Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Clinical Toxicology > Flashcards

Clinical Toxicology Flashcards

1
Q

What science studies the harmful effects of drugs?

A

Clinical Toxicology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s the main difference between toxicology + pharmacology?

A

Overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alcohol intoxication is what type of poisoning?

A

Ethanol (C2H5OH) poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of salicylate (aspirin) poisoning?

A
  • tinnitus
  • hyperventilation
  • sweating
  • coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the side effects of too much aspirin?

A
  • causes internal bleeding + renal failure (toxic for kidneys)
  • stimulates resp centre = resp alkalosis, uncoupled oxidative phosphorylation = metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management of aspirin overdose?

A
  • measure plasma salicylate concentration (4-6h post ingestion), electrolytes + blood gas
  • gastric lavage (up to 1h after ingestion) followed by active charcoal
  • in severe poisoning (plasma concentration above 500mgL-1) requires urinary alkalisation or haemodialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

After an overdose of paracetamol, 48-72h later, can cause what?

A

Fatal hepatocellular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is coproxamol?

A

Distalgesic, contains opioids + paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is myosis?

A

Pin-point pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is mitrisis?

A

Dilated pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Types of stimulant drugs..

A
  • amphetamines
  • cocaine + ecstasy
  • piperazimes (contain stimulant + hallucinogenic activity)
  • eugeroics e.g. modafinil prescribed for narcolepsy (abused as wakefulness agents + CNS stimulant in sport)
  • methylxanthines e.g. caffeine
  • nicotine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do stimulants work + what are the side effects?

A

increase dopamine + NA (cause cardiovascular effects)

  • hyper-arousal
  • pleasure
  • paranoia (works same as antipsychotics by increasing dopamine)

Increased levels of serotonin due to reduced reuptake

  • reduces hunger
  • insomnia

Readily excreted urine with varying degrees of metabolism

Side effects;
Tachycardia, hyperpyrexia, dehydration, convulsions, coma
=similar to serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name types of hallucinogens

A
  • LSD
  • magic mushrooms
  • psilocybin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s the toxicology of LSD?

A
  • agonist + antagonist at serotonin receptors
  • serotonin 2A receptors in prefrontal cortex modulate cognition, mood, perception, fear + euphoria (receptors throught to be associated with Schizophrenia)
  • serotonin receptors associated with sympathomimetic stimulation
  • can take 12h to metabolise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What’s the toxicology of psilocybin?

A

-agonist at serotonin receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When there is a drug tolerance, why is there an increased toxic effect seen in cardiovascular tissue?

A

The brain becomes less sensitive due to receptors becoming down regulated. Different tissues desensitise in different ways; the brain becomes densitised fast, however, cardiovascular system doesn’t desensitise at same speed as brain (means cardiovascular system remains sensitive). Therefore, drug dose is increased = causing increased toxic effect in cardiovascular tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What’s the difference between opiates + opioids?

A

Opiates - broader classification, includes naturally extracted from plants e.g. opium (morphine + codeine)

Opioids -e.g. carentanil created in lab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drug is used to treat alcohol addiction?

A

Acetaldehyde

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 routes of poisoning?

A
  • injection e.g. insects, needle stick injury
  • inhalation e.g. gases, insecticides
  • ingestion e.g. alcohol
  • absorbtion e.g. eyes, plants, pesticides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 5 accidental circumstances leading to poisoning?

A
  • medicines e.g. children, elderly
  • food e.g. poor hygiene
  • CO e.g. faulty boilers
  • Chemicals e.g. children mistake for drink
  • plants e.g. children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What poisons have action on cardiovascular system?

A

Cardiac arrhythmias
-belladonna (atropine main component)
-stimulants
Digoxin

Blood

  • CO displaces oxygen from haemoglobin
  • warfarin can cause haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What poisons are neurotoxins?

A

depressive drugs

  • opiates
  • alcohol
  • antidepressants
  • hypnotics

Stimulants

  • ecstasy
  • cocaine

Hallucinogens
-LSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What poisons have an affect on the liver?

