Introduction To Poisoning Flashcards
(160 cards)
1
Q
a prompt and marked disturbance of function or death within a short time
A
Acute Poisoning
2
Q
Acute Poisoning Conditions:
A
- Taking a strong poison
- Excessive single dose of a drug
- Several small doses but frequent administration of a drug
3
Q
poisoning marked by a gradual deterioration of the function of tissues and may or may not result in death
A
Chronic Poisoning
4
Q
Toxicity takes many months/years to become recognizable
A
Chronic Poisoning
5
Q
Chronic Poisoning Conditions:
A
- Take several small doses of drugs at long intervals
- Taking only the toxic dose of a drug
6
Q
Duration and Frequency of Exposure:
less than 24 hours-generally a single dose
A
Acute
7
Q
Duration and Frequency of Exposure:
Repeated exposures- usually dietary
A
Acute
8
Q
Duration and Frequency of Exposure:
Repeated exposure for a month or less
A
Subacute
9
Q
Duration and Frequency of Exposure:
repeated exposure for 1 to 3 months
A
Subchronic exposure
10
Q
Duration and Frequency of Exposure:
exposure for greater than three months
A
Chronic exposure
11
Q
Acute Exposure of Benzene
A
CNS Narcosis
12
Q
Chronic Exposure of Benzene
A
Bone Marrow Damage and Leukemia
13
Q
Acute Exposure of Cigarette smoke
A
Nervous system stimulation
14
Q
Chronic Exposure of Cigarette smoke
A
Cancer of mouth, pharynx, larynx, lung, esophagus, pancreas, bladder, and emphysema
15
Q
Acute Exposure of Ethanol
A
headache, drowsiness, vomiting
16
Q
Chronic Exposure of Ethanol
A
liver cirrhosis or liver cancer
17
Q
an abnormal, undesirable, or harmful effect to the well-being that is indicated by some measurable endpoints
A
Adverse Effects
18
Q
any noxious, unintended, and undesired effects of drugs that occur at normal doses; unpreventable
A
ADR (Adverse Drug Reaction)
19
Q
an injury resulting from medical intervention related to the drug; medication error; preventable
A
ADE (Adverse Drug Event)
20
Q
chromosomal breakage resulting in rearrangement of pieces of chromosomes
A
Clastogenesis
21
Q
carries the genes, a combination of DNA, RNA, protein
A
chromosomes
22
Q
The loss, addition, or rearrangement of chromosomes.
A
Clastogenesis
23
Q
Can be associated with various chronic inflammatory disorders (Doxorubicin, Cisplatin)
A
Clastogenesis
24
Q
Involve 2 different chromosomes wherein they exchanged places in location
A
Translocation
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chemicals with molecular weights of less than 1000
Haptens
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generally react with endogenous carrier molecules to become antigens before immunogenicity
Haptens
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process by which the genetic information of an organism is changed, resulting in a mutation
Mutagenesis
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Ex. Urushiol- poison ivy
Haptens
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Ex. vinca alkaloid (vincristine, vinblastine), bromine, nicotine
Mutagenesis
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refers to an injury produced by a chemical to one kind of living matter without harming some other kind, even though the two may have been an intimate contact
Selective Toxicity
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study of malformations induced during development from conception to birth
Teratology
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Teratogenic Substances - Thalidomide
phocomelia
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Use of thalidomide before
morning sickness
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Use of thalidomide now
Leprosy (Hansen's diseases)
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Teratogenic Substances - Phenytoin
fetal hydantoin syndrome
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Teratogenic Substances - Vit. A
craniofacial dysmorphism;
can also lead to spontaneous abortion
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Teratogenic Substances - Lithium
heart defect
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Teratogenic Substances - ACEis
microcephaly, renal problem
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Teratogenic Substances - Alcohol
fetal alcohol syndrome
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synonymous with harmful in regard to the effects of chemicals
Toxic
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relative term used in comparing one chemical with another
Toxicity
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A relative property of a chemical referring to the harmful effects of the latter on some biologic mechanisms
Toxicity
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expected frequency of a particular untoward effect in response to a particular agent
Risk
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amount of exposure to a given agent that is deemed safe for a period of time
Threshold Limit Value (TLV)
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determination of the ability of agents to produce tumors
Carcinogenicity /Tumorigenicity
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quantity of medicine that can kill an organism
Lethal/Fatal Dose
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Toxin in rotten corn
Aflatoxin
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Toxicity associated with any chemical substance.
Intoxication
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A clinical toxicity secondary to accidental exposure
Poisoning
50
An intentional exposure with the intent of causing self-injury or death.
