B5-093 Toxicology Flashcards
(133 cards)
1
Q
most common cause of acute liver failure in the Western world
A
acetaminophen
2
Q
causes hepatic necrosis secondary to cascade of signaling events, resulting in mitochondrial injury and cell death
A
acetaminophen
3
Q
standard of care for acetaminophen overdose
A
NAC within 8-12 hours of exposure
dose based on nomogram, shows acetaminophen plasma levels
4
Q
- causes tinnitus, dizziness
- eventually causes metabolic acidosis, hyperpyrexia
- can cause coma, convulsions, respiratory failure
A
salicylate
5
Q
treatment for salicylate overdose
A
sodium bicarbonate to alkalize urine to promote excretion, counteracts acidosis
6
Q
cause tachycardia, hypertension, seizures, mydriasis
A
sympathomimetics
cocaine, amephetamines
7
Q
cocaine and amphetamines fall under what classification?
A
sympathomimetics
8
Q
treatment for sympathomimetics overdose
A
maintain airway and respiration
* control convulsions: IV diazepam
* if convulsions interfere with respiration: succinylcholine
* vasopressors
* if orally ingested, charcoal emesis to remove
9
Q
what are contraindicated in the treatment of sympathomimetics overdose?
A
beta blockers
worsen toxicity
10
Q
cause unconsciousness, miosis, slow/shallow respirations
A
opioids
opioid triad
11
Q
morphine, fentanyl, tramedol fall under what classification?
A
opioids
12
Q
treatment for opioid overdose
A
naloxone
short DOA, give repeat doses
13
Q
- have anti-cholinergic effects
- cause cardiovascular toxicity
- blockade of myocardial fast sodium channels causes QT prolongation, hypotensions
- seizures
A
tricyclic antidepressants (amitryptiline)
14
Q
anticholinergic effects
A
dry mouth
tachycardia
nausea
confusion
urine retention
15
Q
treatment for tricyclic anti-depressant overdose
A
sodium bicarbonate to maintain arterial pH, reversing cardiac depressant effects
16
Q
what class of drugs in contraindicated in the treatment of tricyclic antidepressant overdose?
A
class IA anti-arrthymics
quinidine, procainamide, lidocaine, etc
17
Q
- cause first degree heart block, hypotension, and bradycardia
- increased PR intervals
- hypoglycemia and hyperkalemia
- CNS toxicity
A
beta blockers
18
Q
treatment for beta blocker overdose
A
- glucagon for bradycardia/hypotension
- sodium bicarb for conduction defects
19
Q
causes torsade de pointes polymorphous V tach w/ QT prolongation
A
sotalol overdose
20
Q
treatment for sotalol overdose
A
- isoproternol IV
- magnesium
21
Q
cause AMS, fever, agitation, myclonus, hyperreflexia, ataxia, diaphoresis
A
serotonin syndrome
22
Q
drugs that can cause serotonin syndrome
5
A
SSRIs
MAOIs
TCAs
Amphetamines
Opioids
usually SSRI + one of the others
23
Q
treatment for serotonin syndrome
A
- serotonin antagonists (cyproheptadine, propranolol)
- dantrolene
24
Q
organophosphates are […]
reversible/irreversible
A
irreversible
25
carbamates are [...]
| reversible/irreversible
reversible
26
parathion (paraoxon)
malathion (malaoxon)
sarin
soman
| belong to what classification?
organophosphates
| cholinesterase-inhibiting insecticides
27
carbaryl
aldicarb
carbofuran
aminocarb
| belong to what classification?
