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Flashcards in Environ/Toxic/Integ Deck (107):
1

What does the activated charcoal formulation "Actidose-Aqua" have in it and how does that affect bloodwork findings?

Propylene glycol and glycerol

Mean serum osmolality, osmolal gap and lactate concentration were significantly increased after suspension administration, increasing at 1 hour, peaking at 4 hours and returning to baseline at 24 hours.

2

Dose of naloxone

0.01-0.04 mg/kg IV IM or SC

3

Dose of flumazenil and what toxicity can it be used for?

0.01-0.02 mg/kg IV
sleep aid toxicosis

4

What can be used to reverse amitraz collars and imidazole decongestants ?

These toxins have alpha agonist activity so can be reversed with alpha antagonists such as yohimbine (0.1mg/kg IV) or atipamezole (50 mcg/kg IV or IM)

5

Reported SE of intralipid

Fat embolism
Fat overload syndrome
Pancreatitis
worsening of ARDS
coagulopathy

6

What complications can occur if charcoal filter is used without HD ?

hypocalcemia, hypoglycemia, thrombocytopenia

7

Two pathways for acetaminophen metabolisM/

conjugation with sulfate and glucuronide (90% of ingested dose)
cytochrome-p450- 5%

8

At what dose of acetominophen are toxic signs seen in dogs vs. cats

100 mg/kg dogs
10 mg/kg cats

9

What effect does pH have on volume of distribution of salicylate?

Decrease in blood pH increases the VD as drug diffuses out of intravascular space.

10

What effects do COX1 vs. COX2 have on coagulation

COX2 produces prostacyclin (PGI2) from epithelial cells that inhibits platelet aggregation and causes vasodilation

COX1 mediates production of TXA2 from platelets, which increases platelet aggregation and causes vasoconstriction.

11

what drugs can have an increased bioavailability and thus potentially increased toxicity when giving NSAIDs

other anti-inflammatories
warfarin
phenytoin
penicillins
sulfonamide abx
digoxin

will DECREASE lasix

12

what dose of ibuprofen is associated with GI signs? kidney dz? death?

100 mg/kg - GI
kid fail- 175 mg/kg
600 mg/kg- acute death

13

toxic dose of aspirin? single dose? daily dose x 2 days?

single dose 400 mg/kg
75 mg/kg x 2 days

cats 25-100 mg/kg/day - GI ulcers

14

what dose of naproxen is associated with adverse events?

5-10 mg/kg

15

what dose of meloxicam has been shown to cause GI upset? RF?

GI- 0.15-0.2 mg/kg/day x 3 days
RF- 0.6-1 mg/kg/day x 3 days

16

Arrange the following NSAIDS in order of increasing elimination half life in dogs:
aspirin
carprofen
deracoxib
firocoxib
ibuprofen
meloxicam
naproxen

deracoxib- 3 hours
ibuprofen -5 hours
Firocoxib- 6 hours
Aspirin 7.5 hours
Carprofen 11-14 hours
Meloxicam 24 hours
Naproxen 74 hours

17

Arrange the following NSAIDS in order of increasing elimination half life in cats:
aspirin
carprofen
deracoxib
firocoxib
meloxicam

deracoxib 8 hours
firocoxib 12 hours
meloxicam 15-26 hours
carprofen 21 hours
aspirin 37.5 hours

18

MOA acepromazine

Blocks postsynaptic dopamine and alpha1-adrenergic receptors

19

Is baclofen enterohepatically recirculated?

no

20

What is the cellular effect of opioid receptor activation?

inhibition of adenyl cyclase activity, activation of receptor-operated potassium currents, suppression of voltage-gated ca currents.
These effects cause hyper polarization of the cell membrane, decreased NT release and reduced pain transmission

21

what are the effects of the mu opiate receptor?

analgesia
resp depression
euphoria
bradycardia
constipation
vomiting
physical dependence
temperature change (hypothermia dogs, hyperthermia in cats)

22

what are the effects of the delta opioid receptor?

analgesia

23

what are the effects of the sigma opioid receptor?

autonomic stimulation
dysphoria
hallucinations

24

what are the effects of the kappa opioid receptor

analgesia, sedation

25

What are the effects of the epsilon opioid receptor

analgesia

26

What is the primary mechanism of opioid metabolism?

glucuronidation

27

What drugs will opioids interact with that may potentiate their effects?

