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pharm 2 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Anticholinergic Syndromes

A

i.e. Atropine overdose
Signs:
-Tachycardia
-Dry flushed hot skin
-elevated temp
-urinary retention
-agitated delirium

Causes:
-Atropine
-scopolamine
-antihistamines
-anti-parkinsons
-anti-psychotics

Tx: Physostigmine

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2
Q

Sympathomimetic Syndromes

A

i.e. Cocaine
Signs:
-Tachycardia
-Hypertension
-Seizures
-Increased temp
-mydriasis(pupil dilation)
-Delirium
-Paranoia

Causes:
- Cocaine
- amphetamines
-OTC decongestants
-caffiene
-thophylline

Tx: benzodiazepines for seizures,
-Lidocaine for Tachycardia and v fib

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3
Q

Opiates

A

i.e. Heroin
Signs
-Hypotension
-Bradycardia
-coma
-respiratory depression
-miosis, pupil constrict
-hyporeflexia
-CNS depression

causes:
-Narcotics

Tx: Naloxone (narcan)
- symptomatic

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4
Q

Non-opiates

A

i.e. Alcohol
Signs:
Same as opiates

causes:
-Barbituates
-Benzodiazepines
-other sedatives
-ethanol

Tx: Flumazenil for benzodiazepine
-IV saline for ethanol
-symptomatic tx

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5
Q

Cholinergic Syndromes

A

i.e. Insecticides, Nerve agents
Signs:
-confusion
-weakness, paralysis
- CNS depression
- Miosis
-SLUD

Causes:
-Organophosphates
-carbamates
-physostigmine (AchE inhibitor)
-insecticides

Tx: Cholinergic Antagonist: Atropine
-Pralidoxome: (organophosphates only)

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6
Q

Non-specific Tx

A

Determine nature of poison first (lab test, poison control,etc.)

-Activated Charcoal, nonspecific chelator, limits absorption if agent isn’t fast absorbing. only effective up to 4 hours after poisoning.

-Gastric lavage-for caustic liquids ingestion

-Syrup of ipecac-vomit inducer, rarely used

-whole bowel irrigation Poly ethylene glycol in balanced electrolyte solution
(for Fe, Li)

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7
Q

Insecticides

A

-Organophosphates
-Chlorinated Insecticides
-Pyrethrins

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8
Q

Organophosphates

A

AchE inhibitors:

Irreversible:
Organophosphates
-VX nerve agent
- methyl parathion
(2-PAM can “reverse”)
Reversible: Carbamates

Signs:
-Headaches, nausea, dizzy
-cholinergic complaints, SLUD

Mechanism:
Extreme toxic, diaphragm muscle paralysis, respiratory failure,
-CNS depression respiratory centers, bronchoconstriction

Tx:
-Atropine for both
-Pralidoxome (2-PAM) for organophosphates only

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9
Q

Chlorinated Insecticides

A

DDT, methoxychlor, chlordane
can accumulate in food

DDT ok in africa

Less tox than AchE Inhibitors (poor absorption)

MOA: inhibit VG Na channels -seizures

signs: seizures, weakness, numbness, twitches, tremors

Tx:
-Activated charcoal
-gastric lavage
-DO NOT induce vomiting (risk seizure onset)
-Anticonvulsants (phenobarbital, diazepam) slow infusion for seizures

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10
Q

Pyrethrins

A

from chrysanthomum plant, for tx of parasite in farm animals

rapid metabolism in humans
-low toxicity

signs:
-bronchospasm
-skin burning
-irritant
seizures or coma if large amounts (200-500mL concen.)

