Pharmacology - Metal Toxicity & Chelation Therapy I & II - Jeanna Marraffa Flashcards Preview

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Flashcards in Pharmacology - Metal Toxicity & Chelation Therapy I & II - Jeanna Marraffa Deck (29):
1

Associate rice water diarrhea with:

Arsenic poisoning

2

Associate cobalt poisoning with:

Cardiomyopathy

3

Associate basophilic stippling and Burton lines with:

lead poisoning

also

4

Associate painful peripheral neuropathy and alopecia with:

Thallium poisoning

5

Rash of "rain drops in a dusty road" with:

Arsenic poisoning

6

Dimercaprol is also known as:

British Anti-Lewisite (BAL)

7

How is dimercaprol administered?

IM
no IV

8

Use: Dimercaprol

Arsenic poisoning
Lead poisoning
Inorganic mercury poisoning

9

2,3-Dimercaptosuccinic Acid is also known as:

DMSA/Succimer

10

Use: 2,3-Dimercaptosuccinic Acid

Chelation of Cadmium, Lead and Mercury (and Arsenic and Cadmium)

oral and IV available

11

Side effects: 2,3-Dimercaptosuccinic Acid

Nausea, vomiting, flatus, diarrhea;
Mild elevations in AST, ALT

12

Use: CaNa2EDTA (Edetate Calcium Disodium)

Lead poisoning

13

Side effects: Na2EDTA

Hypocalcemia

14

Side effects: CaNa2EDTA (Edetate Calcium Disodium)

Renal toxicity;
Malaise, fever, increases in AST, ALT

15

Use: Prussian blue

Thallium poisoning;
Cesium poisoning

16

Higher levels of lead are associated with:

Encephalopathy

17

How to treat lead poisoning?

Remove from source;
WBI;
Succimer:
CaN12EDTA
BAL (dimercaprol)

18

Iron toxicity is significant when:

the patient is vomiting

19

How to treat iron poisoning?

ABCs;
Xray if vomiting;
CBC, ABG, electrlytes
whole bowel irrigation
chelation therapy w/ deferoxamine

20

Use: Deferoxamine

Acute Iron Poisoning
Chronic Iron Overload (from transfusions)

21

Side Effects: Deferoxamine

– Rate-related hypotension
– Anaphylactoid reactions – Yersinia enterocolitis
• DFO-Iron Chelate facilitates growth of unusual organisms
– Acute Lung Injury
• Occurs in patients that are treated for > 24 hours

22

Heavy Metals cause toxicity by binding to:

Sulfhydryl groups

23

T/F: Medication errors with severe toxicity have occurred when Na2EDTA is given instead of CaNa2EDTA

True

24

Prussian blue is a unique chelator because:

it does not get absorbed after oral administration

25

What is the toxicity?
• Kids:
– Colic
– Lower levels associated with IQ changes
– Think PICA

Lead

26

What is the toxicity?
Adults:
Hypertension
Higher levels than in children

Lead

27

What is the toxicity?
Basophilic stippling, Burton's lines

Lead

28

What is the toxicity?
– Rice-Water Diarrhea
– Prolonged QTc
– Arsenical dermatitis
– “Rain drops on a dusty road”

Arsenic

29

What is the toxicity?
– Labile Mood; “Mad as a Hatter”
– Intention Tremor

Mercury