MAOIs- potentiate morphine. May potentiate serotonin syndrome with some opioids and MAOIs.

phenothiazines and erythromycin potentiate opioids

cimetidine prolongs duration of action

28

what opioids have SSRI effects?

fentanyl, meperidine, methadone, tramadol, dextromethorphan

29

Why is morphine not used in people with biliary or pancreatic dz?

causes spasms of the sphincter of Oddi

30

What is the cellular mechanism of beta2 agonist induced hypokalemia?

Agonist binding of b2 receptor stimulates formation of cyclic AMP which acts through protein kinase A to phosphorylate and activate N/K/ATPase pump, leading to influx of potassium into cells.

31

What are CCB effects on insulin?

inhibit insulin secretion.

32

what are beta blocker effects on glucose balance?

impairs lipolysis, glycogenolysis, and insulin release.

33

What effect does LOW insulin have on the heart?

prevents uptake of glucose by myocytes- decreasing inotropy

34

Describe signalling pathway when epinephrine binds its beta receptor

Epi binds and stimulates beta receptors which are a G-protein coupled receptor. This activates adenylate cyclase, which catalyzes the conversion of ATP to cAMP. cAMP activates protein kinase A, which stimulates the opening of Ca channels in the sarcoplasmic reticulum, increasing intracellular ca which can then bind and cause muscle contraction via actin and myosin.

35

What is the mechanism of MAOI, amphetamines, TCA and SSRIS?

MAOI- inhibits mAO which is responsible for the breakdown of serotonin in the brain.

Amphetamines increase serotonin release

TCA- block reuptake of serotonin

SSRIs- block reuptake of serotonin.

36

Where is most of the serotonin in the body synthesized and stored?

enterochromaffin cells and myenteric plexus in the GIT.

37

Effects of serotonin in the peripheral nervous system?

vasoconstriction, platelet aggregation, uterine contraction, intestinal peristalsis, bronchoconstriction

38

Clinical signs of serotonin syndrome

Neuromuscular: hyperreflexia, inducible clonus, peripheral hypertonicity, shivering
Autonomic: tachycardia, mydriasis, diaphoresis, increased borborygmi, diarrhea
mental: agitation, delirium

Occasional: cardiac arrhythmias, DIC, resp compromise, rhabdomyolysis

39

What were most common signs of ingestion of TCA in 456 companion animals reported to APCC?

Hyperexcitability and vomiting **
Then - ataxia, lethargy, tremors.
Brady cardia seen late.
Death in 7% of those showing adverse signs

40

Does diuresis help enhance elimination of serotonergic medications?

no bc highly protein bound

41

With serotonin syndrome, what is mechanism of hyperthermia?

excessive muscle activity - fever reducers not indicated and should actively cool.

42

What medications can be used with serontin syndrome?

chlorpromazine- 5-HT2 receptor antagonist - SE- sedation and hypotension

Cyproheptadine- 5HT1a and 5HT2 receptor antagonist.- more effective than chlorpromazine

43

What medications increase serotonin-release?

amphetamines, ecstasy, cocaine

44

What medications can stimulate the serotonin receptors?

LSD, lithium, buspirone, sumatriptan

45

What are examples of SSRIs?

fluoxetine, citalopram, paroxetine, sertraline, venlafaxine, tramadol, fentanyl, pethidine, methadone, meperidine, dexxtromethorphan

46

What are examples of TCA?

Amitriptyline, clomipramine, dose-in, imipramine, mirtazipine, trazodone

47

what is the half life of factor 7?

6 hours

48

In a retrospective study evaluating PT prolongation in 151 dogs receiving GI decontamination within 6 hours of anticoagulant rodenticide ingestion _____% required VitK1 therapy and ___ had adverse events develop during time period between ingestion and starting Vit K

8.3%
none

49

List 5 medications that increase renal calcium excretion

lasix
steroids
calcitonin
bisphosphonates
saline

50

What SE is of concern when using calcitonin?

anaphylaxis (salmon origin)

51

What is LD 50 of bromethalin in dogs?

4.7 mg/kg dogs, 1.8 mg/kg cats = LD50
causes severe muscle tremors, hyperthermia, extreme hyper excitability, focal or generalized seizures within 24 hours.

