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GIR Test 2 > B5-093 Toxicology > Flashcards

B5-093 Toxicology Flashcards

1
Q

most common cause of acute liver failure in the Western world

A

acetaminophen

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2
Q

causes hepatic necrosis secondary to cascade of signaling events, resulting in mitochondrial injury and cell death

A

acetaminophen

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3
Q

standard of care for acetaminophen overdose

A

NAC within 8-12 hours of exposure

dose based on nomogram, shows acetaminophen plasma levels

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4
Q
  • causes tinnitus, dizziness
  • eventually causes metabolic acidosis, hyperpyrexia
  • can cause coma, convulsions, respiratory failure
A

salicylate

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5
Q

treatment for salicylate overdose

A

sodium bicarbonate to alkalize urine to promote excretion, counteracts acidosis

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6
Q

cause tachycardia, hypertension, seizures, mydriasis

A

sympathomimetics

cocaine, amephetamines

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7
Q

cocaine and amphetamines fall under what classification?

A

sympathomimetics

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8
Q

treatment for sympathomimetics overdose

A

maintain airway and respiration
* control convulsions: IV diazepam
* if convulsions interfere with respiration: succinylcholine
* vasopressors
* if orally ingested, charcoal emesis to remove

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9
Q

what are contraindicated in the treatment of sympathomimetics overdose?

A

beta blockers

worsen toxicity

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10
Q

cause unconsciousness, miosis, slow/shallow respirations

A

opioids

opioid triad

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11
Q

morphine, fentanyl, tramedol fall under what classification?

A

opioids

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12
Q

treatment for opioid overdose

A

naloxone

short DOA, give repeat doses

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13
Q
  • have anti-cholinergic effects
  • cause cardiovascular toxicity
  • blockade of myocardial fast sodium channels causes QT prolongation, hypotensions
  • seizures
A

tricyclic antidepressants (amitryptiline)

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14
Q

anticholinergic effects

A

dry mouth
tachycardia
nausea
confusion
urine retention

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15
Q

treatment for tricyclic anti-depressant overdose

A

sodium bicarbonate to maintain arterial pH, reversing cardiac depressant effects

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16
Q

what class of drugs in contraindicated in the treatment of tricyclic antidepressant overdose?

A

class IA anti-arrthymics

quinidine, procainamide, lidocaine, etc

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17
Q
  • cause first degree heart block, hypotension, and bradycardia
  • increased PR intervals
  • hypoglycemia and hyperkalemia
  • CNS toxicity
A

beta blockers

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18
Q

treatment for beta blocker overdose

A
  • glucagon for bradycardia/hypotension
  • sodium bicarb for conduction defects
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19
Q

causes torsade de pointes polymorphous V tach w/ QT prolongation

A

sotalol overdose

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20
Q

treatment for sotalol overdose

A
  • isoproternol IV
  • magnesium
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21
Q

cause AMS, fever, agitation, myclonus, hyperreflexia, ataxia, diaphoresis

A

serotonin syndrome

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22
Q

drugs that can cause serotonin syndrome

5

A

SSRIs
MAOIs
TCAs
Amphetamines
Opioids

usually SSRI + one of the others

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23
Q

treatment for serotonin syndrome

A
  • serotonin antagonists (cyproheptadine, propranolol)
  • dantrolene
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24
Q

organophosphates are […]

reversible/irreversible

A

irreversible

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25
Q

carbamates are […]

reversible/irreversible

A

reversible

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26
Q

parathion (paraoxon)
malathion (malaoxon)
sarin
soman

belong to what classification?

A

organophosphates

cholinesterase-inhibiting insecticides

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27
Q

carbaryl
aldicarb
carbofuran
aminocarb

belong to what classification?

A

carbamates

cholinesterase-inhibiting insecticides

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28
Q

cause salivation, lacrimation, urination, defecation

A

cholinesterase-inhibiting insecticides

SLUD

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29
Q

cholinesterase-inhibiting insecticides overdose treatment

A
  • atropine - blocks cholinergic effects
  • 2-pralidoxime (2-PAM) - reactivates ACHase enzyme

2-PAM for organophosphates only

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30
Q

2-PAM is contraindicated for […] toxicity

A

carbamate

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31
Q

chemicals affecting heme

A
  • methemoglobin inducing agents (nitrates)
  • carbon monoxide
  • cyanide
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32
Q
  • causes hypertension, hypoxia, and cyanosis
  • chocolate colored blood
A

nitrate induced methemoglobin

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33
Q

treatment for nitrate induced methemoglobin

A

methylene blue

will convert methemoglobin back to hemoglobin

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34
Q

odorless and colorless gas that is a major cause of lethal poisoning in US

A

carbon monoxide

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35
Q

carboxyhemoglobin cannot transport

A

oxygen

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36
Q
  • causes headaches, dizziness, stupor, progressive brain anoxia
  • bright red mucous membranes
A

carbon monoxide

carboxyhemoglobin is cherry red

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37
Q

treatment for carbon monoxide poisoning

A

oxygen

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38
Q

complexes with ferric iron of cytochrome oxidase inhibiting oxygen use in mitochondria

