CH41: Alcohol, Drugs, Toxins and Chemical Agents Flashcards
Neurotransmitters and modulating agents attach to receptors at synapses are able to increase or decrease the permeability of ion channels and stimulate or inhibit second cytoplasmic messengers. Give examples. (p. 1210)
L dopa: dopamine
Tryptophan: serotonin
Choline: acetylcholine
No particular aspect of alcohol metabolism has been found to account for the development of addiction with the possible exception of (p. 1211)
aldehyde dehydrogenase
Energy liberated by oxidation of alcohol (p. 1211)
7cal/g
Determine state of these alcohol levels (p. 1211) 30 50 100 200 300 400
30 mild euphoria 50 mild incoordination 100 obvious ataxia 200 confusion and reduced mental activity 300 stuporous 400 deep anesthesia
Drugs that have eh effect of disulfiram but less potent (p. 1212)
sulfonyluroeas
metronidazole
furazolidone
Refers to the period of severe intoxication for which the patient later has no memory– even though the state of consciousness was not grossly altered during that interval (p. 1213)
blackout
Can be a therapeutic option for blood alcohol concentrations more than 500mg/dL (p. 1214)
hemodialysis
Characteristic of methyl alcohol intoxication (p. 1214)
damage to retinal ganglion cells (scotomata)
bilateral degeneration of the putamen
Major constituent of antifreeze (p. 1214)
Ethylene glycol
Finding in ethylene glycol toxicity that may aid in the diagnosis (p. 1214)
Hippurate crystals (that can also be found in toluene ingestions)
Treatment of alcohol intoxication (p. 1214)
Fomepizole (IV 4-methylpyrazole)
Characteristic tremor of Alcohol Withdrawal (p. 1215)
fast frequency 6-8 Hz, slightly irregular, variable in severity, tending to diminish when the patient is in quiet surroundings and increase with motor activity or emotional stress
Most common hallucinations of alcohol withdrawal (p. 1216)
Human voices
Chronic auditory hallucinosis vs Paranoid schizophrenia (p. 1216)
the alcoholic illness develops in close relation to a drinking bout and the past history rarely reveals schizoid personality traits
Withdrawal seizures from peak at around what time (p. 1216)
13 and 24 hours
T/F During period of withdrawal, he patients are sensitive to stroboscopic stimulation; almost half of he patients respond with generalized myoclonus or convulsive seizure (p. 1216)
T
Frequency of EEG findings is rum fits (p. 1217)
No greater than in normal persons in shapr conrast to the EEGs of nonalcoholic patients with recurrent seizures
Treatment of Withdrawal seizures (p. 1218)
diazepam or sodium phenobarbital
How many percent of cases of delirium tremens end fatally (p. 1217)
15%
Early phase of alcohol withdrawal is associated with these metabolic abnormalities (p. 1218)
drop in serum magnesium
hypokalemia
rise in arterial pH
low pCO2
These drugs should be avoided because it may decrease the threshold to seizures in patients with alcohol withdrawal (p. 1219)
phenothiazine
T/F Alcoholic dementia lacks a distinctive, well- defined pathology (p. 1220)
TRUE
Requisite for successful treatment of alcohol dependence (p. 1221)
Total abstinence from alcohol
Drugs for alcohol dependence (p. 1221)
Disulfiram- dont give to patients with cardiac or advanced liver disease
Naltrexone
Acomprosate
Topiramate
Acute opioid poisoning clinical findings (p. 1223)
Unresponsiveness Shallow respirations Slow respiratory rate or periodic breathing Pinpoint pupils Bradycardia Hypothermia
Cause of death in opioid overdose (p. 1223)
Respiratory depression with asphyxiation
Treatment of opioid overdose (p. 1223)
Naloxone 0.4 to 0.5mg repeated every 2 mins o a dose of 15mg IV
The desensitization of opioid receptors mainly these accounts for tolerance through a mechanism of uncoupling of the receptor from the G protein complex (p. 1224)
mu type
Treatment of Opioid Abstinence syndrome (p. 1225)
Methadone substitution- habituation
Clonidine
Naloxone/ Naltrexone
Opioid complicaions (p. 1226)
occlusion of cerebral arteries
amblyopia
transverse myelopathy
peripheral neuropathy
MRI findings in opioid users (p. 1226)
Widespread white matter hyperintensity involving supra and infratentorial structures; predilection for CST and below the IC; with sparing of subcortical U fibers and grey matter structures
