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Toxicology Flashcards

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1
Q

What is the definition of toxicology?

A

Branch of pharmacology that encompasses the deleterious effects of chemicals on biologic systems

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2
Q

What are the classifications of toxic chemicals in the environment?

A

Pollutants: air, environmental
Agricultural chemicals: pesticides, herbicides
Solvents

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3
Q

What are the classification of air pollutants?

A 
Carbon monoxide 50%
Sulfur oxides 18%
Hydrocarbons 12%
Particulate matter 10%
Nitrogen oxides 6%
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4
Q

Define carbon monoxide in terms of characteristics and affinity to hemoglobin. At what level does collapse and syncope occur?

A

Colorless, odorless gas
More than 200-fold greater affinity for hemoglobin than O2
When 40% of Hgb has been converted to carboxyhemoglobin

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5
Q

Treatment for CO poisoning

A

Removal of source

100% oxygen

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6
Q

Define sulfur dioxide

A

Colorless, irritating from combustion of fossil fuels

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7
Q

What is formed when sulfur dioxide comes in contact with mucous membranes?

A

Sulfurous acid

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8
Q

What are the effects of sulfur dioxide exposure?

A

Conjunctival irritation and bronchospasm
Delayed pulmonary edema
Aggravate cardiopulmonary disease

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9
Q

Define nitrogen oxides.

A

Brownish, irritant gas from fires and silage on farms

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10
Q

Define ozone.

A

Bluish irritant gas produced in air and water purification devices and in electrica fields

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11
Q

What are some of the aliphatic hydrocarbon solvents?

A

Chloroform
Trichloroethylene
Carbon tetrachloride

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12
Q

What are the adverse effects of aliphatic hydrocarbon exposure?

A

CNS depression
Hepatotoxicity
Nephrotoxicity
Peripheral neuropathy (Tetrachloroethylene, Trichoroethylene)

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13
Q

What are some of the aromatic hydrocarbon solvents?

A

BTX
Benzene
Toluene
Xylene

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14
Q

What are adverse effects of chronic aromatic hydrocarbon exposure?

A

CNS depression - ataxia, coma

Hematologic toxicity and cancers

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15
Q

What are the classifications of pesticides?

A

Acetylcholinesterase inhibitors: carbamates, organophosphates
Botanical agents: rotenone, pyrethrum alkaloids, nicotine
Chlorinated hydrocarbons: DDT and its analogs

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16
Q

What are the clinical manifestations in ACh inhibitor toxicity?

A 
DUMBBELSS
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation
Lacrimation
Salivation
Sweating
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17
Q

What is the treatment for ACh-esterase inhibitor toxicity?

A

Atropine+Pralidoxime

Mechanical ventilation, if necessary

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18
Q

What are the adverse effects of botanical agents?

A

Ropenone: GI distress, conjunctivitis, contact dermatitis
Pyrethrum: CNS excitation, peripheral neurotoxicity, CD
Nicotine: excitation -> paralysis of CNS and neuromuscular transmission

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19
Q

What are some of the commonly used herbicidees and their corresponding adverse effects?

A

Chlorophenoxy acids: muscle hypotonia, coma, inc.risk of NHL

Glyphosate: eye and skin irritation

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20
Q

Clinical manifestations of herbicide toxicity?

A

GI irritation
Hematemesis
Bloody stools
Progressive pulmonary impairment (pulmonary fibrosis)

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21
Q

What are common environmental pollutants?

A

P-D-A
Polychlorinated biphenyls: electrical equipment
Dioxins:by-products of chemical industry, stable and resistant to degradation
Asbestos: used in manufacturing and buildings

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22
Q

Adverse effects of pollutants:

Study These Flashcards
A

Polychlorinated biphenyls: dermatoxocity, inc.liver enzymes and TAG
Dioxin: dermatitis, chloracne, carcinogenic and teratogenic
Asbestos: fibrotic lung disorders, cancers

23
Q

What are some of the heavy metals and chelators?

