-II  (Tachrolimus - FK-506) – second generation anti-rejection drug
    Rots everything – more toxic gram-per-gram than CYA, but takes less drug.

    Dosage based upon trough level.  50% bound to RBC so specimen is EDTA whole blood (one of the few on whole blood).
  10. Identify some Anti-Convulsants
    • Phenytoin (Dilantin)
    • Valproic Acid (VPA)
    • Primidone  (and Phenobarbital – active metabolite)
    • Carbamazepine  (Tegretol)
    • Ethosuximide
  11. Identify some Anti-Arrhythmic Agents
    • Digoxin and Digitoxin – although not used for arrhythmia.  More for heart failure.
    • Quinidine
    • Procainamide (Pronestyl, Procain) (and NAPA)
    • Lidocaine  (Xylocaine)
    • Disopyramide (Norpace)
    • Propranolol  (Inderal)
  12. Identify some Anti-Anxiety Drugs

    • A frequent drug of abuse. 
    • This isn’t for therapeutic monitoring.  Drug cocktails often contains these, like with cocaine.

    • Diazepam (Valium) – can develop a chemical dependence to this.  A muscle relaxant as well.
    • Chlordiazepoxide (Librium)
    • Alprazolam (Xanax)
    • Prazepam (Centrax, Verstran)
    • Halazempam (Paxipam)
    • Oxazepam (Serax)
    • Larazepam (Atavan)
    • Flurazepam (Dalmane)
  13. Identify some Tricyclic Anti-Depressants (TADs)
    A frequent drug of abuse. Euphorics if you’re not depressed or if you take too much

    • Amitriptyline (Nortriptyline)
    • Imipramine  (Desipramine)
    • Doxepin  (Desmethydoxepin) – sometimes used for itching
  14. Identify some Analgesics
    A frequent drug of abuse.

    • Salicylates (Aspirin) – more in an emergency toxicology screen: very nephrotoxic.
    • Acetaminophen (Tylenol, etc.) – more in an emergency toxicology screen: very hepatotoxic. Easy to get toxic because so many different drugs contain it.
    • Propoxyphene (Darvon)
  15. Identify some Anti-neoplastic and Immunosuppressives, and Miscellaneous Drugs
    • Theophylline (asthmatic bronchiodilator)
    • Methotrexate (DNA, RNA synthesis inhibitor)
    • Lithium  (treatment for psychological disorders)  
    • Cyclosporine-A (Immuran, an immunosuppressant)
    • FK-506 (Tacro-II)
  16. Name the drugs that are currently a component of the UUMC ER Stat Toxicology Screen, and their preferred specimens.
    • Serum. 
    • Ethanol (Alcohol Dehydrogenase Method) 
    • Salicylates 
    • Acetaminophen
    • Tricyclic Anti-Depressants
    • Primidone (Barbiturate) Metabolites (Phenobarbital if positive)
    • Benzodiazapines (Urine as well)
    • Osmolality  by Freezing Point Depression method (and calculate
    • Osmolal Gap to find out if something else it there)

    • Urine because they have a short half-lives. 
    • Stimulant Amines  (speeds: benzadrine, dexidrin, amphetamines, methamphetamines, etc – testing for a common metabolite)
    • Opiate Metabolites (heroin, morphine, codein, papaverine) – pin-point pupils 
    • Cocaine Metabolites
  17. Drugs that are not part of the current UUMC ER Toxicology STAT panel and their preferred specimens:
    • Phenothiazines (urine)
    • Halucinogens

    • Phencyclidine (PCP) (angel dust) (urine)
    • Illusions of grandeur, severe paranoia

    • Tetrahydrocannabinol Metabolites (THC, Marijuana, Hash) (urine is best)
    • Too quickly metabolized. Won’t see the parent drug but can see metabolites in urine.  They continue to shed metabolites for five weeks.

    • Organophosphate Poisoning (Malathion, Parathion) (serum)
    • Inhibits cholinesterase activity, so I think they test cholinesterase activity.

    • Iron  (serum)
    • Rots liver and GI track; iron poisoning for kids
    • Above 500 ug/dL critical
    • Above 700 ug/dL lethal

    • Carbon Monoxide  (EDTA whole blood – purple top)
    • Greater affinity than oxygen to hemoglobin.  Bright cherry red blood --> Carboxyhemoglobin.  Person might have a very ruddy or healthy looking complexion.