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Clinical implication of human poisoning > Lecture #8: Pesticides > Flashcards

Lecture #8: Pesticides Flashcards

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1
Q

Insecticide classifications

A
  1. Cholinesterase Inhibitors
  2. Organochlorine
  3. Pyrethrins/ Pyrethoids
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2
Q

Insecticide classifications

A
  1. Cholinesterase Inhibitors
  2. Organochlorine
  3. Pyrethrins/ Pyrethroids
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3
Q

Insecticides: Cholinesterase Inhibitors 2 main types

A

Organophosphates and Carbamates

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4
Q

classifications of organophosphates

A

two types: Oxons and thions

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5
Q

Oxons

A

direct action on AchE

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6
Q

Thions

A

indirect, requires conversion into oxon first via desulfuration

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7
Q

mechanisms of oxons and thions

A

binds reversibly to AchE at the hydroxyl group

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8
Q

can irreversible binding occur with OP?

A

Yes

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9
Q

And what can irreversible OP binding cause?

A

Aging

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10
Q

Nerve agent vs organophosphates?

A

nerve agent causes aging, OP has the potential to cause againg

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11
Q

Nerve agent vs organophosphates?

A

nerve agent causes aging, OP has the potential to cause aging

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12
Q

Antidote for nerve agents/organophosphate?

A

Oxime

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13
Q

mechanism of oxime>

A

reactivation of Ache by attaching to the phosphorus and forming complex allowing to split away from AchE molecule

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14
Q

Does OP and carbamates inhibit other forms of enzymes aside from AchE?

A

yes

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15
Q

What are some treatment when aging occurs at RBC AchE?

A

get more RBC, but RBC takes 120 days to regenerate. this means patients will need to undergo ventilation for long period of time.

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16
Q

Toxicity of Organophosphates?

A

Respiratory complications- bronchorrea and spasm, muscle paralysis and skeletal muscle dysfunction (fasciculation)

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17
Q

What are other clinical presentations /independent effects other than respiratory complications?

A

independent effects such as hydrocarbon co-injury can occur from surfactants used to package the pesticide

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18
Q

is paralysis common in OP toxicity?

A

No, it is rare because it does not occur in isolation. only in patients who develop severe muscarinic toxicity and progression of nicotinic symptoms.

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19
Q

How to diagnostically test for OP toxicity?

A
  1. measure cholinesterase activities in RBC
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20
Q

RBC AchE vs plasma ButyrlCHE

A

RBC provides better estimation of neuronal ACHe levels, but regenerates much slower.
Butyyl is much faster

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21
Q

Why is carbamates less toxic than organophosphate?

A

It does not cause aging and not all inhibits cholinesterase and poisoning is less than 24 hours

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22
Q

What are some examples of carbamates?

A

Physostigmine used medicinally to treat anticholinergic poisoning

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23
Q

Acute toxicity of carbamates?

A

similar to OP, but shorter duration. However, can experience coma and respiratory failure with persistent aspiration

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24
Q

What are some other complications or delayed syndromes?

A

NMJD (neuromuscular junction dysfunction)

