Miscellaneous Pharm

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Boards
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77255
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Miscellaneous Pharm
Updated:
2011-04-06 11:39:57
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Toxicology
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Toxicology
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  1. Common Toxic Syndromes
    P. 309 in pharm book Kaplan
  2. Heavy Metal Poisoning: ARSENIC
    • Where it is found: wood preservatives, pesticides, ant poisons)
    • Sxs: ACUTE: gastroenteritis, hypotension, metabolic acidosis, garlic breath, "rice water" stools, torsades, seizures CHRONIC: pallor, skin pigmentation (raindrop pattern), alopecial, stocking glove neuropathy, myelosuppression
    • Intervention/antidote: activated charcoal, dimercaprol, penicillamine or succimer
  3. Heavy Metal Poisoning: Iron
    • Where it is found: medicinal for anemias, prenatal vitamins)
    • Sxs: ACUTE: mainly children, severe GI distress, necrotizing gastrogeneteritis with hematemesis & blood y diarrhea, dysnpea, shock, coma (blood from both ends)
    • Intervention/antidote: gastric aspiration + carbonate lavage, deferoxamine IV
  4. Heavy Metal Poisoning: Lead
    • Where it is found: tap water, leaded pain chips, herbal remedies, gas sniffing, glazed kitchenware)
    • Sxs: ACUTE: nausea/vomiting, GI distress, pain, malaise, tremor, tinnitis, paesthesia, encephalopathy (red or black feces). CHRONIC: multisystem effects: anemia (decreased heme synthesis), neuropathy (wrist drop), nephropathy (proteinuria, failure), hepatitis, mental retardation (from pica), decreased fertility, increased stillbirths, will see Pb on Xray in long bones
    • Intervention/antidote: DECONTAMINATION: gastric lavage + dimercaprol (severe) or EDTA or succimer (penicillamine if unable to use dimercaprol or succimer), children: succimer PO
  5. Heavy Metal Poisoning: Mercury
    • Where it is found: elemental in instruments, salts in amalgams, batteries, dyes, electroplating, fireworks, photography
    • Sxs: ACUTE: vapour inhalation- chest pain, dyspnea, pneumonitis, inorganic ingestion- hemorrhagic gastrogenteritis, acute tubular necrosis, shock. CHRONIC: organic Hg- CNS effects, ataxia, paresthesias, auditory and visual loss, loosening of teeth
    • Interventions/antidote: succimer PO or dimercaprol (IM). Activated charcoal for ingestion, then support with succimer PO or dimercaprol (not IV) bc it causes redistribution of Hg to CNS = neurotoxicity
  6. Antidotes: (note chart on page 311 in kaplan)
    Acetaminophen poisioning
    Acetylcysteine
  7. Antidotes:
    AChEI inhibitors poisoning: physostigmine, neostigmine, pyridostigmine, organophsophates (insecticieds like malathion & parathion)
    Atropine + pralidoxime (or irreversible AChE inhibitors)
  8. Antidotes:
    Iron and Iron Salts
    Deferoxamine
  9. Antidotes:
    Digoxin
    Digoxin immune F(ab)
  10. Antidotes:
    Arsenic, gold, mercury, lead
    Oral succimer for milder lead and mercury toxicity, dimercaprol (BAL)
  11. Antidotes:
    theophylline, beta agonist
    Esmolol
  12. Antidotes:
    Benzodiazepine, zolpidem, zalplon
    Flumazenil
  13. Antidotes:
    Opiod analgesics
    Naloxone
  14. Antidotes:
    Carbon monoxite
    oxygen
  15. Antidotes:
    copper (Ex: Wilson's disease), iron, lead, mercury
    Penicillamine
  16. Antidotes:
    Anticholinergics: atropine, antihistamine, antiparkinsonian- not TCAs
    Physostigmine
  17. Antidotes:
    Heparins
    Protamine
  18. Antidotes:
    warfarin, coumarin anticoagulants
    Vitamin K
  19. Antidotes:
    Nonspecific: all oral poisonings except Fe, CN, Li, solvents, mineral acids, corrosives
    activate charcoal (time dependent though)
  20. Natural Medicinals: ECHINACEA
    • Medicinal use: decrease cold sxs
    • Possible mechanism: increases IL and TNF
    • Toxocity: GI distress, dizziness, headache
  21. Natural Medicinals: GARLIC
    • Medicinal use: hyperlipidemia, cancer (weak evidence)
    • Possible mechanism: inhibitos HMG-CoA Reductase and ACE
    • Toxicity: allergies, hypotension, antiplatelet actions, caution when using with anticoagulants
  22. Natural Medicinals: *GINKO*
    • Medicinal use: intermitten claudication, AD (weak evidence)
    • Possible mechanism: antioxidant, free radical scavenger, increases NO
    • Toxicity: anxiety, GI distress, insomnia, antiplatelet actions, caution when using anticoagulants
  23. Natural Medicinals: GINSENG
    • Medicinal use: possible increas in mental and physical performance (weak evidence)
    • Possible mechanism: uknown
    • Toxicity: insomnia, nervousness, htn, mastalgia, vaginal bleeding
  24. Natural Medicinals: *SAW PALMETTO*
    • Medicinal use: symptomatic BPH
    • Possible mechanism: 5alpha-reducaste inhibitor and androgen receptor antagonist
    • Side effects: GI pain, decreased libido, headache, htn
  25. Natural Medicinals: *ST. JOHN'S WART*
    • Medicinal use: depressive disorder variable evidence for clinical efficacy)
    • Possible mechanism: may enhance brain 5HT functions
    • Toxicity: major drug interactions serotonin syndrome with SSRI, induces P450, leading to decreased effects of multiple drugs
  26. Purified Nutritional Supplements: DHEA
    • Pharmacology: androgen precursor used for tx of AIDS (increases CD4 count in females), AD & "aging" diabetes, hypercholesterolemia, SLE (decreases sxs of flareups)
    • Toxicity: FEMALES: androgenization & CV dz and breast cancer MALES: feminization in young, BPH and cancer in elderly
  27. Purified Nutritional Supplements: Melatonin
    • Pharmacology: serotonin derivative, used for 'jet lag' and sleep disorders
    • Toxicity: drowsiness, sedation, headache,
    • Contraindication: PREGNANCY, women trying to conceive (decreases LH), nursing mothers (decreases PRL)

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