A

cyanide

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39
Q

causes dizziness, headache, hypotension, unconciousness, respiratory failure

A

cyanide

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40
Q

treatment for cyanide poisoning

A
  • induce methemoglobin via nitrates (high affinity for cyanide ions)
  • hydroxocobalamin: binds to cyanide ions to excrete in urine
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41
Q

metals causing toxicity

5

A
  • arsenic
  • lead
  • mercury
  • cadmium
  • manganese
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42
Q

causes hemolysis, hemoglobinurea, GI disturbances, ventricular arrhythmias, vasodilation, rosy complexion

A

acute arsenic poisoining

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43
Q

causes nephritis, dermatitis, cancer of bladder/liver

A

chronic arsenic toxicity

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44
Q

binds to sulfahydryls, especially in lipoic acid, interfering with energy production

A

arsenic

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45
Q

preferred chelator for acute arsenic poisoning

A

dimercaprol

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46
Q

preferred chelator for chronic arsenic poisoning

A

succimer

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47
Q

most exposure comes from smoke, smog, or old paint

A

lead

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48
Q

causes kidney damage and GI irritation

A

acute lead poisoning

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49
Q

causes plumbism, microcytic anemia, constipation, abdominal pain, neurological damage

A

chronic lead poisoning

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50
Q

causes developmental deficits, low IQ, growth retardation, irritability in children

A

lead poisoning

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51
Q

causes hypertension, cholic, anemia in adults

A

lead poisoning

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52
Q

treatment for lead poisoning

A

chelation therapy:
* CaNa2EDTA
* BAL
* penicillamine (oral)
* succimer (oral)

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53
Q

kids should be treated for lead poisoning at what blood lead level?

A

greater than 5 ug/dl

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54
Q

therapeutic index

55
Q

margin of safety

56
Q

lower doses have protective effect, higher doses have adverse effects

A

hormesis

vitamins, alcohol

57
Q

dose related toxicity due to non-immune mechanism

58
Q

allergic reactions involving immune system

A

hypersensitivtty

59
Q

abnormal responses not linked to immune system

A

idiosyncrasies

60
Q

dose related adverse effects of drugs, which is generally an overextension of the pharmacological response

A

drug toxicity

can causes minor adverse effects or severe organ directed toxicities

61
Q

adverse effect of atropine

62
Q

adverse effect diazepam

A

drowsiness

63
Q

aspirin overdose causes […] toxicity

organ directed

A

gastrointestinal

64
Q

acetaminophen causes […] toxicity

organ directed

65
Q

doxorubicin causes […] toxicity

organ directed

66
Q

drugs that cause direct fetal toxicity

3

A
  • sulfonamide - kernicterus
  • chloramphenicol- Gray baby syndrome
  • tetracycline- teeth discoloration, bone growth retardation
67
Q
  • physical defects in developing fetus due to drug exposure in mother during gestation
  • effects more pronounced during organogenesis (day 20-end of first trimester)
A

teratogenicity

68
Q

teratogens

4

A
  • thalidomide
  • alcohol
  • lithium
  • antifolates
69
Q

abnormal response resulting from previous sensitizing exposure activating immonologic mechanism

A

drug allergy/hypersensitivity

70
Q

untoward reactions to drugs that occur in a small fraction of patient and have no obvious relationship to dose or duration of therapy

A

idosyncrasies

71
Q

hemolytic anemia in reponse to […] is due to differences in G6PD activity

drug name

A

primaquin

example of idiosyncracies

72
Q

most drug idiosyncrasies are due to

A

genetic variation within SNPs

73
Q

patients with abnormal serum cholinesterase develop sleep apnea when given normal doses of

A

succinylcholine

example of idiosyncracy

74
Q

what is the major challenge of treating drug toxicity?

