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PRELIMS > PHCT Mod 2-3 > Flashcards

PHCT Mod 2-3 Flashcards

1
Q

TYPE OF POISONING
a prompt and marked
disturbance of function or
death within a short timethat are caused by:
1. Taking a strong poison
2. Excessive single dose of a drug
3. Several small doses but frequent
administration of a drug

A

Acute Poisoning

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2
Q

poisoning marked by a gradual
deterioration of function of tissues and may or may not result in death

A

Chronic Poisoning

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3
Q

TYPE
-less than 24 hours-generally a singledose
-Repeated exposures- usually dietary

A

Acute

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4
Q

TYPE
Repeated exposure for a month or less

A

Subacute

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5
Q

TYPE
repeated exposure for 1 to 3 months

A

Subchronic exposure

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6
Q

TYPE
exposure for greater than three months

A

Chronic exposure

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7
Q

Benzene
Acute Exposure =

A

CNS Narcosis

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8
Q

Benzene
Chronic Exposure =

A

Bone Marrow Damage and Leukemia

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9
Q

Cigarette smoke
Acute exposure =

A

Nervous system stimulation

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10
Q

Cigarette smoke
Chronic exposure =

A

Cancer or mouth, pharynx,larynx, lung, esophagus, pancreas, andbladder,emphysema

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11
Q

-Major route of entry of poisons in the industrial setting
-Atmospheric pollutants gain entry mainly by _______

A

Inhalation

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12
Q

the lowest concentration of a certain odor compound that is perceivable by the human sense of smell.

A

Odor threshold

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13
Q

ROUTE
via GIT;
result of ingesting contaminated food or beverages, touching the mouth with contaminated fingers, or swallowing inhaled particles

A

Ingestion

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14
Q

ROUTE
Bypasses the protection provided by the intact skin and provides direct access in the bloodstream.

A

Injection

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15
Q

occur in hypersensitive individuals or after sensitization in allergic or sensitized persons.

Often requires binding of chemical (hapten)to endogenous protein in order to be recognized by the immune system.

Reaction ranges from skin irritation to fatal anaphylactic shock.

A

Allergic reactions

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16
Q

occur in individuals who have genetic polymorphisms that lead to structural changes in biomolecules, making them very sensitive or insensitive to chemical.

A

Idiosyncratic Reactions

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17
Q

Most chemicals exert their effects soon after exposure.

A

Immediate Toxicity

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18
Q

Others may be delayed for days to years (cancer)

A

Delayed Toxicity

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19
Q

Depends on tissue’s ability to regenerate itself at a variety of levels: molecular, cellular and tissue.

ex. Liver vs. CNS

A

Reversible vs.Irreversible Effects

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20
Q

Corrosives and irritants act ____

A

locally

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21
Q

Little goes _____

A

systematic

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22
Q

Chemical Interaction
combined effect is the same as the sum of effects when given alone

A

Additive

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23
Q

Chemical Interaction
combined effects are much greater than the sum of effects when given alone

A

Synergistic

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24
Q

Chemical Interaction
exposure to a chemical with no toxicity increases the toxicity of another compound.

A

Potentiation

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25
Q

Chemical Interaction
co-administration of two chemicals interferes with the toxicity of both or one of them

A

Antagonism

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26
Q

Ex of Antagonism

A

Antidotal therapies

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27
Q

Type of Antagonism
Chemicals counter balance each other by exerting opposite effects on a physiological function

A

Functional

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28
Q

Type of Antagonism
Chemical reaction between two compounds leads to less of the toxic compound.

A

Chemical (or inactivation)

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29
Q

Ex Chemical Antagonism (Inactivation)

A

Chelators and metals; Antivenins

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30
Q

An antitoxin active against the venom of a snake, spider, or other venomous animal or insect

A

Antivenins

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31
Q

Type of Antagonism
Disposition of toxic chemical is changed so that
concentration and/or duration is diminished.

A

Dispositional

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32
Q

Type of Antagonism
Chemicals compete for the same receptor, decreasing effective binding of toxic compound.

A

Receptor

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33
Q

(Antagonism)
Ex of competitive inhibition

A

Naloxone and morphine

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34
Q

(Antagonism)
Ex of antagonist of the estrogen receptor in breast tissue

A

Tamoxifen and estradiol

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35
Q

A state of decreased responsiveness due to prior exposure to the same or structurally similar chemical in an individual.

A

Tolerance

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36
Q

TYPE OF TOLERANCE
A decreased amount of chemical reaches the site where the effect is produced.

A

Dispositional Tolerance

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37
Q

TYPE OF TOLERANCE
Ex of Dispositional (metabolism inhibition)

A

Carbon tetrachloride CCl4

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38
Q

TYPE OF TOLERANCE
Ex of Dispositional

A

Cd and metallothionein

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39
Q

TYPE OF TOLERANCE
Same amount of chemical reaches the site, but target receptor response decreased

A

Receptor Tolerance

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40
Q

Ex of Receptor Tolerance

A

Nicotine in cigarettes
Morphine and Opioid receptors

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41
Q

A change in the susceptibility to a chemical at the population level.