MOA:Inhibit VG Na channels

Tx: Activated Charcoal
- NO vomitting
give o2 and bronchodilator

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11
Q

Alcohols

A

-Methanol
-Ethylene Glycol
-Diethylene Glycol

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12
Q

Methanol

A

Wiper Fluid, pain removers, hand sanitizer

Signs:
-CNS depression like ethanol

Toxic metabolites: Formaldehyde and Formate
-cause blindness and metabolic acidosis

Tx: ADH Inhibitors (or ethanol outcompete)
- Fomepizole
-Na bicarbinate IV

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13
Q

Ethylene Glycol

A

Antifreeze

metabolized to oxalic acid
-hypocalcemic tetany
-oxalic acidurea (crystals in urine)
-CNS depression

Tx: Ca IV
-ADH inhibitor
-Fomepizole
-pyridoxine, folate, thiamine

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14
Q

Diethylene Glycol

A

Toothpaste in china
subtitute for propylene glycol

signs:
-Anuric renal failure
-Hepatitis
-pancreatitis

Tx:
- symptomatic tx
- supportive for organ failure

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15
Q

Metals

A

Body has natural defense mechanisms:
-Cellular chelators
-antioxidant system for metal induced oxidative stress

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16
Q

Lead

A

Inorganic form is toxic
-contaminated food (utensils for prep)
-chocolate candy processing
-ingestion of paint chips/dust
-contaminated drinking water (10-20%)
-toys, gasoline, occupational

17
Q

Lead Symptoms

A

-Hypochromic Microcytic anemia
-PNS weakness (wrist extensors
-CNS weakness- lead encephalopathy
fatal in children

Children absorb 40% ingested Lead, 10% in adults
Deteriorates BBB easily in children
Low IQ, ADHD, aggresive behavior if childhood exposure

18
Q

Lead Tx

A

Lead replaces Ca,Zn,Mg in enzymes and bone
-inhibits hemoglobin synthesis

take action if 5ug/dL

Severe-45 in children, 50 in adults, should use oral chelator:
Succimer

19
Q

Arsenic

A

Most toxic is elemental trivalent and pentavalent

Organic Arsenicals: least toxic, in seafood

elemental in rural water supplies

MOA: oxidative stress
-affinity for -SH groups on proteins

20
Q

Arsenic signs

A

signs: (acute) hemorrhagic gastroenteritis
-rice-water diarrhea
-garlic odor breath

Chronic intoxication: more common and insidious
-hyperkeratosis, exfoliative dermatitis on feet
-vasodilation, fatty liver, cancer

Tx: metal chelator
- Dimercaprol given IM

21
Q

MethylMercury

A

Organic form is most dangerous, inorganic Hg can be biotransfered into methylmercury by aquatic organisms
-Inorganic Hg poorly absorbed (dental, thermometers, inorganic salts(preservatives), less toxic)
Ethyl mercury- antibacterial/fungal, not correlated with autism in children from vax

Methylmercury highly absorbed in GI
-readily passes BBB
- in fish,
-grain fungicide (seeds, in Iraq)
-Minamata Disease (Minamata bay)

22
Q

Methylmercury signs/tx

A

Signs:
-loss of balance
-ataxia
-sensory defect
-deafness
-dysarthria
All irreversible, kills neurons

MOA: Increases intracellular Ca

Tx: chelator therapy if high levels, levels can rebound

23
Q

Metal chelators

A

only reduces readily accessible pool, can rebound. for severely elevated
-Dimercaprol (BAL)-for Arsenic, Hg, sometimes lead
-EDTA-severe Lead (kidney tox at high dose), AE: chills, fever, nausea, vomiting
- Deferoxamine- for Iron, AE: allergy
-Succimer- for Lead
oral

24
Q

CO

A

from burning/combustion

high O2 demand organs suffer first

-Headache
-Increased HR

outcompetes O2 for Hemoglobin

Tx: hyperbaric O2

25
Q

Cyanide

A

plastic smoke, wool burning, cigarettes

signs: bitter almond breath
-tachypnea(low levels)
-apnea (high levels)

MOA: inhibits cytochrome oxidase in ETC in mitochondrial for ATP

Tx: cyanokit

better than 2 step method( which is also bad for CO poisoning at same time)

26
Q

Asbestos

A

filamentous silica

mesothelioma lung cancer after 15-20 years

migrate to form pleural plaques/effusions(5-10yrs

No Tx

27
Q

PCBs and Dioxin

A

Flame retardants, plasticizers, insulating material in elecric transformers
PCB in farm raised Salmon

signs: Dermal erruptions, Chloracne
-nausea, vomitting, headache

Dioxin-Agent orange byproduct
contaminant of industrial processes(not intentionally produced

No Tx

28
Q
A

pharm 2 (11 decks)

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