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Toxicology > Lecture 2 > Flashcards

Lecture 2 Flashcards

Decontamination, Elimination, Antidotes (89 cards)

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1
Q

If symptoms have already occured?

A

Means absorption has already occurred and its efficacy decreases with time

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2
Q

What is the concept of activated charcoal>?

A

Toxicant-Ac complex is not systemically abosrbed, toxicant and it is excreted

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3
Q

What is activated charcoals adsorptivity attributed to?

A

Highly porous structure

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4
Q

Adsorption of drugs and toxins occurs through ___

A

weak intermolecular forces

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5
Q

Activated charcoal becomes ____ effective with use

A

less

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6
Q

___ and ___ compound bind more avidly than ___ ___ ___

A

Non ionized, organic compounds, dissociated, inorganic ones

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7
Q

What agents are adsorbed by AC? (10)

A
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8
Q

What medications are NOT adsorbed by AC? (9)

A
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9
Q

What is the typical dosing of AC in <1

A

1g/kg

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10
Q

What is the dosing of AC in 1-12 yo

A

25-50g

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11
Q

What is the dosing of AC in >12 yo

A

25-100

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12
Q

When can we provide AC in context of the poison absorption

A

Within 1 hour of ingestion

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13
Q

If a patient has ingested a potentially toxic amount of poison up to 1 hour following ingestion

A

Insufficient data to support or exclude the use of AC more than 1 hour passed since ingestion

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14
Q

What are some other dosage forms of AC we can provide?

A
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15
Q

What are some factors that increase AC appropriateness?

A

Alert, cooperative, and adsorb

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16
Q

What are the contraindications of AC?

A

Toxicant known not to adsorb AC
Unprotected airway
Ingestion of hydrocarbon
Risk of GI perf
Endoscopy required

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17
Q

Examples of hydrocarbons

A
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18
Q

What is the risk of GI perforation products?

A
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19
Q

What is emesis?

A

Vomitting

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20
Q

What are some complications of AC?

A

Vomitting
Constipation/diarrhea.
Pulmonary aspiration
Black stool

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21
Q

When should we reserve gastric lavage for?

A
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22
Q

What is a whole bowel irrigation?

A

Cleanses bowel with large amounts of peg solutions to minimize drug absorption and expel intraluminal contents

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23
Q

When is WBI an option?

A

Whole bowerl irrigation: Expediting the gastrointestinal luminal clearance, drug smugglers lololol

