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Head & Neck 2-My Flashcards > Dental Toxicology (6 questions) > Flashcards

Dental Toxicology (6 questions) Flashcards

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1
Q

Father of toxicology who said “the dose makes the poison” “All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from remedy”

A

Theophrastus Phillippus Aureolus Bombastus von Hohenheim aka Paracelsus

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2
Q

In 1930 the name of Food, Drug, and insecticide Administration shorted to

A

Food and Drug Administration (FDA)

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3
Q

1960’s Thalidomide disaster, drug used for?

A

nausea associated with pregnancy. Sold over the counter. Found to be teratogenic. Caused phocomelia (underdeveloped limbs).

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4
Q

Toxicology

A

is the study of the adverse effects of chemical, physical, or biological agents on living organisms and the ecosystem, including the prevention and amelioration of such adverse effects”-Society of Toxicology

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5
Q

FDA (Food and Drug Administration)

A

control/regulates drugs used for human and veterinary drugs, dietary supplements, medical devices, food products, cosmetics, products that emit radiation.

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6
Q

Toxicants

A

substance that produces adverse biological effects of any nature

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7
Q

posisons

A

toxicant that cause immediate death or illness when experienced in very small amounts

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8
Q

toxins

A

specific proteins produced by leaving organisms

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9
Q

Bioaccumulation

A

The accumulation of a substance, such as a toxic chemical, in various tissues of a living organism. Bioaccumulation takes place within an organism when the rate of intake of a substance is greater than the rate of excretion or metabolic transformation of that substance. Happens in the SAME ANIMAL.

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10
Q

Biomagnification

A

The increasing concentration of a substance, such as a toxic chemical, in the tissues of organisms at successively higher levels in a food chain. DIFFERENT ANIMAL BUT SAME FOOD CHAIN. Process of taking non-toxic chemical to a chemical one.
e.g. PCB (Polychlorobiphenyls in Great Lakes), Mercury in Minimata bay in Japan)

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11
Q

Bioactivation

A

The metabolic activation of xenobiotic compounds into reactive, toxic compounds. Body turns it toxic. e.g. tylenol.

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12
Q

Detoxification

A

physiological or medicinal removal of toxic substances from the body

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13
Q

What form of Mercury is toxic?

A

Dimethylmercury (organic)

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14
Q

Fluoride antidote?

A

1% CaCl2 or calcium gluconate or milk

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15
Q

Tylenol target organ?
maximum adult use?
What entitiy cause toxicity?
Antidote?

A

Liver
4g in 24 hours
NACQI
N-acetylcysteine (NAC)

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16
Q

Cocaine antidote?

A

no specific antidote

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17
Q

Antidepressants antidote?

A

No specific antidotes.

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18
Q

Cardiovascular drug: Digoxin antidote?

A

Digiband

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19
Q

Cardiovascular drug: Calcium channel antagonists?

A

Antidote: Activated charcoal within 1-2 hours, IV calcium chloride in serious poisoning, positive inotropes, insulin

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20
Q

Name 3 regulatory agencies

A

FDA
EPA
OSHA

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21
Q

EPA (environmental protection agency)

A

the objective of the EPA is to: ‘use its best endeavours – a) to protect the environment; and b) to prevent, control and abate pollution and environmental harm.’

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22
Q

OSHA (Occupational Safety and Health Administration)

A

OSHA assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

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23
Q

State the year in which FDA established?

A

1930

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24
Q

Ex. of Biomagnification in Great Lakes and marine life?

A

PCB (a pesticide) aka persistent organic pollutants are endocrine disruptures. Chemicals get magnified as they go to higher levels in the food chain. e.g. zooplankton feed off phytoplankton thus more PCB conc. in that.

More mercury in large fish like Shark in marine life.

