EXAM #5: INTRODUCTION TO TOXICOLOGY Flashcards Preview

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Flashcards in EXAM #5: INTRODUCTION TO TOXICOLOGY Deck (46):
1

What is toxicology?

Subtopic of pharm concentrating on the effects and properties of toxic substances

2

What does it mean that poisoning if situational and quantitative in nature?

Any substance at the right DOSE and for the right amount of TIME can be a poison

3

Why do we study toxicology?

1) Protect us from adverse effects of toxicants
2) To develop improved toxicants

4

What is the definition of the LD50?

Dose at which 50% of animals die

5

What is the definition of the TI i.e. how do you calculate the TI?

LD50/ED50

6

What does a big TI indicate?

Safe drug

7

What is the ALD?

Average Lethal Dose

*Note that this is estimated from accidental deaths in humans

8

What is the primary determinant of toxicity?

Dose--you want to know:
- How much?
- When?

9

How do you clinically manage poisoning?

1) Support patient's vitals:
- ABCs
2) Reduce or remove drug

10

What are two treatments that can be considered for an "unconscious for unknown reason" type patient?

1) Glucose
2) Naloxone

11

What is a toxidrome?

Group of signs and symptoms constituting the basis for the diagnosis of poisoning

12

What are two emesis inducers?

1) Apomorphine
2) Syrup of Ipecac

13

What are the contraindications to emesis inducers?

- Chemical pneumonitis e.g. WD40
- Acid or alkali agents

14

What is the MOA of activated charcoal?

Very large SA that binds to toxic agent

15

When should charcoal be administered?

Within 30 min. or ingestion

16

What cross reaction do you need to remember about activated charcoal?

Efficacy of other medications will decrease with charcoal administration

17

What is the antidote to organophosphate poisonin e.g. Sarin, insecticide bomb...etc?

Pralidoxime or 2-PAM
- Binds organophosphate

Atropine= blocks muscarinic effects

18

What is the MOA of cyanide poisoning?

Deactivation of cytochrome C in mitochondrial membrane

*CNS and cardiac tissue most affected*

19

What is the antidote for cyanide poisoning?

Amyl nitrite
Sodium nitrite
Sodium thiosulfate

*All with O2

20

What is the most potent poison known to man?

Botulinum toxin (prevents ACh release from nerve terminal)

21

What are BAL, EDTA, DMSA, DMPS, calcium EDTA, and deferoxamine used to treat?

Heavy metal poisoning

22

What is DMSA specifically indicated for?

Treatment of:
- Arsenic
- Mercury
- Lead poisoning

23

How is DMSA dosed?

10mg/kg PO for 5x days if OVER 12
- Under 12, add an additional 14 days for 19 total days of treatment

24

What is the antidote for Botulinsm toxin?

Antibody for Botulism A, B, and E

25

What is the MOA of the drugs used to treat cyanide poisoning?

1) Oxidize Hb to methemoglobin
2) Binds cyanide to make cyanmethemoglobin

ADD Sodium thiosulfate
3) Cyanmethemoglobin-->thiocyanate and Hb

26

How can ethylene glycol/methanol/isopropyl alcohol poisoning be treated without an antidote?

Ethanol that will competitively inhibit alcohol dehydrogenase

27

What is the antidote for ethylene glycol/ methanol/ isopropyl alcohol poisoning?

Fomepizole

28

What is the MOA of Fomepizole?

Blocks alcohol dehydrogenase from making toxic metabolites

29

How does the affinity of CO for Hb compare to O2?

CO has 210x greater affinity

30

What is the treatment for CO poisoning?

Hyperbaric O2

31

What is the classic appearance of CO poisoning?

Cherry red lips/gums

32

How does an overdose of Warfarin present?

Excessive bleeding e.g:
- Hemoptysis
- Bruising
- Bleeding from nose or gums
- Blood in the urine/stool

33

What is the antidote for Warfarin?

Vitamin K

34

What are the antidotes for opoid overdose? What is the difference?

Naloxone= acute OD b/c of short half-life

Naltrexone= longer duration of action

35

What is methemoglobinemia?

Heme iron is in the Fe3+ state that cannot bind O2

36

What is the antidote for methemoglobinemia?

Methylene Blue

37

What is the MOA of Methylene Blue for Methemoglobinemia?

Direction chemical reduction of methemoglobin back to Hb

38

List the signs/ sx associated with a sympathomimetic toxidrome.

Mydriasis
HTN
Tremor
Hyperthermia

39

What are the drugs associated with sympathomimetic toxidromes?

Cocaine
Amphetamines
PCP

40

List the signs/ sx associated with a sedative/hypnotic toxidrome.

Coma
Decreased respiratory drive
Miosis or mydriasis
Hypotension

41

What are the common drugs that lead to a sedative/hypnotic toxidrome?

Alcohol
Barbiturates
Benzodiazepines

42

List the signs/ sx associated with a opiate toxidrome.

Coma
Respiratory depression
Miosis

43

List the signs/ sx associated with an anticholinergic toxidrome.

CNS agitation
Mydriasis

Fever
Dry skin
Flushing
Urinary retention

Remember, "Hot Dry Red Mad and Blind"

44

What is the mnemonic to remember the toxidrome associated with Cholinergic agents?

SLUDGE

Salivation
Lacrimation
Urination
Diaphoresis
GI Upset
Emesis

45

List the signs/ sx associated with a TCA toxidrome.

Agitation-->coma
Mydriasis
Dysrhythmia
Convulsions
Hypotension

46

List the signs/ sx associated with a salicylate/aspirin toxidrome.

Increased respirations
Diaphoresis
Tinnitus
Agitation
Hyperpyrexia

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