Group 8

Question 1

What is protamine’s classification, source, and mechanism of action?

Answer 1

• Classification: Antidote/heparin antagonist.
• Source: Originally from salmon sperm; now produced via recombinant DNA.
• MOA: Binds negatively charged heparin → neutralizes anticoagulant effects.

Question 2

What are the dosing guidelines for protamine?

Answer 2

• UFH reversal: 0.5–1 mg IV per 100 units of heparin.
• LMWH reversal: 1 mg IV per 100 units (partial neutralization).

Question 3

Name three serious adverse reactions to protamine.

Answer 3

Anaphylaxis, hypotension, bradycardia (especially in fish-allergic or vasectomized patients).

Question 4

How is protamine administration monitored?

Answer 4

Measure aPTT/ACT 5–15 minutes post-dose.

Question 5

Differentiate monovalent and polyvalent antivenoms.

Answer 5

• Monovalent: Targets venom from a single species (e.g., boomslang antivenom).
• Polyvalent: Targets multiple species (e.g., SAIMR polyvalent for cytotoxic/neurotoxic snakes).

Question 6

What is the dose for neurotoxic snakebite (e.g., mamba)?

Answer 6

80–200 mL IV (8–20 ampoules) of polyvalent antivenom.

Question 7

What are the clinical features of Parabuthus scorpion stings?

Answer 7

Severe pain, hyperesthesia, respiratory failure, muscle cramps, and salivation.

Question 8

Describe immediate vs. delayed antivenom reactions.

Answer 8

• Immediate: Anaphylaxis, rash, fever.
• Delayed (5–10 days): Serum sickness (fever, joint pain).

Question 9

How is marine envenomation (e.g., jellyfish) managed?

Answer 9

Irrigate with vinegar/seawater, remove stinging cells, and use topical steroids.

Question 10

How is scorpion antivenom dosed for systemic envenomation?

Answer 10

10 mL IV, with a follow-up 5 mL if partial response.

Question 11

Classify pesticides by target organisms.

Answer 11

1. Insecticides (e.g., DDT).
2. Herbicides (e.g., glyphosate).
3. Fungicides (e.g., mancozeb).
4. Rodenticides (e.g., warfarin).
5. Nematicides (e.g., aldicarb).

Question 12

What is the MOA of organophosphate insecticides?

Answer 12

Inhibit acetylcholinesterase → acetylcholine accumulation → SLUDGE symptoms (salivation, lacrimation, etc.).

Question 13

What does SLUDGE stand for?

Answer 13

Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis.

Question 14

Rank pesticide toxicity: organophosphates, pyrethroids, carbamates.

Answer 14

1. Highly toxic: Organophosphates (e.g., parathion).
2. Moderately toxic: Carbamates (e.g., carbaryl).
3. Low toxicity: Pyrethroids (e.g., permethrin).

Question 15

List three safety measures for pesticide handling.

Answer 15

1. Use PPE (gloves, masks).
2. Avoid eating/drinking during use.
3. Store in labeled containers away from children.

Question 16

What are teratogenic effects of pesticides?

Answer 16

Birth defects due to prenatal exposure (e.g., hormonal disruption).

Question 17

What is the primary cause of death in scorpion envenomation?

Answer 17

Respiratory failure (manage with airway support).

Question 18

Why is protamine contraindicated in vasectomized men?

Answer 18

Risk of anti-protamine antibodies from sperm exposure.

Question 19

What herbicide targets plant photosynthesis?

Answer 19

Atrazine (disrupts photosystem II).

Question 20

Which snake antivenom is ineffective against boomslang venom?

Answer 20

Polyvalent antivenom (use monovalent boomslang antivenom).

Question 21

Name three herbicides and their targets.

Answer 21

1. Glyphosate (inhibits EPSP synthase, disrupting amino acid synthesis).
2. Atrazine (disrupts photosystem II in plants).
3. Mancozeb (fungicide targeting fungal cell membranes).

Question 22

What are examples of rodenticides and nematicides?

Answer 22

• Rodenticides: Warfarin, bromadiolone (anticoagulants).
• Nematicides: Aldicarb, carbofuran (act on nematode nervous systems).

Question 23

Beyond SLUDGE, what severe effects can pesticide toxicity cause?

Answer 23

Hormonal disruptions, pulmonary fibrosis, and teratogenicity (birth defects).

Question 24

How do fungicides like chlorothalonil work?

Answer 24

They inhibit fungal cell membrane synthesis or respiration, preventing fungal growth.

Question 25

How is **acanthotoxic fish envenomation** (e.g., stingrays) managed?

Answer 25

Irrigate with **saltwater**, use **local anesthetic (without adrenaline)** for pain, and monitor for systemic reactions (e.g., cardiac arrhythmias).

Question 26

When does scorpion antivenom reach peak effect?

Answer 26

**2–6 hours post-administration**, requiring close monitoring for delayed symptoms.

Question 27

What spider species does the antivenom target, and what is the dose?

Answer 27

**Latrodectus species (button spider)**. Dose: **10 mL IV**, with a follow-up **5 mL** if needed.

Question 28

How is hypersensitivity to antivenom managed?

Answer 28

**Pre-medicate with antihistamines/corticosteroids** and use desensitization protocols if necessary.

Question 29

Why must protamine be administered slowly?

Answer 29

To prevent **severe hypotension** or **anaphylactoid reactions**.

Question 30

How does glyphosate differ from atrazine in action?

Answer 30

**Glyphosate** inhibits EPSP synthase (amino acid synthesis), while **atrazine** disrupts photosynthesis (photosystem II).

Question 31

What long-term effects can pesticide exposure cause?

Answer 31

**Hormonal imbalances**, **organ damage (liver/kidneys)**, and **carcinogenicity**.