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25
Explain biotransformation and processes involved in it?
Biotransformation- chemical alternation of chemicals such as nutrients, aa, toxins, and drugs in the body. Lipophilic chemical-->Hydrophilic Chemical-->readily excreted Accumulation-->Phase I--> Phase II
26
LD50
Dose that is lethal in 50 % of the exposed animals
27
Median Toxic dose (TD50)
toxic dose in 50 % of the population or Lethal dose (LD50)
28
Median effective dose (ED50)
effective dose in 50 % of the population
29
Therapeutic Index (Window)
margin of safety; how selective a drug is in producing its desired effects over adverse effects
30
Additive Effect
1+1 = 2 if two compounds that causes similar types of toxicity together cause an effect that is sum of the individual effects Toluene & p-xylene
31
Synergism
1=1 =5 if two compounds together causes an effect that is stronger than additive effect of the two Ethanol & CCL4 & Tylenol
32
Potentiation
0+1 = 3 if one of the compounds is not toxic by itself, but enhances the toxicity of another compound 2-propranolol & CCl4
33
Antagonism
1+0 = 0
34
Subacute: exposure period?
1-14 days
35
Subchronic: exposure period?
14-28 days
36
Chronic toxicity: exposure period?
6-24 months
37
Preclinical studies
sdfsss
38
four phases of clinical FDA evolution of New Drugs
Phase I: Effect of drug under investigation in healthy volunteer human subjects (20-80) Determine toxicity and dose, PK Phase II: Effectiveness of drugs in human subjects for particular indication Well controlled, monitored, small studies in patients [several hundred (100-300)] Phase III: Double blind study, compares effect against standard treatment Extrapolation to general population for risk benefit analysis & information for physician labeling Several thousand (1000-3000) subjects are involved Phase IV: Post marketing surveillance
39
Institutional Review Board (IRB):
Ethical treatment & full consent for studies | Roseman has IRB (members are from Faculty, Staff, Community)
40
Pb-drug example? Target organ? Toxicity mechanism? Trreatment/Antidote?
``` Drug example: piston-engine aircrafts Coal-fired plants (major source in environment) Lead-based paints (old houses) Auto emissions (TEL, now rare) Toxicity mechanism: Coal-fired plants (major source in environment) Lead-based paints (old houses) Auto emissions (TEL, now rare) Target organ: Encephalopathy (acute, emergency), Anemia, CNS deficits Treatment/Antidote: Chelation Therapy (IV) ```
41
Mercury (Hydragyrum) sources
Contaminated drinking dental amalgam, water, Coal-fired power plants (~13 tons/year), Food (fish, waterfowl etc.) contaminated with mercury, Mercury thermometers, Leaching of mercury from badly fitting dental amalgams, Vaccines containing thimerosal, Button cells (battery)
42
Most toxic form of mercury?
Dimethylmercury (organic)
43
Hg Toxicity Mechanism
Interacts with SH groups in enzymes, causes necrosis of proximal tubular epithelium, Organic mercury is more toxic to CNS
44
Hg target organ?
Toxicokinetics: Absorbed from respiratory tract, GIT and organic form from skin also; Metabolised to divalent mercury; Distributed mainly to kidney, brain; Excreted in urine and faeces (inorganic) or in faeces (alkyl Hg)
45
Hg antidote
chelation
46
Hg Antidote MOA
Chelation Dimercaprol
47
Acetaminophen (Tylenol)-poisoning signs
Phase 1- No symptoms or mild GI symptoms such as vomiting Phase 2- Right upper quadrant abdominal tenderness, Tachycardia, Hypotension Phase 3- Jaundice, Coagulopathy, including GI bleeding, Hepatic encephalopathy Phase 4- Resolution
48
Acetopminophen target organ
Liver and kidney
49
Acetominophen Poisoning-Antidote
Activated charcoal (AC) can adsorb APAP and is useful as a decontaminant if given within 1 hr of ingestion N-acetylcysteine (NAC) is the specific antidote - p.o. usually given in cola drinks to mask taste NAC reacts directly with NAPQI and prevents cellular damage NAC is a glutathione precursor >> repletes glutathione storage >> conjugate NAPQI NAC has some non-specific cellular protective effects, anti-oxidant effects Effective when given within 8 hrs of ingestion