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24
Q

There is a ___ of WBI being succesful in body packers

A

98%

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25
WBI ___ lithium concentration
Decreases
26
Are there an established indications of WBI?
No
27
What is the theoretical benefit of drug
28
What are the contraindications of whole bowel irrigation
29
What are some of the complications of PEG-ES? (5 main points)
30
What are the other methods of decontamination? (3)
Surgery, kayexalate for lithium Cholestyramine (Dont need to know the names)
31
A Vd of ___ is considered large
>1 L/Kg, only a small portion of total dose is in the plasma
32
What are the intracorporeal elimination methods?
Multiple dose activated charcoal
33
What are the Extracorporeal? elimination methods?
Hemodialysis, Hemofiltration. Hemoperfusion
34
MDAC ___ absorption to the tissues when large amount of xenobiotics are ingested and dissolution is delayed OR when reabsorption can be prevented by lowering concentration of free toxic substance in the intestinal lumen
Decreases
35
For the MDAC how is dosing determined?
The amount and dosage form of xenobiotic
36
MDAC is enhanced in (5)
Carbamazepine. Dapsone, phenobarbital, quinine, theophyline
37
What are the main CI of MDAC?
Multi dose activated charcoal is CI in
38
What are the complicaitons of MDAC?
Reduciton of therapeutically used xenobiotics as the therapeutic xenobiotic may bind to the AC
39
What is the indication of MDAC?
Drugs with long t1/2 small Vd and those that undergo enterhepatic recirculation
40
What is hemodialysis?
uses diffusion through a concentration gradient
41
What is hemofiltration?
Uses convection through a pressure gradient (Helps to remove large molecules)
42
What is hemoperfusion?
Blood passes through adsorbent substance (large molecule, plasma removed and treated)
43
What is Hemodiafiltraiton?
Combines hemodialysis and hemofiltration
44
What is the difference between hemodialysis and hemofiltraiton?
45
What is hemoperfusion?
BLood passes through a cartridge containing sorbet (AC)
46
Ionized drugs ____ cross the lipid bilayer
cannot
47
Alkalization of the urine helps clear weak acids by trapping the xenobiotic in the tubular lumen's and ________ it to be passively reabsorbed into the blood stream
not allowing
48
Alkalinizaiton by
Sodium bicarbonate
49
What are the CI of alkalinzation?
Renal failure, heart failure
50
What are the complications of alkalinization?
51
What are the indications of alkalinization?
Moderate to severe salicylate poisoning who do not meet the criteria for hemodialysis
52
What are the 4 types of antidotes?
Receptor antagonists Chemical/Chelator Dispositional Unclassified
53
What are some receptor antagonist exmaples?
Atropine, Vitamin K
54
What are some examples of chemical Chelator?
Forms compounds of lesser toxicity that is removed
55
What is dispositional?
Ethanol, fomepizole
56
What is atropine?
Acetyl cholinesterase inhibitors
57
What is the general principle of antropine?
Prevents breakdown of acetylcholine thereby increasing acetylcholine available to stimulate cholinergic receptors
58
Atropine pathway
Parasympthathetic blockers Decreases salivia
59
Atropine is reversed by?
Physostigmine
60
What is deferoxamine used for?
When serum levels of iron is >90umol/L
61
How does Deferoxamine work?
Acts as a chelator and binds free iron to for ferrixoamine which is renally excreeted
62
What is the complications of Deferoxamine?
63
What is Digifab?
DIgoxine-specific antibody fragments
64
How does Digoxin work?/
Blocks NA/K atpase pump which allows for calcium to accumulate and allow for better contraction
65
What is Digifab?
Antibody fragment
66
Each vial of digifab binds
0.5mg
67
Average # of vials of digifab needed for acute toxicity is
10
68
Average # of vials needed for chronic toxicity is (Digifab)
6
69
What are the complications of digifab?
Inotropic effect of digoxin decreases may need to be treated with inotropes or vasodilators.
70
What is Idarucizumab/praxbind
Reverses dabigatran
71
What is praxbind>?
Idarucizumab
72
Reversal of anticoagulant effects of dabigatran can result in
life-threatening bleeding
73
WHat is the precautions of idarucizumab>
Contains 4g of sorbitol which can have serious adverse effects
74
Toxic alcohols
Ethylene glycol, methanol, isopropranol
75
Lethal dose of ethylene glycol is?
1.4mL/kg
76
Lethal dose of methanol?
1-2ml/Kg
77
ethylene glycol and methanol are not toxic
Kinda true, the metabolites are what are toxic
78
Why do we use ethanol for ethylene glycol and methanol overdose?
So they are not metabolized and ethanol is metabolized
79
Ethanol has a ___ affinity for alcohol dehydrogenase
15.5x
80
Good slide to review
81
Ethanol has ___ more affinity than ethylene glycol
67x
82
What enzymes metabolize methanol?
Alcohol deydrogenase Aldehyde dehydrogenase
83
What enzymes metabolize ethylene glycol
Aldehyde dehydrogenase Lactate dehydroganse
84
What is the toxic compound sof ethylene glycol>
Glycoaldehyde, glycolic acid, oxalic acid
85
What are the toxic metabolites or methanol?
Formaldehyde, formic acid
86
Review
87
Why do we want to give hemodialysis for patients once alcohol dehydrogenase?
88
The relative affinity of fomeprizole for human ADH is ___ greater than that of methanol and ethylene glycol and ___ than that of ethanol
80 000, 8000
89

Toxicology (3 decks)

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