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Flashcards in Toxicology Deck (85):
1

Aspirin MOA

uncoupling of oxidative phosphorylation --" icnreased Co2

icnreased heat production

ketone bodies

increased pyruvate and lactate

2

symptoms of aspirin

n/v, fever, tachypnea

fluid loss and dehydration
tinnitus
mixed resp alklaosis and increased anion gap metabolic acidosis

3

death from aspirin = ?

respiratory failure due to central respiratory paralysis

4

tx of aspirin

IV sodium bicarbonate = acidosis and at severe - hemodialysis

5

acetaminophen death?

fulminant liver failure -- hepatic encephalopathy and death

6

tx of acetaminophen?

NAC and liver transplant with fulminant hepatic failure

7

list the amphetamines and other stimulants

end in E

methamphetaminE
methylenedioxymethamphetaminE
cocainE
pseudoephedrinE
ephedrinE
phenylpropanolaminE

8

sxs of amphetamines and stimulants at usual doses

euphora
wakefulness
sense of power
sense of well being

9

sx of amphetamines and stimulants at higher doses

agitation
acute psychosis

10

o/d of amphetamines and stimulants = ?

tachyarrhtymias
seizures and muscular hyperactivity -- hyperthermia and rhabdomyolsis

11

~*~*~pupils dilated with warm and sweaty skin

amphetamines and stimulants

12

treatment of amphetamines and other stimulants

symptomatic only. no specific antidote

- ammonium chloride* acidification of urine
* phentolamine or nitroprusside - HT
* propanolol or esmolol - tachyarrhthymias
* benzos - seizures

13

List drugs that have anticholinergic effects

anticholinergics
antihistamines
antidepressnats TCAs
antipsychotics

14

a/se of antihistamines

anticholinergic -- seizures

15

a/se of TCAs

anticholinergic -- CV toxicity

16

typical presentation of anticholinergic

red as a beet - skin flushed
hot as a hare - hyperthermia
dry as a bone - no sweating and dry mucous membranes
blind as a bat -- blured vision, cyclopledia, pupillary dilation
mad as a hatter - condusion delirium, tachycardia

17

treatment of anticholinergics

pysostigmine

18

treatment of TCA overdose

so not give physostigmine bc will aggravate cardiotoxicity

19

most toxic beta blocker

propranolol bc at high doses it blocks Na channels

lipophilis and enters the CNS causing seizures and coma

20

sx of beta blocker

bradycardia
hypotension

seizures and cardiac conduction block bc lipophilic and blocks Na channels

21

tx of bb blocker

IV glucagon -- increases cAMP

22

CCB overdose

Ca IV
glucagon
epinephrine
to icnreased BP at refractory hyptension

23

symptoms of TCA

antag at muscarnic - mad, hot, blind, dry
alpha blockers - vasodilation
quinidine like depressnat at heart - block na channels - slow conduction and depress contractility

24

treat TCA overdose

NE for hypotehsnion and sodium bicarbonate

25

MAOi symptoms

severe hypertension reactions when with tyramine foods or drugs like phenylpropnaolamine or ephedrine

26

treat MAOi

phentolamine or labetolol

27

what is serotonin syndrome

MAOI with a serotenergic agent --> overstimulation with 5HT1a and 5HT2 receptors

28

sxs of serotonin syndrome

hyperthermia
muscle rigidity
myoclonus
hyperreflexia

29

treatment of serotonin syndrome

cyproheptadine 5HT2 antag

benzos - rigidity, serizures, agitation

30

Neuroleptic malignant syndrome caused by

antipsychotics

31

sx of neuroleptic malignant syndrome

muscle ridigity
hyperthermia
metabolic acidosis
confusion
FEVER
F: fever
E: encephalopathy
V: vitals unstable
E: elevated enzymes
R: rigidity of muscles

32

tx of neuroleptic malignant syndrome

bromocriptine and dantroline

33

O/d sxs of opioids

letaryg
small pupils
bp and pulse decrease

34

higher dose o/d opioids

coma
respiratory depression
apnea

35

treatment of opioids

maintain vitals
naloxone
nalmefene

36

what is the most common side effect of sulfonylureas and meglitinides?

hypoglycemia

37

how to treat sulfonylureans and meflinitides

glucose bolus
IV octretoide - antagonizes insulin release

OR

diazoxide - antagonize insulin release

38

CO + Hb

carboxyhemoglobin
LEFT SHIFT

39

sx of Co poisoning

headache and tightness in temporal region
death - respiratory paralysis

40

tx of CO

100& O2 hyperbaric

41

Ethanol sxs

disinhibition, lethary, ataxia, impaired judgement, stupor, coma, death

42

ethanol signs

hypoglycemia
hypothermia
increased anion gap metabolic acidosis

43

tx ethanol

prevent aspiration
thiamine
IV dextrose
correct electrolytes

44

Methanol is found where?