Lower doses manifest c/s in 1-3 days- hind limb ataxia, paresis or paralysis, CNS Depression

52

What histopathologic changes are seen with bromethalin?

diffuse white matter vacuolation (spongy degeneration) with microgliosis.

53

What is MOA of strychnine?

prevents uptake of glycine at inhibitory synapses of Renshaw cells in CNS.
i.e., inhibits the inhibitory pathway...aka "disinhibition" ..results in a net excitatory effect.

54

what clinical signs are associated with zinc phosphide intoxication and what increases toxicity?

ingestion of food increases toxicity (increases acidity of stomach which increases hydrolysis)

Gi signs most common, also neuro signs, resp distress and cardiovascular compromise.

55

Def- 1st degree burn

superficial- epidermis only

56

Def- 2nd degree burn

Epidermis and dermis- may be varying degrees of dermis.

57

Def- 3rd degree burn

Full thickness- entire epidermis and dermis. Skin will appear black, leathery; eschar is present.

58

Def 4th degree burn

Full thickness with extension to muscle, tendons and bone

59

Describe how to estimate total body surface area in burn victims

"rule of 9s"
head and neck - 9%
each forelimb- 9%
Each rearlimb- 18%
Dorsal trunk-18%
Ventral trunk- 18%

60

What % of TBSA burned indicates poor prognosis?
At what % can hypovolemic shock occur?

50%
20%

61

What is ideal syringe size and needle gauge to generate ____psi of pressure during lavage?

35 cc syringe, 19 guage needle = 8 psi

62

Effects of aloe vera?

Antithromboxane effects that prevent vasoconstriction and thromboembolic seeding of the dermal vasculature.

63

In patients that recover from CO poisoning, what residual deficits might they have?

hearing loss w/ no permanent effects.
permanent CNS abnormalities.

64

What is half life of CO at room air and at FiO2 100%?

250 minutes
26-148 minutes

65

What medications can be used in CN toxicity and what should be used specifically in smoke inhalation patients?

Sodium nitrite and sodium thiosulfate.
Sodium nitrite can cause methemoglobin and therefore should not be used in smoke inhalation.

66

What is prognosis for smoke inhalation?

In ppl- <10% if no dermal burn and 25-65% with dermal burn.

Dogs- 8/27 died or were euthanized in one study and 1/27 died in another study.
Smoke exposed dogs w/ neuro signs mortality of 46%

67

What are classifications of hypothermia based on temp and clinical signs?

Mild- 32-37 (90-98) shivering ataxia, vasoconstriction
Mod- 28-32 (82-90) decreased level of consciousness, hypotension, +/- shivering
Severe- < 82- complete loss of shivering, dysrhythmias, profound CNS deficits.

68

Main temperature sensors in the body?

prepotic and anterior hypothalamic nuclei.

69

What is often the initial dsyrhythmia with severe hypothermia?

a fib.
progresses to vtach and vfib

70

At temperatures below ____C, sensitivity to partial pressure of CO2 decreases, and CO2 production decreases by ___% with a ____C fall in body temperature.

At temperatures below 34 (93.2 F), sensitivity to partial pressure of CO2 decreases, and CO2 production decreases by 50% with an 8 C fall in body temperature.

71

For each 1 degree C drop in core body temperature, cerebral blood flow decreases ____%

6-10%

72

Solubility of CO2 is increased/ decreased in cooled blood.

increased -> increased CO2 content -> acidosis

73

Mech of thrombocytopathia with hypothermia

Decreased platelet aggregation secondary to decreased thromboxane B2
Decreased platelet granule secretion
Attenuation of P selection expression
Diminished expression of VWF receptor

74

Hct decreases/increases by ___% for every 1 degree C decline in temperature?

increases by 2% for every 1 degree decline in temp.

75

mech of hyperglycemia in hypothermic patients?

renal dysfunction; decreased insulin sensitivity, reduced insulin secretion.

76

What is rewarming shock

When surface re-warming causes peripheral vasodilation leading to relative hypovolemia

77

Define heat stroke

Hyperthermia associated with a systemic inflammatory response leading to a syndrome of MODS in which encephalopathy predominates.

78

What adaptations occur in humans to the heat and how long does it take to acclimatize?