Overdose
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drugs that have almost exclusively harmful effects (no therapeutic effect whatsoever)
Poisons
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Refers to toxic substances produced naturally
Toxin
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Botulinum toxin
Clostridium botulinum
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Botulinum toxin A
Botox
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Tetanus toxin
Clostridium tetani
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Corynebacterium diphtheriae
Diphtheria toxin
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Bufo frog
Bufotoxin
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Rosary pea
abrin
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Rotten apple (aspergillus invade apple)
Patulin
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Denotes the altered pharmacodynamics of a drug when given in toxic dosage, since normal receptors and mechanisms may be altered
Toxicodynamics
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applied to the pharmacokinetics of toxic doses of chemicals, since the toxic effects of an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material
Toxicokinetics
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log dose that can produce 50% mortality in a population
LD50 or Median Lethal Dose
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Dose that is required to kill half the members of a tested population after a specified test duration
LD50 or Median Lethal Dose
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ability of a chemical agent to cause injury in a given situation or setting
hazard
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are clinical syndromes that are essential for the successful recognition of poisoning patterns
Toxidromes
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constellation of signs and symptoms that suggest a specific class of poisoning
toxidrome
67
The most important toxidromes,
clinically, are:
■ Sympathomimetic
■ Sedative Hypnotic
■ Opiate
■ Anticholinergic
■ Cholinergic
68
Examples of Sympathomimetic drugs
Epinephrine, norepinephrine, amphetamine, methamphetamine, caffeine
69
Examples of Sympathomimetic toxidromes
tachycardia, HTN, mydriasis, tremor, hallucination
70
Examples of Sedative hypnotic drugs
Barbiturates, Benzodiazepines
71
Examples of Opioid drugs
Morphine, codeine, heroine, oxycodone, fentanyl, methadone
72
Examples of Anticholinergic drugs
Atropine, scopolamine, antihistamine, benadryl
73
Examples of Cholinergic drugs
Organophosphates, carbamates, nerve gases
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Examples of sedative hypnotic toxidromes
Sedation, CNS depression, confusion, blurred vision
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Examples of opiate toxidromes
Pinpoint pupils (miosis)
Respiratory depression
Coma
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Triad of Toxicity
Pinpoint pupils (miosis)
Respiratory depression
Coma
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Examples of anticholinergic toxidromes
mydriasis, dryness, urinary retention
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Examples of cholinergic toxidromes
■ Diarrhea
■ Urination
■ Miosis
■ Bradycardia
■ Bronchoconstriction
■ Emesis
■ Lacrimation
■ Salivation
■ Sweating
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DUMBBELSS
■ Diarrhea
■ Urination
■ Miosis
■ Bradycardia nerve
■ Bronchoconstriction
■ Emesis
■ Lacrimation
■ Salivation
■ Sweating
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Evidences contributed by circumstances. Deduced from various occurrences and facts.
Circumstantial or Moral Evidence
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Includes symptoms observed during poisoning
Symptomatic Evidence
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Examples: motives for poisoning purchasing the poison keeping the materials used
Circumstantial or Moral Evidence
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Examples: arsenic poisoning is like cholera alcoholic coma may stimulate diabetic coma
Symptomatic Evidence
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Evidence obtained by chemical analysis of the suspected substance, or the vomitus or secretion of the body
Chemical Evidence
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This alone is not reliable because the poison may be decomposed or changed or it may have been placed anywhere after death.
Chemical Evidence
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Evidence from examination of tissues and organs after death.
Post-mortem Evidence
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After death evidence
Post-mortem Evidence
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Obtained by administering the suspected substance to some living animal and noting the effects or symptoms.
Experimental Evidence
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This is not a very conclusive procedure since tolerance may not be the same as in man.
Experimental Evidence
90
Major route of entry of poisons in the industrial setting.
Inhalation
91
Atmospheric pollutants gain entry mainly by ______
Inhalation
92
Ex. sulfur oxides, nitrogen oxides, carbon monoxide, and carbon dioxide. What route?
Inhalation
93
the lowest concentration of a certain odor compound that is perceivable the human sense of smell
Odor threshold
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Route of exposure for water & soil pollutants
Oral ingestion
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may occur in high concentrations or prolonged exposure to some substances
Olfactory fatigue
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Hydrogen sulfide smell
Rotten egg
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via GIT, the result of ingesting contaminated food or beverages, touching the mouth with contaminated fingers, or swallowing inhaled particles
Ingestion
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Bypasses the protection provided by the intact skin and provides direct access in the bloodstream.
Injection
99
Most dangerous route of exposure
Injection
100
occur in hypersensitive individuals or after sensitization in allergic or sensitized persons
Allergic reactions
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Reaction mediated by IgE
Allergic reactions
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occurs when a person reacts to certain substances in the environment
Allergy
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Often requires binding of chemical (hapten) to endogenous protein in order to be recognized by the immune system.