50
Sedative Hypnotics-
benzodiazepines | barbituates
51
Sedative Antidote
Flumazenil Antidote to Benzodiazepine Overdose/Poisoning | Barbituates have no antidote
52
Opiods (Morphine, hydrocodone, methadone, oxycodone) antidote?
non-selective opioid antagonist | e.g. Naloxone, Naltrexone
53
CVS drugs (Cardiovascular drugs)-Calcium channel antagonists; antidote?
Activated charcoal within 1-2 hours, IV calcium chloride in serious poisoning, positive inotropes, insulin
54
CVS drug-Digoxin; antidote?
Digiband
55
Tricyclic Antidepressants; antidote?
No specific antidotes; activated charcoal, gastric lavage, treated with symptomatic care and intravenous sodium bicarbonate
56
Stimulants and Street Drugs
``` Cocaine Amphetamine Methamphetamine Heroin Lysergic acid diethylamide (LSD) Khat Bath salts ```
57
Cocaine: acute toxicity?
Prevents reuptake of DA>> increased DA in CNS
58
Cocaine: antidote?
No specific antidote Treatment is symptomatic Convulsion > diazepam Myocardial ischemia > nitrates, beta blockers, Ca channel blockers Hypertension > nitroprusside, phentolamine, Ca++ channel blockers
59
Methods for decontamination
``` Activated charcoal Emetics Cathartics Gavage Whole bowel irrigation Enhancing elimination (Hemodialysis/hemoperfusion, Urine pH manipulation) ```
60
Activated charcoal advantage/dis.
Pro: Adsorbs substances to prevent systemic absorption Con: Mostly aromatic molecules & gases are adsorbed. Limited value after 1-2 hours of ingestion
61
Emetics (a medicine or other substance that causes vomiting)
Syrup of Ipecac | Should be administered with 30-60 minutes of ingestion
62
Orogastric Lavage (stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach)
Removes stomach content through a large bore tube until the return is clear
63
Cathartics ( a substance that accelerates defecation)
MOA: increases motility of intestine, decreases intestinal residence time Agents: Sorbitol or Magnesium citrate
64
List chemicals/drugs for which hemodialysis may be helpful?
Amphetamines, antibiotics, isoniazid, phenobarbitol, salicylates, thiocyanates
65
Explain how urine pH manipulation helps elimination of toxicant?
Mechanism of Action: ionic chemicals are trapped in urine (prevent reabsorption) Acidified urine will enhance elimination of weak bases Alkalinized urine will enhance elimination of weak acids
66
State few services that are provided by poison control centers?
Assessment, treatment recommendations, signs and symptoms, decontamination recommendations, locating antidotes/antivenoms, pill and toxidrome identification Toxidrome: The chemical structure of a compound. Lab tests take too long for a diagnosis, in the clinic we want to use signs and symptoms as a quick way to diagnose the chemical grouping/toxidrome/category of toxin in order to treat the patient quickly.
67
emesis
vomiting
68
emesis induced by
ipecac tincture
69
antidote of morphine
naloxone
70
antidote of diazepam
flumazenil
71
overdose scenario morphine
urine pH manipulation
72
amphetamine overdose
urine pH manipulation
73
tricyclic antidepressant poisoning
activated charcoal
74
overdose of delayed release drugs
magnesium citrate | polyethylene glycol lavage solution
75
Patient tried to kill themselves, doesn't remember what they took. Have symptom of nausea and after 24 hours lab results showed serum of ALT(Alanine transaminase) in blood. What drug did they try to overdose on?
Acetaminophen (Tylenol)
76
Diazepam
Flumazenzil
77
Acetaminiphin convertered to NAQI
Bioactivation
78
TI
TI=LD50/ED50
79
Nalaxone (NARCAN)
opiods
80
Succimer (CHEMET)
heavy metal
81
Calcium (IV)
CCBs
82
Overdose situation treated with acidification of urine using ammonium chloride
Morphine (Weak base)
83
ALT and AST is a ___ specific enzyme
liver

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