2 weeks
Enhanced cardiac performance, salt conservation by kidney and sweat glands via activation of RAAS, increased capacity to sweat, plasma volume expansion, increased GFR, and increased ability to resist exertion rhabdomyolysis.

79

NRBC of ___ or more/ 100 leukocytes had high sensitivity and specificity of death in heat stroke?

18 or more- 91% sensitivity and 88% specificity

80

Do alternating or direct currents cause more injury?

Alternating.

81

What type of electric current typically causes muscular tetany

Alternating, not direct.

82

Theory that smaller or larger dogs are more susceptible to lightning injury?
dogs or people more susceptible?

Larger dogs are more susceptible and dogs more susceptible than people.

83

The retrospective study on drowning in vet med, what was the mortality rate?

36%

84

Most (85%) of submersion victims that survive are thought to have aspirated less than ___mL/kg water

22 mL/kg

85

Most common cause of hypoxemia in drowning victim

intrapulmonary shunt (no ventilation areas - aspirated water, bronchospasm, atelectasis (surfactant washout), pneumonitis, ARDS)

86

What is the dive reflex

When the face touches cold water (<41 F, <5 C), a reflex (mediated by trigeminal nerve) causes bradycardia, hypertension, and preferential shunting of blood to cerebral and coronary circulation.

87

Does cold/warm water or salt/fresh water have an effect on survival of drowning victim?

only cold water = better

88

What is recommended if epinephrine doesn't work for anaphylaxis and what is MOA?

glucagon.
Inotropic, chronaotropic and vasoactive effects independent of beta receptors and causes endogenous catecholamine release.

89

50% of dogs with influx of air at ___mL/kg/min infused will overwhelm lung filter of air emboli.

0.35 mL/kg/min .
Pigs have tolerated a single bolus of 2 mL/kg, but dogs have more toleration to gas than pigs.

90

What inflation pressure is it recommended to stay under to reduce risk of air embolism?

15 mmHg

91

what toxin is in black widow venom

alpha-latrotoxin

92

mechanism of scorpion venom

blocks voltage-gated potassium and sodium channels in nervous tissue.

93

Lethal dose of ethylene glycol

4.4-6.6 mL/kg dogs
1.5 mL/kg cats

94

Food increases/decreases EG absorption

decreases

95

Which EG metabolite is considered major mediator of toxicity and why

glyoxylic acid
long half life

96

Osmolal gap after ingestion of EG increases ___hours after ingestion, peaks at ___ hours, and remains elevated for ___ hours after ingestion.

Osmolal gap after ingestion of EG increases 1 hour after ingestion, peaks at 6 hours, and remains elevated for 18 hours after ingestion.

97

When does high anion gap metabolic acidosis develop after ingestion of EG? peak? lasts for __?

Develops within 3 hours of ingestion, peaks at 6 hours, lasts for 48 hours.

98

__% of intoxicated dogs w/ EG have ionized hypocalcemia

>50%

99

Calcium oxalate crystalluria seen in ___hours of EG ingestion in cats and within ____ hours in dogs

3 hours in cats
4-6 hours in dogs

100

How long will urine fluroesce with woods lamp post ingestion of EG?

up to 6 hours.

101

Dose of chocolate causing GI vs. cardiac vs. seizures?

20 mg/kg GI
40 mg/kg cardiac
60 mg/kg seizures

102

Symptoms of macadamia nut toxicity?

weakness, vomiting, poss pancreatitis

103

Which lilies are and aren't toxic to cats?

Lilium or Hemerocallis species toxic
Benign lilies include the Peace, Peruvian, and Calla lilies (do contain oxalates so may cause GI irritation)

104

Treatments for cyanide toxicity

Sodium thisulfate- converts cyanide to thiocyanate
Hydroxycobalabim- binds cyanide and excretes in kidneys
Sodium nitrite- only for severe cases- forms methemoglobin and then cyanomethemoglobin (potent vasodilator).

105

What binds lead?

Ca EDTA
Succimer
Penicillamine

106

Antidote for OP poisoning?

2-PAM

107

mech of botulism?

Binds pre-synaptic membrane of NM synapse, preventing Ach vesicles from fusing with membrane -> prevents release of Ach- > flaccid paralysis