A

Paracetamol

  • eliminated by conjugation with glutathione =makes it stable + inactive
  • high doses saturate pathway - not enough glutathione to inactive paracetamol. Paracetamol is oxidised
  • reactive oxidised paracetamol binds covalently to thiol groups in cell proteins + kills cells
  • acetylcysteine or methionine used in overdose by boosting production of glutathione in the liver
  • pts taking enzyme inducing drugs (including alcohol) + those with glutathione depletion (pts with eating disorders) are at increased risk.

Magic mushrooms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What poisons have an affect on the respiratory system?

A
  • Opiates
  • paraquat (causes pulmonary oedema, and O2 increases its toxicity)
  • cyanide (cellular toxin) found in almonds, pips/seeds
  • agrochemical (paralyse resp system)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What poisons affect the kidneys?

A
  • paracetamol

- aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the main 2 types of poisons?

A

Carrosive (see damage on tissue + clothes)

  • battery acid
  • bleech

Non-carrosive (NO burning or irritation action)
-have systemic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Initial assessment of poisoned pt ABCDE additional only…

A

Airway

  • is it protected e.g. was mask used
  • clue in airway regarding poison
    • smell (alcohol)
    • colour (methaemaglobinaemia) usually dark in colour
    • tablet residue
    • Brutus (acid or alkalis)

Breathing

  • rate (opiates)
  • patten (kussmauls breathing -hyperventilation + aspirin intoxication)
  • efficiency (organophosphates + paraquat) - caused by pulmonary oedema

Circulation
-signs of IVDA

Disability

  • pin point pupils = opiates, organophosphates, other cholinergics
  • large pupils = alcohol, anti-cholinergics, amphetamines, beta blockers

Exposure

  • removal of clothes - main side effect of most drugs = hypothermia (be careful)
  • injection sites
  • use protection (some drugs can penetrate skin + from concealed needles)
  • clues in pts pockets
28
Q

When taking the PC what should be noted?

A
  • what they took
  • how much taken (dosage)
  • when taken
  • where taken
  • why taken -intensional?
  • anyone else involved?
29
Q

When taking history of presenting complaint what should be noted?

A
  • taken before? -tolerance or allergy
  • other medications -interactions (serotonin syndrome)
  • underlying diseases
  • family history
30
Q

Why is it important to note when the pt last ate/drank?

A

To note absorbtion of drug

31
Q

Who do you call to find the antidote?

A

TOXBASE

32
Q

What are the treatments useful in hospital for elimination + reduction of absorption?

A
  • activated charcoal
  • gastric aspiration + lavage
  • whole bowel irrigation
  • emisis
  • haemodialysis + haemoperfusion
  • alkaline diuresis
33
Q

What’s the advantage of using activated charcoal?

A
  • has a large surface area in relation to weight
  • effective up to one hour post-ingestion - won’t work if drugs already been absorbed
  • useful in paracetamol overdose, carbamazepine, theophylline + digoxin

☹️doesn’t absorb iron, lithium, corrosive agents or organic solvents
☹️contraindicated in pts with unprotected airway e.g. drowsiness or comatose due to risk of aspiration

34
Q

Why is gastric aspiration + lavage used?

A
  • orogastric tube is passed into stomach, which is washed out with 30-600ml water (repeated 3-4 times until effluent is clear).
  • ET tube needed if pts unconscious
  • only removes small amount of poison - early lavage within 60min of ingestion may benefit to pts who have taken life threatening amount
  • contraindicated in poisoning with corrosives or petroleum compounds
35
Q

How does haemodialysis- haemoperfusion work?

A
  • in haemodialysis, drug passes down concentration gradient through dialysis machine + is removed in dialysis fluid e.g. lithium, methanol, salicylates
  • in haemoperfusion, blood passed through column of activated charcoal or resin to which the drug is absorbed e.g. theophylline, barbiturates
  • needs to be small molecules to pass across the semi-permeable membrane
36
Q

What are the side effects of haemodialysis + haemoperfusion?

