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Clinical Toxicology > Cardiotoxicity > Flashcards

Cardiotoxicity Flashcards

1
Q

Anthracycline - what are they?

A

Chemotherapeutic agents used to treat cancer

They have a complication with heart failure (2.4 fold increase? of congestive heart failure- in children)

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2
Q

Anthracycline - clinical signs and symptoms

A

Three main types - acute, early onset, late
.acute - sinus tachycardia/ arrhythmias
.early onset - symptoms of clinical heart failure, most common
.late - asymptomatic, lower ejection fraction, arrhythmias

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3
Q

Anthracycline - mechanism

A

forms free radicals to induce apoptosis

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4
Q

Anthracycline - antidote and management

A

before treatment, must assess baseline clinical cardiovascular examination.
Can be used it enalapril and ACEi
Affects the left ventricular function of the heart therefore must monitor the function of that side,

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5
Q

Cocaine - exposure and administration

A 
Body packers 
. oral (alcohol can increase cocaine absorption)
. smoking 
. snorting 
. intravenous
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6
Q

Cocaine - clinical signs and symptoms

A

Chest pain, SoB, dizziness, hypertension, left ventricular hypertrophy, palpitations
. Identification- urine toxicology, echocardiogram

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7
Q

Cocaine - mechanism

A

Sympathomimetic agent - neurotransmitter receptors on post-synaptic membrane are stimulated more,, prevents reuptake catecholamine

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8
Q

Cocaine - management

A

.acute - anti-platelet drug, alpha blockers, nitric-oxide mediated vasodilators
.chronic - amlodipine, ACEi, diuretic drugs
.Monitoring - drug history, temperature, bp, CT scan, BNP
THERE IS NO SPECIFIC PHARMACOLOGICAL ANTIDOTE FOR COCAINE OVERDOSE

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9
Q

Ecstasy - exposure, administration

A

Typically powder, pill or crystal (oral or snot) - others include rubbing into gums
Dose varies with individuals

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10
Q

Ecstasy - clinical signs and symptoms

A

Systemic - heightened sensation, euphoria, clenched jaw, uncontrolled body movements, excessive sweating, yellowish skin, restlessness

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11
Q

Ecstasy - clinical signs and symptoms

A

anxiety, loss of consciousness, chest pain, hypertension, confusion, seizures, headache
. may also lead to cardiac arrhythmia, fatality, myocardial necrosis

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12
Q

Ecstasy - mechanism

A

Myocyte necrosis with macrophage inflammatory response, or necrosis of contraction band in myocardium

cont.

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13
Q

Ecstasy - antidote, management

A

No specific treatment - withdrawal symptoms caused by serotonin deficiency
. SSRIs (selective serotonin reuptake inhibitors)
Overdose - rehydration and lowering body temperature
Monitoring - ECG, echocardiography, hepatic blood test, C-reactive protein
High relapse rate

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14
Q

Cyclophosphamide - what is it used for?

A

In treatment of cancer to supress the immune system

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15
Q

Cyclophosphamide - exposure

A

Chemotherapeutic agent, occupation and secondary exposure.

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16
Q

Cyclophosphamide - signs and symptoms

A

Alopecia, pul. fibrosis, syndrome of inappropriate anti-diuretic hormone secretion (SIADH)

17
Q

Cyclophosphamide- Cardiotoxicity symptoms

A

Tachicardia, cardiac arrhythmias, SoB, chest pain, severe lethargy, dry cough

18
Q

Cyclophosphamide - identification

A

ECG, listening to heart for an irregular rhythm.

Chest x-ray for heart enlargement or pulmonary oedema. Troponin blood test

19
Q

Cyclophosphamide -mechanism

A

CYC metabolised by P450 in the liver –> oxidative damage –> cause multifactorial myocardial necrosis and myocarditis, cardiac tamponade

20
Q

CYC- antidotes and management of side effects

A

Bladder bleeding - intermittent dosing, lots of fluids
Infertility - intermittent dosing
All risks are lower with a lower dosage
Cardiotoxicity - beta-blockers, ACE inhibitors, diuretics
CONTRAINDICATIONS: TERATONGENIC in pregnant women

21
Q

Methamphetamine - what is it?

A

Strong CNS stimulant (recreational drug). Severe psychological withdrawal. Lots of deaths due to heart attack and stoke.

22
Q

Methamphetamine - exposure

A

Powder - taken in binge-crash cycle (run), inhaled, smoked, swallowing a pill, snorting, injection
Can also be used to treat ADHD, narcolepsy, obesity in children and nasal decongestants - but used minimally due to high risk of misuse and addiction

23
Q

Methamphetamine - Clinical signs and symptoms

A

Increased bp and breathing rate, body temp, dilated pupils, sleeplessness, paranoia, unpredictable behaviour, tremors, nausea, anxiety, depression, seizures, teeth grinding

Long term - microvascular hemmorrhage, eye damage, vision, mood disorders, impaired sexual motivation and performance.

24
Q

Methamphetamine - mechanisms of cardiotoxicity

A

Increase release of catecholamines - adrenaline, serotonin, dopamine. Blocking the reuptake of these -> increase reactive oxygen species, mitochondrial injury and loss of myoglobin

25
Q

Methamphetamine - antidotes and management

A

Monitoring - through IV, heart rate, medications to slow bp and ease anxiety, activated charcoal
Treatment - ACEis, beta adrenergic antagonists
Management - considered for heart transplant w severe symptoms

26
Q

Herb-induced aconitine - what is it used for

A

Used in traditional Chinese medicine, fast acting toxin, there is no antidote, often mistaken for horseradish

27
Q

Aconitine - symptoms

A

Presenting with paresthesias (numbness), muscle weakness, vomiting and cardiac abnormalities

Cardiovascular - palpitations, chest tightness, hypotension, ectopic
Neurologic - sensory and motor convulsions
Gastrointestinal - nausea, abdominal pain,
confusion and mania

28
Q

Aconitine - mode of action

A

Sodium channel agonist. bonds sodium channels at receptor site of alpha subunit –> persistent activation

29
Q

Aconitne- how does it cause bradycardia

A

Vagus nerve - innervates heart and slows rate (it is overstimulated)

30
Q

Aconitine - treatment

A

Intravenous fluids for dehydration, activated charcoal, temporary pacemaker for severe bradycardia. atropine, dopamine for treating bradycardia

Clinical Toxicology (8 decks)

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