A selective process (evolution) by which sensitive individuals do not survive and only those with a genetic trait that accommodates the chemical survive.

A

Resistance

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42
Q

Evidences contributed by circumstances

A

Circumstantial

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43
Q

Deduced from various occurrences and facts.

A

Moral Evidence

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44
Q

Examples:
 motives for poisoning
 purchasing the poison
 keeping the materials used

A

Circumstantial / Moral Evidence

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45
Q

Includes symptoms observed during poisoning.

A

Symptomatic Evidence

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46
Q

 alcoholic coma may stimulate _____

A

diabetic coma

47
Q

arsenic poisoning is like ______

A

Cholera

48
Q

Examples:
- arsenic poisoning
- alcoholic coma

A

SymptomaticEvidence

49
Q

Evidence obtained by chemical analysis of the suspected substance, or the vomitus or secretion of the body.

 This alone is not reliable because the poison may be decomposed or changed or it may have been placed anywhere after death.

A

Chemical Evidence

50
Q

Evidence fromexaminationof tissuesandorgans after death.

A

Post-mortem Evidence

51
Q

Obtained by administering the suspected substance to some living animal and noting the effects or symptoms.

 This is not a very conclusive procedure since tolerance may not be the same as in man.

A

Experimental Evidence

52
Q

Denotes the alteredpharmacodynamicsof a drug when givenintoxicdosage,since normal receptors andeffector’smechanisms may bealtered.

A

Toxicodynamics

53
Q

applied to the pharmacokineticsof toxic doses of chemicals, since the toxic effect sof an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material

A

Toxicokinetics

54
Q

log dose that can produce 50% mortality in a population

–Dose that is required to kill half the members of a tested population after a specified test duration

A

LD50 or Median Lethal Dose

55
Q

is defined as the into which a substance is distributed.

A

Volume of Distribution(Vd)

56
Q

A ______ implies that the drug is not readily accessible to measures aimed at purifying the blood such as hemodialysis

A

large VD

57
Q

Drugs with large volumes of distribution (6)

A
  1. Antidepressants
  2. Antimalarials
  3. Narcotics
  4. Propranolol
  5. Antipsychotics
  6. Verapamil
58
Q

Drugs with relatively small volume of distribution (6)

A
  1. Salicylate
  2. Phenobarbital
  3. Lithium
  4. Valproic Acid
  5. Warfarin
  6. Phenytoin
59
Q

a measure of the volume of plasmathatiscleared of drug per unit time.

A

Clearance

60
Q

is the sum clearances of excretion by the kidneys and metabolism by the liver

A

Total clearance

61
Q

2 Types of Clearance

A

First-order kinetics
Zero-order kinetics

62
Q

in planning detoxification strategy, it is important to know the contribution of each organ to total clearance.

For example, if a drug is by liver metabolism and by renal excretion, even a dramatic increase in urinary concentration of the poison will have little effect on overall elimination

A

Clearance

63
Q

Most _______ poisoning are due to intentional suicidal overdose by an adolescent or adult

A

Acute

64
Q

Childhood deaths due to _______ ingestion of a drug or toxic household product

A

accidental

65
Q

Careful management of _______ (4)
will result in an improved survival of patients who reach hospital alive.

A

respiratory failure
hypotension
seizures
thermoregulatory disturbances

66
Q

How does a poisoned patient die?

(1) ________ of the central nervous system

A

Depression

67
Q

Types of Cardiovascular toxicity

A

Hypotension
Peripheral Vascular Collapse
Lethal arrythmia

68
Q

How does a poisoned patient die?
(2) ________ toxicity

A

Cardiovascular

69
Q

How does a poisoned patient die?
(3) ________ frequently lose their airway protective reflexes and their respiratory drive.

A

Comatose patients

70
Q

How does a poisoned patient die?
(4) _______________

A

Hypothermia or hyperthermia

71
Q

Signs and Symptoms of Hypoxia (4)

A

Hypotension
Tachycardia
Severe Lactic Acidosis
Signs and Ischemia on the ECG

72
Q

How does a poisoned patient die?
(5) _______________It occurs in spite of adequate ventilation and oxygen administration when poisoning is due to certain toxic compounds.

A

Cellular hypoxia

73
Q

How does a poisoned patient die?
(6) _______ may result in death.

A

Seizures, muscular hyperactivity, andrigidity

74
Q

Drugs that can often cause seizures (7)

A
  1. Antidepressants
  2. Theophylline
  3. Isoniazid (INH)
  4. Diphenhydramine
  5. Antipsychotics
  6. Cocaine
  7. Amphetamines
75
Q

How does a poisoned patient die
(7) _____ decrease BV

A

Hypovolemia

76
Q

How does a poisoned patient die
(8) ________ may occur after poisoning, and is sometimes delayed in onset.