Study These Flashcards
A 
Heavy metals: M-A-I-L
Mercury
Arsenic
Iron
Lead

Chelators
S-P-E-D-D
Succimer
Penicillamine
EDTA
Dimercaprol
Deferoxamine
24
Q

Clinical manifestation and treatment for acute inorganic lead toxicity

Study These Flashcards
A

Abdominal colic and CNS changes (acute encephalopathy)

Tx: prompt chelation

25
Clinical manifestation and treatment in children with Plumbism
Growth retardation, neurocognitive deficits, developmental delay Tx: -Chelation with oral succimer (OPD) or EDTA+/- Dimercaprol (severe) -High dietary calcium
26
Organic lead poisoning is usually due to what?
Tetraethyl lead | Tetramethyl lead
27
Acute arsenic poisoning is manifested as? Treatment?
Rice-watery stools -> dehydration, shock Sweet, garlicky odor in breath and stools Tx: fluid replacement, chelation with dimercaprol
28
Clinical manifestations and presentation of chronic arsenic poisoning Treatment?
CM: GI disturbances, bone marrow depression, hair loss Presentation: Mee’s lines and skin changes -Hyperkeratosis -Raindrop hyperpigmentation -Milk and roses complexion Tx: Dimercaprol chelation
29
Noted presentation in arsine gas exposure | Treatment
``` Massive hemolysis (jaundice, hemoglobinuria) Tx: exchange transfusion, vigorous hydration, HD ``` *chelators are of no clinical value
30
What life-threatening condition is caused by acute inorgnic mercury poisoning? Treatment?
Hemorrhagic gastroenteritis -> renal failure | Treatment: ICU, Succimer oral, Dimercaprol IM
31
What are the clinical manifestations of chronic inorganic mercury poisoning? Treatment?
Loosening of gums and teeth Erethism (neurologic and behavioral changes) Tx: succimer, unithiol *dimercaprol: redistributes mercury to the CNS
32
Organic mercury poisoning acquired from consumption of fish or grains containing methylmercury
``` Minamata disease: M-D-C-B Mental retardation Deafness Cerebral palsy Blindness ```
33
Clinical manifestation of iron poisoning | Treatment
``` Gray-J-P-G-H Gray cyanosis GI necrosis Pneumonitis Jaundice Hemosiderosis, hemochromatosis ``` Deferoxamine
34
What is the MOA of chelators?
Forms water-soluble complexes with metals -> excreted in urine
35
What is co-administered with dimercaprol in chronic lead poisoning?
EDTA
36
When is succimer given?
Lead poisoning with blood concentrations greater than 45ug/dL
37
When do you give penicillamine?
Copper poisoning | Wilson disease
38
What are the side effects of penicillamine?
P-A-N Pancytopenia Autoimmune dysfunction Nephrotoxicity with proteinuria
39
What are the SE of EDTA?
H-E-N Hypocalcemia ECG changes Nephrotoxicity
40
What is the presentation of antimuscarnic poisoning?
``` Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter ```
41
What are the interventions for cholinemimetic/organophosphate poisoning?
Support respiration Atropine + Pralidoxime Decontaminate
42
What are the manifestations of opioid overdose?
PCR Pupillary contriction Comatose Respiratory depression
43
What is the antidote for opioid overdose?
Naloxone
44
What are the clinical features of salicylate/ASA poisoning?
``` CHAFS Coma Hyperventilation Acidosis (HAGMA) Fever Seizure ```
45
What are the interventions for ASA poisoning?
Correct acidosis and electrolyte imbalance Hemodialysis Alkaline diuresis
46
What are the manifestations of sedative-hypnotic poisoning?
``` HHHDCN Hypothermia Hypotension Hypoactive BS Disinhibition Coma Nystagmus ```
47
What are the 3Cs of TCA overdose?
Coma Convulsions Cardiotoxicity
48
How do you manage TCA overdose?
``` S-N-T-S Sodium bicarbonate Norepinephrine Temperature control Seizure control ```
49
What is the formula for calculated osmolarity?
Sum of twice the sodium, 18th of Glucose, and third of BUN
50
What substances causes an increase in stool osmolar gap?
``` M-E-D-I-E Methanol Ethanol Diuretics Isopropyl alcohol Ethylene glycol ```
51
What is the formula for anion gap? | NV?
AG = (Na+K) - (Cl-HCO3) | 12 - 16 mEq/L
52
What are the drugs that cause hyperkalemia?
``` B-D-F-L-P Beta blockers Digitalis Fluoride Lithium Potassium-sparing diuretics ```
53
What are the drugs that cause hypokalemia?
``` BB-MD Beta agonist Barium Methylxanthines Diuretics, most ```

Pharmacology (8 decks)

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