carbamates
| cholinesterase-inhibiting insecticides
28
cause salivation, lacrimation, urination, defecation
cholinesterase-inhibiting insecticides
| **SLUD**
29
cholinesterase-inhibiting insecticides overdose treatment
* atropine - blocks cholinergic effects
* 2-pralidoxime (2-PAM) - reactivates ACHase enzyme
| 2-PAM for organophosphates only
30
2-PAM is contraindicated for [...] toxicity
carbamate
31
chemicals affecting heme
* methemoglobin inducing agents (nitrates)
* carbon monoxide
* cyanide
32
* causes hypertension, hypoxia, and cyanosis
* chocolate colored blood
nitrate induced methemoglobin
33
treatment for nitrate induced methemoglobin
methylene blue
| will convert methemoglobin back to hemoglobin
34
odorless and colorless gas that is a major cause of lethal poisoning in US
carbon monoxide
35
carboxyhemoglobin cannot transport
oxygen
36
* causes headaches, dizziness, stupor, progressive brain anoxia
* bright red mucous membranes
carbon monoxide
| carboxyhemoglobin is cherry red
37
treatment for carbon monoxide poisoning
oxygen
38
complexes with ferric iron of cytochrome oxidase inhibiting oxygen use in mitochondria
cyanide
39
causes dizziness, headache, hypotension, unconciousness, respiratory failure
cyanide
40
treatment for cyanide poisoning
* induce methemoglobin via nitrates (high affinity for cyanide ions)
* hydroxocobalamin: binds to cyanide ions to excrete in urine
41
metals causing toxicity
| 5
* arsenic
* lead
* mercury
* cadmium
* manganese
42
causes hemolysis, hemoglobinurea, GI disturbances, ventricular arrhythmias, vasodilation, rosy complexion
acute arsenic poisoining
43
causes nephritis, dermatitis, cancer of bladder/liver
chronic arsenic toxicity
44
binds to sulfahydryls, especially in lipoic acid, interfering with energy production
arsenic
45
preferred chelator for acute arsenic poisoning
dimercaprol
46
preferred chelator for chronic arsenic poisoning
succimer
47
most exposure comes from smoke, smog, or old paint
lead
48
causes kidney damage and GI irritation
acute lead poisoning
49
causes plumbism, microcytic anemia, constipation, abdominal pain, neurological damage
chronic lead poisoning
50
causes developmental deficits, low IQ, growth retardation, irritability in children
lead poisoning
51
causes hypertension, cholic, anemia in adults
lead poisoning
52
treatment for lead poisoning
chelation therapy:
* CaNa2EDTA
* BAL
* penicillamine (oral)
* succimer (oral)
53
kids should be treated for lead poisoning at what blood lead level?
greater than 5 ug/dl
54
therapeutic index
TD50/ED50
55
margin of safety
TD1/E99
56
lower doses have protective effect, higher doses have adverse effects
hormesis
| vitamins, alcohol
57
dose related toxicity due to non-immune mechanism
toxicity
58
allergic reactions involving immune system
hypersensitivtty
59
abnormal responses not linked to immune system
idiosyncrasies
60
dose related adverse effects of drugs, which is generally an overextension of the pharmacological response
drug toxicity
| can causes minor adverse effects or severe organ directed toxicities
61
adverse effect of atropine
dry mouth
62
adverse effect diazepam
drowsiness
63
aspirin overdose causes [...] toxicity
| organ directed
gastrointestinal
64
acetaminophen causes [...] toxicity
| organ directed
hepato
65
doxorubicin causes [...] toxicity
| organ directed
cardiac
66
drugs that cause direct fetal toxicity
| 3
* sulfonamide - kernicterus
* chloramphenicol- Gray baby syndrome
* tetracycline- teeth discoloration, bone growth retardation
67
* physical defects in developing fetus due to drug exposure in mother during gestation
* effects more pronounced during organogenesis (day 20-end of first trimester)
teratogenicity
68
teratogens
| 4
* thalidomide
* alcohol
* lithium
* antifolates
69
abnormal response resulting from previous sensitizing exposure activating immonologic mechanism
drug allergy/hypersensitivity
70
untoward reactions to drugs that occur in a small fraction of patient and have no obvious relationship to dose or duration of therapy
idosyncrasies
71
hemolytic anemia in reponse to [...] is due to differences in G6PD activity
| drug name
primaquin
| example of idiosyncracies
72
most drug idiosyncrasies are due to
genetic variation within SNPs
73
patients with abnormal serum cholinesterase develop sleep apnea when given normal doses of
succinylcholine
| example of idiosyncracy
74
what is the major challenge of treating drug toxicity?