A

Other organ system damage

77
Q

attacks lung tissue, resulting in pulmonary fibrosis, beginning several days after ingestion.

A

Paraquat

78
Q

due to poisoning by acetaminophen or certain mushrooms results in hepatic encephalopathy and death 48–72 hours or longer after ingestion.

A

Massive hepatic necrosis

79
Q

Intoxication with alcohol and other ______ drugs is a frequent contributing factor to motor vehicle accidents

A

Sedative-Hypnotic

80
Q

Patients under the influence of hallucinogens such as________ may die in fights or fall from high places.

A

pencyclidine (PCP) or LSD

81
Q

“ABCDs” of PoisoningTreatment

A

Airway
Breathing
Circulation
Dextrose

82
Q

Obstruction of airway is caused by:

A

flaccid tongue, pulmonary aspiration of gastric contents, or respiratory arrest.

83
Q

The airway should be cleared of _____ or any other obstruction

A

vomitus

84
Q

An _________ tube maybe inserted if needed.

A

oral airway or endotracheal tube

85
Q

For many patients, simple positioning in the ____________ position is sufficient to move the flaccid tongue out of the airway.

A

lateral decubitus

86
Q

A soft, flexible tube is passed through the nose and into the trachea using a “blind” technique.

A

Nasotracheal intubation.

87
Q

The tube is passed through the mouth into the trachea under direct vision.

A

Orotracheal intubation.

88
Q

Advantages of Nasotracheal intubation

May be performed in a conscious patient without requiring _______

A

neuromuscular paralysis

89
Q

Advantages of Nasotracheal intubation

Once placed, it is better tolerated than ________

A

orotracheal tube

90
Q

are major cause of morbidity and death in patients with poisoning or drug overdose.

Complications:
-ventilatory failure
-hypoxia
-bronchospasm

A

Breathing difficulties

91
Q

Breathing should be assessed by observation and ________ and, if in doubt,by measuring ________.

A

oximetry; arterial blood gases.

92
Q

Patients with respiratory insufficiency should be

A

intubated and mechanically ventilated

93
Q

Correct hypoxia. Administer ______ as indicated based on arterial PO2

Intubation and assisted ventilation may be required.

A

supplemental oxygen

94
Q

BREATHING
If carbon monoxide poisoning is suspected, give _____

A

100% oxygen

95
Q

BREATHING
2. Treat Pneumonia
Obtain frequent sputum samples and initiate appropriate ________ when there is little evidence of infection.

A

antibiotic therapy

96
Q

There is no basis for ____________ of aspiration- or chemical-induced pneumonia.

A

prophylactic antibiotic treatment

97
Q

May result from the following:
 Direct irritant injury from inhaled gasesorpulmonary aspiration of petroleum distillates or stomach contents.  Pharmacologic effects of toxins
 Hypersensitivity or allergic reactions

A

Bronchospasm

98
Q

BREATHING
Administer bronchodilators such as :

A

Aerosolized ß2 stimulant

99
Q

If Aerosolized ß2 stimulant IS not effective, and particularly for betablocker-induced wheezing, give ______

A

aminophylline

Dose: 6mg/kg IV over 30 minutes.

100
Q

For patients with bronchospasm and bronchorrhea caused by organophosphate or other anticholinesterase poisoning, give _____

A

atropine

101
Q

An ________ should be placed and blood drawn for serum glucose and other routine determinations.

A

intravenous line

102
Q

At this point, every patient with altered mental status should receive a challenge with ______
, unless rapid bedside blood sugar test demonstrates that the patient is not hypoglycemic

A

concentrated dextrose

103
Q

Dextrose Dose Adult

A

25g (50mLof 50% dextrose solution) intravenously,

104
Q

Dextrose Dose Children

A

0.5g/kg (2mL/kg of 25%dextrose).

105
Q

_______ may appear to be intoxicated

A

Hypoglycemic patients

106
Q

Alcoholic or malnourished patients should also receive ____________________ at this time to prevent Wernicke’s syndrome.

A

100mg of thiamine IM or in the IV infusion solution

107
Q

________ will reverse respiratory and CNS depression due to all varieties of opioid drugs

A

Naloxone

108
Q

The opioid antagonist naloxone maybe given in a dose of _______

A

0.4–2mg intravenously

109
Q

_______ may be of value in patients with suspected benzodiazepine overdose

A

Flumazenil

110
Q

_____ should not be used if there is a historyof tricyclicantidepressant overdose or a seizure disorder, asitcaninduce convulsions in such patients.

A

Flumazenil

111
Q

_____ should not be used if there is a historyof tricyclicantidepressant overdose or a seizure disorder, asitcaninduce convulsions in such patients.

A

Flumazenil

112
Q

Examples:
- arsenic poisoning
- alcoholic coma

A

SymptomaticEvidence

113
Q

Examples:
- arsenic poisoning
- alcoholic coma

A

SymptomaticEvidence

114
Q

Hydromorphone

A

SymptomaticEvidence

PRELIMS (13 decks)

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