Increases the potency of drugs (p. 1227)
higher lipid solubility
lower plasma PH
MOA of Barbiturates (p. 1227)
suppress neuronal transmission, presumably by enhancing GABA inhibition at pre and post receptor sites to reduce excitatory potentials
Fast acting barbiturates (p. 1227)
Pentobarbital, secobarbital
Potential fatal dose of phenobarbital (p. 1227)
6 to 10g
lethal overdose at 60mgdL for Pb
10mgdL for pentobarbital and amibarbital
Treatment for barbiturates overdose (p. 1227)
Hemodialysis and hemofiltration with charcoal
MOA of Benzodiazepines (p. 1228)
Act in concert with GABA to open chloride ion channels and hyperpolarize postsynaptic neurons and reduce their firing rate. Primary actions are on: cerebral cortex and limbic system
MOA of Flumazenil (p. 1228)
binding o CNS diazepine receptors and thereby blocking the activation of GABAergic synapses
Selective 5HT1A receptor serotenergic agonist (p. 1229)
Buspirone
Of all the phenothiazines, this has the tendency to cause akathisia (p. 1230)
Molindone
Treatment: Propanolol
Treatment for post-phenothiazine dyskinesia (p. 1230)
Amantadine
Treatment for Neuroleptic Malignant Syndrome (p. 1231)
Bromocriptine
Dantrolene
Most common adverse effect of all MAO inhibitors (p. 1231)
Postural hypotension
Contraindicated when taking MAO inhibitors (p. 1232)
phenothiazines CNS stimulants TCA and serotonergic antidepressants sympathomimetic amines tyramine- containing foods
Presently are the most effective drugs for the treatment of patients with depressive illness (p. 1232)
TCA
Serotonergic drugs
Treatment of Serotonin Syndrome (p. 1233)
Discontinuation of medication
Cyroheptadine
Neuro findings of Lithium intoxication (p. 1233)
fast frequency action tremor or asterixis Nausea Loose stools Fatigue Polydypsia and polyuria
Cocaine withdrawal syndrome (p. 1234)
insomnia restlessness anorexia depression hyperprolactenemia dopaminergic sensitivity
Marijuana activates this receptor, mainly on GABA-ergiv neurons in the hippocampus, amygdala and cortex (p. 1235)
CB1
The source of recurrent inhibition of spinal and brainstem motor neurons preferentially affected by Tetanus Toxin (p. 1236)
Renshaw Cell
Differentiate stiffman syndrome and tetanus (p. 1237)
In Tetanus, the physiologic silent period that occurs 50 to 100ms after reflex contraction is loss
Treatment for Tetanus (p. 1237)
Antitoxin
10day course of Penicillin
Metronidazole
Tetracycline
How to give tetanus immunity (p. 1238)
Toxoid every 10 years
If has a threat, one dose then 6 weeks after
Most common clinical type of diphtheria (p. 1238)
faucial- pharyngeal form
Characterized by early oropharyngeal symptoms, ciliary paralysis with retained pupillary response to light, subacute evolution of a delayed symmetrical sensorimotor peripheral neuropathy (p. 1238)
Diphtheria
Has been useful in reversing the weakness of limn and extraoccular muscles in Botulism (p. 1239)
Guanidine hydrochloride
Workup for lead poisoning (p. 1241)
Lead lines at the metaphysis of long bones
Basophilic stippling in red cells
Basophilic stippling of bone marrow erythroblasts
Confirmation of Lead toxicity (p. 1241)
Lead excretion with calcium disodium edetate given in three doses (25mg/kg)
500mg in 24hrs means there is toxicity
Treatment for Lead toxicity (p. 1242)
2,3 dimercaprol
oral penicillamine
Transverse lines 1 to 2mm in width above the lunula of each fingernail (p. 1243)
Mees lines
found in arsenic
Treatment for arsenic toxicity (p. 1243)
Dimercaprol
Cock gait. Which element is in excess (p. 1244)
Manganese
Treatment: L dopa
Pathologic findings in Mercury poisioning (p. 1244)
Striking degeneration of the granular layer of the cerebellar cortex with relative sparing of the Purkinje cells and neuronal loss and gliosis of the calcarine cortex
Treatment for Mercury poisoning (p. 1245)
Penicillamine or Dimercaprol
Symptoms reversing organophosphate poisoning (p. 1245)
Atropine and Pralidoxime
Biopsies in patients who had Cisplatin (p. 1247)
Primary axonal degeneration
MOA of neuropathy for patients taking Paclitaxel and Docetaxel (p. 1247)
Inhibitors of depolymerization of tubulin
Most frequent side effect of Calcineurin inhibitors (p. 1249)
Tremor