no credible info
stabilize patient first, then try to figure out toxin
75
ABCDts of EM
airway
breathing
circulation
drugs
temperature
76
constellation of clinical symptoms that are associated with exposure to certain toxicological classes of chemicals
toxidrome
77
# identify the toxidrome
* increased BP
* increased pulse
* slight temperature increase
* mydriasis
* hyperalert
* increased reflexes
sympathomimetic
| amphetamine, methamphetamine, pseudoephedrine
78
# identify the toxidrome
* increased pulse
* increased temperature
* mydriasis
* decreased bowel sounds
* altered mental status
anticholinergic
79
# identify the toxidrome
* decreased pulse
* miosis
* increased bronchial sounds
* increased bowel sounds
* altered mental status
cholinergic
80
# identify the toxidrome
* decreased BP
* decreased pulse rate
* decreased temperature
* miosis
* rales
* decreased bowel sounds
* decreased level on consciousness
opioid
| fentanyl, oxycodone, hydrocodone
81
hypertension and tachycardia
amphetamine
82
hypotension and tachycardia
TCAs
83
hypotension and bradycardia
beta blockers
84
rapid respiration
carbon monoxide
85
hyperthermia
| 2
anticholinergics, salicylates
86
hypothermia
| 2
ethanol, sedatives
87
pupil constriction (miosis)
opioid
88
pupil dilation (mydriasis)
amphetamines
89
dry skin
atropine
90
excessive sweating
organophosphates
91
cyanosis
methemoglobin (nitrates)
92
jaundice
hepatotoxicity, acetaminophen
93
twitching
cocaine
94
muscle rigidity
anti psychotics
95
flaccid coma
opioids
96
hypertension, tachycardia, mydriasis, seizure
amphetamines
97
anion gap equation
Na-(HCO3+Cl)
98
AT MUD PILES
Alcohol
Toluene
Methanol
Uremia
DKA
Paraldehyde
Iron, Isoniazid
Lactic Acid
Ethylene Glycol
Salicylates
99
high anion gap indicates
metabolic acidosis
100
osmolar gap calculation
101
normal osmolar gap
285
102
normal anion gap
12
103
MAE DIE
Methanol
Acetone
Ethanol
Diuretics
Isopropanol
Ethylene gylcol
104
drugs that cause Torsades de Pointes
| 2 main ones
* Quinidine (Class IA and III antiarrhythmics)
* TCA
105
prolonged QT is caused by
beta-1 stimulation and intense sympathetic activation
106
treatment for torsades de pointes
magnesium sulfates
107
removal and elimination treatments for toxicity
* gastric lavage with activated charcoal
* emesis via ipecac syrup
| only used if injested orally, can cause aspiration
108
methods for preventation of further toxicity absorption
inhalation: ventilation
topical: remove contaminated clothes
injestion: lavage, emesis, irrigation, etc
109
methods to remove blood from plasma
* hemodialysis
* hemoperfusion
* hemofiltration
* plasma exchange
110
fomepizole is an antidote for
ethylene glycol
111
hydroxicocobolamine is an antidote for
cyanide
112
atropine is an antidote for
| 2
organophophates
nerve gas agents
113
fab fragments are antidotes for
digoxin
114
dimercaprol is a chelator for
| 4
* arsenic
* gold
* mercury
* acute lead
115
calcium disodium EDTA is a chelator for
lead
116
penicillamine is a chelator for
| 2
lead
copper
117
succimer is an oral chelator for
lead
118
used to determine adverse effects on large populations
quantal dose response
119
used to determine dose dependent increase in toxicity to a number of doses
| 2
graded and individual dose response
120
used to demonstrate that chemicals have adverse effects when they are both deficienct in the body and present in very high quantities
| vitamins
quantal dose response
121
formula to calculate margin of safety
TD01/ED99
122
* decreased blood pressure, pulse and temperature
* pupil constriction
opioids
123
* agitated delirium
* confusion, restlessness, picking at imaginary objects
anticholinergics
124
* tachycardia
* hypertension
* hypertherma
* tachypnea
* mydrasis
* diaphoresis
* tremor
* hyperactive bowel
* rhabdo
* seizures
* psyhchoses
sympathomimetics
125
* salivation
* lacrimation
* urination
* defecation
cholinergic
126
distinguishing feature of TCA overdose
torsades de pointes
127
administration of sodium bicarb is based on what treatment principle
ion trapping
128
used to treat lead, mercury, iron, and arsenic poisoning
chelation therapy
129
used to alkalinize urine to inhibit reabsorption of weakly acidic toxins across renal tubular membrane
ion trapping with bicarb
130
acetaminophen OD is treated with
N acetyl cysteine
131
TCA OD is treated with
sodium bicarb
132
treatment for beta blocker OD
glucagon
atropine
epi
calcium salts
133
treatment for lead poisoning
chelation