paint solvent
photocopying fluid
windshield washing fluid

45

what is methanol metabolized to?

formaldehyde

46

consequences of methanol

acidosis
retinal damange
blindness
death - sudden cessation of respiration

47

tx of methanol

ethanol @ oh dehydrogenase
fomepizole - inhibits alcohol dehydrogenase
bicard
hemodialysis

48

Ethylene glycol source

antifreeze

49

ethylene is metabolized to?

aldehydes adn oxalate

50

consequences of ethylene

severe acidosis
renal dmage

51

treatment of ethylene

ethanol
fomepizole

52

a high osmolar gap suggests poisoning with?

methanol
ethylene glycol

53

toxicity from cholinesterase inhibitors found @ whom?

suicidal
work exposure
terrorist attack

54

sxs of muscarinic overactivation like organophosphates

DUMBELS:
D - diarrhoea
U - urination
M - miosis
B - brady cardia an dbronchoconstriction
E - emesis
L - lacrimation
S - salivation and sweating

55

signs of nicotinic overactivation @ organophosphates

hypertension, tachy or brady

muscle twicth and fasiculations

most common cause of death is resp paralysis

56

treatment of organophosphates

atropine and pralidoxime

57

treatment of carbamate insecticides

atropine only bc short lived and spontaneously reversible no pralidoxime

58

sources of cyanide

plastic, jewelry, wool, silk, cassave and apricot seed

59

cause of death @ cyanide

respiratory arrest

60

MOA cyanide

high affinity for Fe3+ -- binds heme of cytochrome a, a3 = O2 cant act as final acceptor in the ETC -- CYTOTOXIC HYPOXIA - lactic acidosis

61

treatment of cyanide

provide a large pool of ferric iron to compete for cyanide

62

compnent of cyanide antidote kit

amyl nitrite pearls
sodium nitrite
sodium thiosulfate

63

how do the components of the cyanide antidote kit work?

nitrites oxidze Hb to methemoglobin (prilocaine) --> forms cyanmethemoglbin and cytochrome oxidase is restored

64

how does thiosulfate help cyanide antidote style?

thiosulfate donates sulger that then makes cyanmethemoglobin thiocyante and methemoglobin by rhodanese --> pee out thicyanate

65

what does methylene blue do?

restores methemoglobin to ferrous form

66

how does hydroxocobalamin help wtih cyanide poisoning?

reacts with cyanide to yield cyanocobalamin (precursor of B12)

better because no metemoglobin

67

source of lead

ammunition
lead miners
battery manufacturers
lead containing pain

68

sx of acute lead poisoning

abdominal colic and CNS changtes

69

sx of acute lead poisoning

plumbism
peripheral neuropathy - tremor, anaemia, anorexia, weight loss gi symptoms
normocytic/microcytic and hypochromic anaemai

delta ALA dehydratase and ferrochetlase
a

70

treat lead poisoning

diazepam - seizures
mannitol and dexamethasone - cerebral oedema


chelation - EDTA , dimercaprol siccimer

71

What are you treating? diazepam, manntiol, dexamethasoen, EDTA, dimercaprol, succimer

lead poisoning

72

arsenic

contaminated wine or moonshine and water of fodo contamination - shell fish and other seafood

73

i say diarhhoea ricewater stools and sweet garlicky breath

acute inorganic arsenic poisoning

74

sx or arsine gas

massive hemolysis

75

sxs of chronic organic arsenic poisonings

skin changes
cancer
RAINDROP

76

MOA arsenic

trivalent react wtih SH
uncouple oxidative phosphoylation
hemolysis by depleting glutathione in the rbc

77

tx of arsenic

unithiol
dimercaprol

78

MOA mercury

SH groups

79

source of mercury

battery
thermometer
barometer
fish

80

symptoms of mercuric chloride

corrosive - hemorrhagic gastroenteritis

81

symptoms of chronic meurcry poisoning

classic triad
1) tremor
2) neuropsychiatric disturbances
3) gingivostomatis

82

mercury poisoning in children

acrodynia

painful erythemia
mil

83

treatment of mercury

unithiol and succimer
DO NOT USE DIMERCAPROL

84

iron symptoms

vomiting
gi bleeding
lethardy
GRAY CYANOSIS
gi necrosis

85

treatment of iron

deferoxamine