A

no credible info

stabilize patient first, then try to figure out toxin

75
Q

ABCDts of EM

A

airway
breathing
circulation
drugs
temperature

76
Q

constellation of clinical symptoms that are associated with exposure to certain toxicological classes of chemicals

77
Q

identify the toxidrome

  • increased BP
  • increased pulse
  • slight temperature increase
  • mydriasis
  • hyperalert
  • increased reflexes
A

sympathomimetic

amphetamine, methamphetamine, pseudoephedrine

78
Q

identify the toxidrome

  • increased pulse
  • increased temperature
  • mydriasis
  • decreased bowel sounds
  • altered mental status
A

anticholinergic

79
Q

identify the toxidrome

  • decreased pulse
  • miosis
  • increased bronchial sounds
  • increased bowel sounds
  • altered mental status
A

cholinergic

80
Q

identify the toxidrome

  • decreased BP
  • decreased pulse rate
  • decreased temperature
  • miosis
  • rales
  • decreased bowel sounds
  • decreased level on consciousness
A

opioid

fentanyl, oxycodone, hydrocodone

81
Q

hypertension and tachycardia

A

amphetamine

82
Q

hypotension and tachycardia

83
Q

hypotension and bradycardia

A

beta blockers

84
Q

rapid respiration

A

carbon monoxide

85
Q

hyperthermia

2

A

anticholinergics, salicylates

86
Q

hypothermia

2

A

ethanol, sedatives

87
Q

pupil constriction (miosis)

88
Q

pupil dilation (mydriasis)

A

amphetamines

89
Q

dry skin

90
Q

excessive sweating

A

organophosphates

91
Q

cyanosis

A

methemoglobin (nitrates)

92
Q

jaundice

A

hepatotoxicity, acetaminophen

93
Q

twitching

94
Q

muscle rigidity

A

anti psychotics

95
Q

flaccid coma

96
Q

hypertension, tachycardia, mydriasis, seizure

A

amphetamines

97
Q

anion gap equation

A

Na-(HCO3+Cl)

98
Q

AT MUD PILES

A

Alcohol
Toluene
Methanol
Uremia
DKA
Paraldehyde
Iron, Isoniazid
Lactic Acid
Ethylene Glycol
Salicylates

99
Q

high anion gap indicates

A

metabolic acidosis

100
Q

osmolar gap calculation

101
Q

normal osmolar gap

102
Q

normal anion gap

103
Q

MAE DIE

A

Methanol
Acetone
Ethanol
Diuretics
Isopropanol
Ethylene gylcol

104
Q

drugs that cause Torsades de Pointes

2 main ones

A
  • Quinidine (Class IA and III antiarrhythmics)
  • TCA
105
Q

prolonged QT is caused by

A

beta-1 stimulation and intense sympathetic activation

106
Q

treatment for torsades de pointes

A

magnesium sulfates

107
Q

removal and elimination treatments for toxicity

A
  • gastric lavage with activated charcoal
  • emesis via ipecac syrup

only used if injested orally, can cause aspiration

108
Q

methods for preventation of further toxicity absorption

A

inhalation: ventilation
topical: remove contaminated clothes
injestion: lavage, emesis, irrigation, etc

109
Q

methods to remove blood from plasma

A
  • hemodialysis
  • hemoperfusion
  • hemofiltration
  • plasma exchange
110
Q

fomepizole is an antidote for

A

ethylene glycol

111
Q

hydroxicocobolamine is an antidote for

112
Q

atropine is an antidote for

2

A

organophophates
nerve gas agents

113
Q

fab fragments are antidotes for

114
Q

dimercaprol is a chelator for

4

A
  • arsenic
  • gold
  • mercury
  • acute lead
115
Q

calcium disodium EDTA is a chelator for

116
Q

penicillamine is a chelator for

2

A

lead
copper

117
Q

succimer is an oral chelator for

118
Q

used to determine adverse effects on large populations

A

quantal dose response

119
Q

used to determine dose dependent increase in toxicity to a number of doses

2

A

graded and individual dose response

120
Q

used to demonstrate that chemicals have adverse effects when they are both deficienct in the body and present in very high quantities

vitamins

A

quantal dose response

121
Q

formula to calculate margin of safety

122
Q
  • decreased blood pressure, pulse and temperature
  • pupil constriction
123
Q
  • agitated delirium
  • confusion, restlessness, picking at imaginary objects
A

anticholinergics

124
Q
  • tachycardia
  • hypertension
  • hypertherma
  • tachypnea
  • mydrasis
  • diaphoresis
  • tremor
  • hyperactive bowel
  • rhabdo
  • seizures
  • psyhchoses
A

sympathomimetics

125
Q
  • salivation
  • lacrimation
  • urination
  • defecation
A

cholinergic

126
Q

distinguishing feature of TCA overdose

A

torsades de pointes

127
Q

administration of sodium bicarb is based on what treatment principle

A

ion trapping

128
Q

used to treat lead, mercury, iron, and arsenic poisoning

A

chelation therapy

129
Q

used to alkalinize urine to inhibit reabsorption of weakly acidic toxins across renal tubular membrane

A

ion trapping with bicarb

130
Q

acetaminophen OD is treated with

A

N acetyl cysteine

131
Q

TCA OD is treated with

A

sodium bicarb

132
Q

treatment for beta blocker OD

A

glucagon
atropine
epi
calcium salts

133
Q

treatment for lead poisoning

GIR Test 2 (18 decks)

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