B5.055 Prework 2: Adverse Drug Reactions

Question 1

organophosphates

Answer 1

irreversible cholinesterase inhibiting insecticides
parathion
malathion
sarin
soman

Question 2

carbamates

Answer 2

irreversible cholinesterase inhibiting insecticides
carbaryl
aldicarb
carbofuran
aminocarb

Question 3

insecticide toxidrome

Answer 3

SLUD

salivation, lacrimation, urination, defecation

Question 4

mild insecticide poisoning symptoms

Answer 4

anorexia, headache, dizziness, nausea

Question 5

moderate insecticide poisoning symptoms

Answer 5

excessive sweating, vomiting, abdominal cramps

Question 6

severe insecticide poisoning symptoms

Answer 6

pinpoint and nonresponsive pupils
heart block
coma

Question 7

serum cholinesterase levels following exposure

Answer 7

levels are low

measured as a confirmatory test

Question 8

treatment of insecticide poisoning

Answer 8

atropine: small dose to block cholinergic effects, increase as needed
2-PAM to reactivate acetylcholinesterase enzyme prior to aging (only use for organophosphates, not carbamates)

Question 9

mechanism of methemoglobin inducing agents

Answer 9

oxidize hemoglobin (fe2+) to methemoglobin (fe3+) which is incapable of carrying oxygen
nitrates

Question 10

carbon monoxide effects on heme protein

Answer 10

binds to hemoglobin to produce carboxyhemoglobin

binds much tighter than O2 and inhibits O2 carrying

Question 11

cyanide effects on heme protein

Answer 11

inhibits cytochrome c oxidase, enzyme in electron transport chain
blocks oxidative phosphorylation and respiration
extremely rapid action

Question 12

symptoms of nitrate induced methemoglobinemia

Answer 12

chocolate colored blood
hypotension, hypoxia, cyanosis
convulsions, coma, resp failure

Question 13

treatment of methemoglobinemia

Answer 13

only needed when 35% or more hemoglobin is oxidized

methylene blue will convert methemoglobin back to hemoglobin

Question 14

normal carboxyhemoglobin levels

Answer 14

non smokers = 1%
smokers = 5-10%
auto exhausts = 4-7%

Question 15

symptoms of CO poisoning

Answer 15

headache, dizziness and stupor due to brain anoxia

cherry red blood

Question 16

treatment of CO poisoning

Answer 16

terminate exposure
administer O2
avoid respiration stimulating drugs
hyperbaric O2 if severe

Question 17

symptoms of cyanide poisoning

Answer 17

RAPID

dizziness, headache, hypotension, unconsciousness, convulsions, resp failure

Question 18

treatment of cyanide poisoning

Answer 18

induce methemoglobinemia bc methemoglobin competes for cyanide ion with cytochrome oxidase
hydroxocobalamin- binds to CN- to form cyanocobalamin which is excreted in urine

Question 19

arsenic

Answer 19

naturally occurring

most widespread and common environmental metal contaminant

Question 20

lead

Answer 20

anthropogenic, accumulates in body, differential effects in adults and children

Question 21

mercury

Answer 21

biomagnification issue

Question 22

cadmium

Answer 22

multiorgan carcinogen, no chelator

Question 23

manganese

Answer 23

parkinsons like symptoms, no chelator

Question 24

mechanism of arsenic toxicity

Answer 24

binds to sulfhydryl groups on enzymes and interferes with cellular metabolism
organic &laquo_space;As5+ &laquo_space;As3+ &laquo_space;arsine

Question 25

acute arsenic poisoning

Answer 25

``` hemolysis and hemoglobinurea GI disturbances ventricular arrhythmias vasodilation hyperpigmentation of skin kidney tubular damage ```

Question 26

chronic arsenic poisoning

Answer 26

nephritis dermatitis cancer of multiple tissues (bladder, liver)

Question 27

treatment for arsenic toxicity

Answer 27

remove ingested arsenic by lavage or emesis dimercaprol is preferred for acute poisoning succimer is preferred for chronic poisoning

Question 28

routes of lead toxicity

Answer 28

anthropogenic | exposure via smoke, smog, old paint

Question 29

acute lead effects

Answer 29

kidney damage, GI irritation

Question 30

chronic lead effects

Answer 30

interference with heme biosynthesis leading to microcytic anemia constipation and abdominal pain neurological damage

Question 31

symptoms of lead poisoning in children

Answer 31

developmental deficits low IQ growth retardation irritability

Question 32

symptoms of lead poisoning in adults

Answer 32

hypertension cholic anemia

Question 33

treatments of lead toxicity

Answer 33

remove unabsorbed lead by gastric lavage calcium gluconate for GI effects chelation therapy: Ca Na2EDTA, BAL (dimercaprol), penacillamine (oral), succimer (oral)

Question 34

when is treatment for lead toxicity in children recommended

Answer 34

> 5 micrograms/dL