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25
NMJD (neuromuscular junction dysfunction)
delayed muscle weakness that occurs 24-96 hours after exposure or resolution of chlolinergic crisis
26
NMJD (neuromuscular junction dysfunction)
delayed muscle weakness that occurs 24-96 hours after exposure or resolution of cholinergic crisis
27
OPIDN?
after chronic exposure for a few days to weeks and causes sensory problems due to inhibition of neuropathy target esterases
28
Ginger Jake Paralysis
substituted castor oil with TOCP. caused OPIDN
29
Two main antidotes for OP and carbamates
1. Atropine (antimuscurinic) to dry up the secretions. competitive anatagonist 2. 2-PAM
30
what happens if patients devleop atropine toxicity?
can administer glycopyrolate instead and it does not cross the BBB but more potent than atropine
31
What does 2-PAM do?
acts on nicotinic receptors to reverse muscle weakness. it reactivates AcHE and prevents aging. however, timely administration is crucial.
32
decontamination for OP/cabamate toxicity?
removal of article of clothings triple wash skin lavage AC - but requires secure airway.
33
2. Organochlorines what are the 3 types
DDT, Chlorodecone(Kepone) and Lindane
34
What is DDT?
developed due to high response to worldwide Malaria
35
cons
36
consequences of DDT?
causes environmental persistence
37
Chlorodecone (kepone)
precursor for insecdicides company industrial waste into James river
38
What are some treatment when aging occurs at RBC AchE?
get more RBC, but RBC takes 120 days to regenerate. this means patients will need to undergo ventilation for long period of time.
38
Does OP and carbamates inhibit other forms of enzymes aside from AchE?
yes
39
Organochlorines are
neutoexcitatory toxins
40
kepone shakes
outbreak due to kepone contamination resulting in tremors, stuttering speech, psuedotumor
41
lindane
GABA antagonist and is kinetically absorbed transdermally. used for things like scabies
42
lindaine is highly lipophilic
causes many seizures
43
Acute toxicity of organochlorines
overstimulation of CNS causing seizures- overhelemed body and eventually fatigues
44
treatment and care for organochlorine
supportive, lavage, AC is not beneficial because organochlorines are liquids. BENZO for seizures
45
3. Pyrethrins/Pyrethroids
Pyrethrins are derived from Chysanthymums
46
Pyrethrins/Pyrethroids
lipophilic: specific to exoskeleton of insects (penetration) and are sodium channel opening- paralysis
46
lipo
47
Pyrethroids
synthetic deriviative and there are two groups
48
2 types of pyrethroids
type 1: simple ester bind without cyano group (ex. Permethrin) type 2: binds with cyano group (deltamethrin)
49
clincial effects on humans are usually
allergic reactions to the parent compound
50
in large exposure, neurologic toxicity is greater in type ___ than type ____
2, 1
51
what are clinical manifestations of type 1 and type 2 pyrethroids?
type 1: tremors, twitching type 2: CS syndromes, paraesthesias, sallivation, seizures, AMS
52
What are the types of Herbicides?
1. Bipyridyl compounds 2. Chlorophenoxy Agent orange/dioxin 3. Glyphosate
53
2 types of bipyridyl compound
paraquat, diquat
54
paraquat
is the most toxic pesticide available!
55
what are some causes from paraquat/diquat?
irritation/corrosive direct injuries
56
what do they generate? and how?
free radicals that are directly toxic to tissues/ Redox cycling
57
What does paraquats target directly?
pneumocytes in the lungs and can casue multi-organ failure
58
clincia manifestation of paraquat?
GI, oral, throat abdominal pain, necrosis of mucous membranes. respiratory symptoms kicks in a day later
59
management
supportive care, supplemental oxygen is not beneficial due to reactive oxygen generation.
60
What is chlorophenoxy?
agent orange and dioxin. it is a plant growth hormone analog that causes uncontrolled growth that ultimately outstrips their water supply
61
agent orange
contains dioxin
62
g
63
dioxin
carcinogenic, birth defects
64
Glyphosate
most commonly used pesticide
65
toxicity of glyphosate
inhibits enzyme in plants only knonwn as 5-E-3P synthase
66
action of toxicity to plant enzymes
inhibits amino acid synthesis
67
glyphosate is safe on its own except
the surfactant causes pnemonitis effects that causes direct cell membrane injury
68
Fumigants type
1. Phosphide/phosphine 2. methyl bromide
69
phosphine/phosphide
metal phospides aluminum and zinc are leading cause of pesticide poisoning
70
when mixed with ambient moisture
becomes phosphine gas
71
what is toxicity of phosphine gas?
mitochondrial shutdown
72
physical characteristics
greenish grey, garlic, rotten fish
73
mechanism of action?
noncompetitive inhibition of cytochrome c oxidase which blocks ETC
74
clinical effects
abdominal pain, shock,
75
secondary exposure to first responder
PPE required
76
methyl bromide
used as sedative, colorless, odorless and is a nuerotoxin
77
methyl bromide is ____
inhaled
78
what are clinical effects
CNS effects
79
fungicide
dithiocarbamates and metals
80
dithiocarbamates
disulfiram like reactions - flushing neuropathy
81
metals
potent mitochondrial toxin
82
rodenticides
anticoagulants
83
morphine
medical anticoagulant but short acting poison
84
kepone shakes
outbreak due to kepone contamination
84
lindane
GABA antagonist and is kinetically absorbed transdermally. used for things like scabies
84
what are some causes from paraquat/diquat?
irritation/corrosive direct injuries
84
Does OP and carbamates inhibit other forms of enzymes aside from AchE?
yes
84
morphine
medical anticoagulant but short acting poison
84
what do they generate?
free radicals that are directly toxic to tissues
84
what are clinical manifestations of type 1 and type 2 pyrethroids?
type 1: tremors, twitching type 2: CS syndromes, paraesthesias, sallivation, seizures, AMS
84
only toxic to humans if massively ingested
84
agent orange
contains dioxin
84
What are some treatment when aging occurs at RBC AchE?
get more RBC, but RBC takes 120 days to regenerate. this means patients will need to undergo ventilation for long period of time.
84
in large exposure, neurologic toxicity is greater in type ___ than type ____
2, 1
84
What is chlorophenoxy?
agent orange and dioxin. it is a plant growth hormone analog that causes uncontrolled growth that ultimately outstrips their water supply
85
Pyrethrins/Pyrethroids
lipophilic: specific to exoskeleton of insects (penetration) and are sodium channel opening- paralysis
85
superwarfins
long acting anticoagulant to prevent bait avoidance from rodents.
86
Does OP and carbamates inhibit other forms of enzymes aside from AchE?
yes
86
Pyrethrins/Pyrethroids
lipophilic: specific to exoskeleton of insects (penetration) and are sodium channel opening- paralysis
86
What are some treatment when aging occurs at RBC AchE?
get more RBC, but RBC takes 120 days to regenerate. this means patients will need to undergo ventilation for long period of time.
87
lindane
GABA antagonist and is kinetically absorbed transdermally. used for things like scabies
87
in large exposure, neurologic toxicity is greater in type ___ than type ____
2, 1
87
only toxic to humans if massively ingested
87
what do they generate?
free radicals that are directly toxic to tissues
87
what are some causes from paraquat/diquat?
irritation/corrosive direct injuries
87
what are clinical manifestations of type 1 and type 2 pyrethroids?
type 1: tremors, twitching type 2: CS syndromes, paraesthesias, sallivation, seizures, AMS
87
kepone shakes
outbreak due to kepone contamination
87
agent orange
contains dioxin
88
What is chlorophenoxy?
agent orange and dioxin. it is a plant growth hormone analog that causes uncontrolled growth that ultimately outstrips their water supply

Clinical implication of human poisoning (3 decks)

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