Allergic reactions
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Reaction ranges from skin irritation to anaphylactic shock.
Allergic reactions
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occur in individuals who have genetic polymorphisms that lead to structural changes in biomolecules, making them very sensitive or insensitive to a chemical
Idiosyncratic Reactions
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Allergic reactions in skin ex:
itching, dermatitis, urticaria
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A drug that causes prolonged muscle relaxation or short muscle relaxation (APNEA)
Succinylcholine
108
Most chemicals exert their effects soon after exposure.
IMMEDIATE toxicity
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Immediate toxicity is mediated by Ig__
E
110
genetic tendency to develop allergic diseases
Atopy
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acute allergic rxn to an antigen
Anaphylaxis
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condition marked by spasm in the bronchi of lungs (bronchospasm)
Asthma
113
Delayed toxicity is mediated by ______
T-cells
114
Immediate toxicity is mediated by _____
IgE
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Toxicity that may be delayed for days to years (cancer)
DELAYED toxicity
116
Organ/s that can regenerate itself
Liver
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Organ/s that CANNOT regenerate itself
CNS (nerves)
118
Examples:
• Contact dermatitis
• TB - uses Mantoux Test
• Chronic Transplantation Rejection
• Multiple Sclerosis
DELAYED toxicity
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Corrosives and irritants act locally
LOCAL toxicity
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Little goes systemic
SYSTEMIC toxicity
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affects specific site (site of absorption)
Local toxin
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affects the entire body or many organs
Systemic toxin
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Tetraethyl lead - CNS effect. This is an example of
Systemic toxicity
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a drug has a major toxicity to one or two organs
Target organ
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Target organ of lead
soft tissues of the brain
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combined effect is the same as the sum of effects when given alone
Additive
127
1 + 1 = 2
Additive
128
● Alcohol + Benzodiazepine
Additive
129
Organophosphates + nerve gases
Additive
130
combined effects are much greater than the sum of effects when given alone
Synergistic
131
1 + 1 = 3
Synergistic
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Pyrethroids + piperonyl butoxide(PBO)
Synergistic
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● Carbon tetrachloride (hepatotoxic) + ethanol (hepatotoxic)
Synergistic
134
● Alcohol (hepatotoxic) + Acetaminophen (hepatotoxic)
Synergistic
135
exposure to a chemical with no toxicity increases the toxicity of another compound
Potentiation
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1 + 0 = 2
Potentiation
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● Isopropanol (no liver damage) + Carbon tetrachloride (causes liver damage)
Potentiation
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co-administration of two chemicals interferes with the toxicity of both or one of them
Antagonism
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1+1=0
Antagonism
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Basis for antidotes
Antagonism
141
● Oral anticoagulants- Vit. K
● Venom - antivenom
● Alcohol overdose - caffeine
Antagonism
142
Type of antagonism:
Chemicals counterbalance each other by exerting opposite effects on a physiological function.
Functional
143
Type of antagonism:
chemical counterbalance affecting different receptors
Functional
144
Type of antagonism:
Chemical reaction between two compounds leads to less of the toxic compound.
Chemical (or inactivation)
145
e.g. Antivenins-An antitoxin active against the venom of a snake, spider, or other venomous animal or insect
Chemical (or inactivation)
146
An antitoxin active against the venom of a snake, spider, or other venomous animal or insect.
Antivenins
147
Via what reaction is done during chemical antagonism?
Neutralization
148
BAL means
British Anti-Lewisite
149
Type of antagonism:
Disposition of toxic chemical is changed so that concentration and/or duration is diminished.
Dispositional
150
Type of antagonism:
Chemicals compete for the same receptor, decreasing effective binding of toxic compound.
Receptor
151
Naloxone and morphine
Receptor antagonism (Competitive)
152
Tamoxifen and estradiol
Receptor Antagonism
153
DOC for breast cancer
Tamoxifen
154
Once a partial agonist is combined with a pure agonist, it automatically becomes _________
Antagonist
155
A state of decreased responsiveness due to a prior exposure to the same or a structurally similar chemical in an individual.
TOLERANCE
156
A decreased amount of chemical reaches the site where the effect is produced.
Dispositional Tolerance
157
Same amount of chemical reaches the site, but target receptor response decreased
Receptor Tolerance
158
Ability of the organism (bacteria, virus, fungi) to withstand the effects of drugs that are usually effective against them.
RESISTANCE
159
A change in the susceptibility to a chemical at the population level.
RESISTANCE
160
A selective process (evolution) by which sensitive individuals do not survive and only those with a genetic trait that accommodates the chemical survive.
RESISTANCE