A
  • haemorrhage
  • air embolism
  • infection
  • loss of peripheral artery
37
Q

How does alkaline diuresis work?

A
  • urine is made alkaline (pH 7.5-8.5) by administration of IV NaHCO3
  • this ionises weak acids e.g. aspirin in renal tubes + reduced reabsorbtion
  • useful in basic drugs e.g. amphetamines, ecstasy, salicylates + phenobarbitals
  • no longer used - as uses large IV volumes of water containing NaHCO3
38
Q

What is the antidote for BZs?

A

Flumazenil

39
Q

N-acetylcystine or parvolex is used for the overdose of what?

A

Paracetamol

40
Q

What is the antidote to beta-blocker overdose?

A

Glucagon

Adverse effects

  • vomiting
  • hyperglycaemia
  • hypokalaemia
  • hypocalcaemia
41
Q

What is the antidote to organophosphate overdose?

A

Atropine

42
Q

Sodium nitrate + dicobalt edetate is used in the treatment of beta overdose?

A

Cyanide

43
Q

What is the antidote to heavy metal poisoning?

A

Sodium calcium

44
Q

What are reactive oxygen species (ROS)?

A

They are chemically reactive chemical species containing oxygen. They are caused by the reduction of molecular oxygen to a superoxide anion.

E.g. peroxides, superoxide

45
Q

What are immunosuppressant drugs used for?

A
  • to prevent rejection of transplanted organs + tissues
  • treat diseases that have an autoimmune component to their pathogenisis e.g. rheumatoid arthritis, myasthenia gravis, Crohn’s disease
46
Q

Th2 responses predominate when?

A

In allergic conditions e.g. asthma

47
Q

When do Th1 responses predominate?

A

In multiple Diseases e.g rheumatoid arthritis

48
Q

What is rheumatoid arthritis?

A

Characterised by chronic erosive arthritis of synovial joints.
Associated with circulating autoantibodies to reheumatoid factors + extracarticulate manifestatioms e.g. vasculitis.
Characterised by acute flares that cause increased pain + functional impairments due to active synovitis.

49
Q

What else is corticosteroids used in treatment of?

A

E.g. prednisolone used in treatment of cancer + are powerful immunosuppressants.
They inhibit action of transcription factors + reduces transcription of may cytokines genes

50
Q

What are antiproliferative drugs?

A

E.g. azatyioprine used to prevent tissue rejection in transplant surgery + in autoimmune disease e.g. myasthenia gravis (prevents induction phase of immune response)

Mycophenolate mofetil used for prophylaxis of acute rejection following cardiac or renal transplantation

51
Q

What are calcineurin inhibitors?

A

E.g. cyclosporine
Used to prevent + treat rejection of transplanted organs

Side effects

  • nephrotoxixity (damage to kidneys)
  • hypertension
  • hepatotoxicity (damage to liver)

Tacrolimus similar actions but more potent

52
Q

What ar monoclonal antibodies?

A

E.g. basiliximab
IL-2 antagonist + prevents T-cell growth
Used for the prophylaxis of acute rejection in allogenic renal transplantation

53
Q

What are disease-modifying antiheumatoid drugs (DMARDs)

A

Given after RA diagnosis

  • methotrexate used in cancer + RA
  • sulfasalazine suppresses inflammatory action of RA
  • Gold
  • penicillamine
  • hydroxychloroquine
54
Q

What are examples are delayed-action poisons?

A
  • aspirin
  • iron
  • paracetamol
  • tricyclic antidepressants
  • paraquat
55
Q

Overdose sign of coma - what could have been taken?

A

Usually due to CNS depression e.g.

  • hypnotics
  • antidepressants
  • anticonvulsants
  • tranquillisers
  • opioid analgesics
  • alcohol

DOENST occur with paracetamol poisoning unless another drug has all’s been taken

56
Q

Overdose sign of convulsions - what could have been taken?

