Principles of Clinical Toxicology and Treatment of Acute Poisoning Flashcards Preview

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Flashcards in Principles of Clinical Toxicology and Treatment of Acute Poisoning Deck (30):
1

ED50

Effective dose: concentration that produces half of the maximum effect

2

LD50

Dose that kills half of the subjects exposed

3

TD50

Dose that produces the half maximum toxicity

4

Therapeutic index

LD50/ED50

5

Threshold (non-toxic) dose)

No observed adverse effects below this line

6

Carcinogenesis

Metabolically activated: Aromatic amines, nitrosamies, PAHs, Aflatoxin
Alkylating agents: cyclophosphamide, melphalan

7

Teratogenicity Category A

Animal negative/human negative
SAFE

8

Teratogenicity Category B

Animal negative/human not available OR animal adverse/human negative
Presumed to be safe

9

Teratogenicity Category C

Animal adverse/human not available OR animal and human not available
Give only if potential benefit justifies risk
Dangerous in 1st trimester

10

Teratogenicity Category D

Human risk, but benefits to mom may be acceptable in a life threatening/serious disorder

11

Teratogenicity Category X

Risk of the drug clearly outweighs possible benefit
Contraindicated in women who are or who may become pregnant

12

Cholinergic or anticholinesterase syndrome- MOA

Organophosphate and carbamate insecticides > inhibition of cholinesterase and accumulation of acetylcholine

13

Cholinergic or anticholinesterase syndrome symptoms

Muscarinic: sweating, miosis, lacrimation, abdominal cramps, vomiting, diarrhea, bradycardia, hypotension
Nicotinic: Fasiculations, cramps, weakness, paralysis, respiratory compromise
Central: Anxiety, restlessness, coma

14

Cholinergic or anticholinesterase syndrome treatment

Atropine

15

Anticholinergic Syndrome MOA

Atropine, scopolamine, tricyclic antidepressants, antihistamines, jimson weed
Too little acetylcholine at the muscarinic receptor site

16

Anticholinergic Syndrome SE

dry mouth, dysphagia, mydriasis, tachycardia, hyperthermia, dry skin, flushing, lethargy, seizures, confusion, respiratory failure

17

Anticholinergic Syndrome Treatment

Physostigmine

18

Hemoglobinopathy Syndromes

Carboxyhemoglobinemia (CO)
Methemoglobinemia (sulfonamides)
Hypoxia, headache, disorientation, cardiac dysfunction, acidosis, death

19

Narcotic Overdose MOA

Heroin, oxycodone, Morphine, Meperidine

20

Narcotic Overdose Symptoms

respiratory depression, hypotension, pinpoint pupils

21

Sympathomimetic excess MOA

Cocaine, amphetamines, MAOIs > too much NE

22

Sympathomimetic excess symptoms

Diaphoresis/dehydration, nervousness, tremor, CNS excitation, hypertension, tachycardia, seizures

23

Withdrawal syndrome (opiate vs. non-opiate symptoms)

Opiate withdrawal: mydriasis, piloerection, rhinorrhea, lacrimation (no seizures)
NON-opiate CNS depressants: hallucinations, tachycardia, hyperpyrexia, SEIZURES

24

Cardiac conduction/rhythm problems (AV block, brady, tachy)

AV block: digitalis
Sinus brady: digitalis, beta-blockers, ca channel blockers
Sinus tachy: cocaine, amphetamines

25

Metabolic acidosis

Aspirin, methanol and ethylene glycol

26

GI dysfunction

Cholinergic syndrome: cramping, n/v
Iron poisoning: bloody diarrhea

27

Seizures cause

Intoxication, withdrawal

28

Seizure treatment

Diazepam/lorazepam: acute control
Phenobarbital: long term

29

Antidotes:
Iron-
Acetaminophen-
Organophosphate-
Anticholinergic-
Methanol and ethylene glycol-
Digitalis-

Iron- Deferoxamine
Acetaminophen- Acetylcystine
Organophosphate- 2-PAM or atropine
Anticholinergic- Physostigmine
Methanol and ethylene glycol- Ethanol
Digitalis- Digitalis Antibodies

30

Indications for elimination of absorbed substances

Severe poisoning that does not respond to supportive therapy
Deterioration despite full supportive care
Overwhelming dose of a chemical
Impairment of normal excretory routes
Severe disease that precludes tolerance of supportive care