A

Caused by CNS stimulation by;

  • anticholinergics
  • sympathomimetics
  • tricyclic antidepressants
  • MOAI
57
Q

Overdose sign of respiratory features - what could have been taken?

A
  • cough, wheeze, SOB can occur after inhalation of irritant gases e.g. ammonia, chlorine + smoke
  • cyanosis could be due to methaemoglobineamia caused by poisons such as Chlorates, nitrates, nitrites, herbicides
  • hypoventilation common in CNS depressant
  • reduction in RR = opioids
  • hyperventilation = salicylate poisoning, CNS stimulants + cyanide
  • pulmonary oedema = inhaled poisons or herbicides e.g. paraquat
58
Q

Overdose sign of cardiovascular features- what could have been taken?

A
  • tachycardia = anticholinergic, sympathomimetics + salicylates
  • bradycardia = digoxin or beta blockers
  • dysrhythmias = tricyclic antidepressants, antihistamines, antiarrhymics (if taken in excess) + antipsychotics
  • hypotension (systolic <70mmHg can lead to irreversible brain da,age or acute tubular necrosis) = CNS depressants, diuretics
  • hypertension uncommon but may occur following sympathomimetics e.g. amfetamine
59
Q

Overdose sign of changed body temp - what could have been taken?

A
  • hypothermia = following phenothiazines or barbiturates

- hyperthermia = CNS stimulant e.g. amfetamines

60
Q

What drugs induce liver enzymes?

A
  • anticonvulsants
  • rifampicin
  • st Johns wort
  • alcohol
61
Q

What are the features of hepatic failure?

A
  • vomiting
  • abdo pain
  • confusion
  • hyperventilation
  • hypoglycaemia
  • cerebral oedema
  • bleeding
62
Q

What are the symptoms of aspirin overdose?

A
  • tittinus, N+V, deafness, sweating, vasodilation, hyperventilation, lethargy + dehydration
  • salicylate centrally stimulates respiratory system producing hyperventilation
  • respiratory alkalosis follows with compensatory metabolic acidosis + dehydration. Hypokalemia may occur
  • lactic acidosis also occurs
  • overdose of salicylate increases heat production, oxygen + glucose use = high temp, tachycardia + hypoglycaemia
  • alters platelet function + may result in bleeding
63
Q

What are the features of tricyclic antidepressant overdose?

A
  • anticholinergic symptoms e.g. dry mouth, dilated pupils, urinary retention
  • dry + warm skin
  • tachycardia + hyperthermia
  • jerky limb movements
  • hypotension-they block the alpha-adrenergic receptor on blood vessels, resulting in vasodilation.
  • increased muscle tone + reflexes
  • respiratory depression
  • LOC
  • convulsions
  • cardiac arrhythmias - drug has a sodium channel-blocking effect = widened QRS (width linked to severity), VT, torsades de pointes + atrioventricular dissociation.
64
Q

What are the features of SSRI overdose?

A
  • N+V
  • agitation, tremor + nystagmus (rapid movement of eyes)
  • drowsiness
  • sinus tachy
  • convulsions
  • occasionally serotonin syndrome with hyperthermia
65
Q

Why cant flumazenil be taken with tricyclic antidepressants?

A

May precipitate seizures

66
Q

What are the features of a beta-blocker overdose?

A
  • bradycardia + hypotension
  • AV block, conduction delay, Ventricular arrhythmias + cardiac arrest
  • pulmonary oedema, bronchoconstriction + hypoglycaemia
  • convulsions + coma (if lipid-soluble drug e.g. propranolol)
67
Q

What are the features of calcium channel blocker overdose?

A
  • verapamil is a negative inotrope = decreases cardiac contractivity = complete heart block + asystole. Causes hypotension + vasodilation
  • N+V
  • dizziness, agitation + confusion
  • metabolic acidosis
  • hyperglycaemia (due to blocking calcium channels on beta cells causing decreased insulin release).
  • cardiogenic shock

Pharmacology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions