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Implications of human poisoning > Death by pesticides > Flashcards

Death by pesticides Flashcards

1
Q

Insecticides

A

Cholinesterase Inhibitors; OP and Carbamates
Organochlorines; Chlorodecone, Lindane, DDT
Pyrethrins/Pyrethroids; Permethrin, Deltamethrin

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2
Q

Acetylcholine is located where?

A 
Sympathetic and Parasympathetic ganglia
Skeletal NMJ
Post ganglionic sympathetic nerves
Sympathetic sweat glands
CNS nerve endings
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3
Q

What is a muscarinic receptor?

A

G protein linked

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4
Q

What is a nicotinic receptor?

A

Ligand mediated ion channel

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5
Q

What is the Cholinergic Toxidrome acronym?

A 
DUMBBELS; Muscarinic
Diarrhea
Urination
Miosis
Bronchorrea
Bradycardia
Emesis
Lacrimation
Salivation
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6
Q

What are organic phosphorous compounds?

A

Increase ACh concentration in synapse muscarinic and nicotinic
Cholinergic toxidrome
X is the leaving group

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7
Q

Organic phosphorous compounds oxons vs. thions

A 
oxons = direct action on AChE
thions = prodrugs; must be converted to active compound by p450 enzymes
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8
Q

What is the mechanism of action for oxons and thions?

Ex of oxons: 2 PAM or praladoxime

A

binds to hydroxyl group of AChE active site
stable but reversible bond forms
speeds up rate of reactivation of AChE
aging occurs when oximes can’t reactivate AChE (bond becomes permanent)

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9
Q

What do OP’s and Carbamates inhibit?

A

carboxylic ester hydrolases in the body

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10
Q

Acute toxicity of cholinesterase inhibition presentation?

A

Awake and alert
anxiety, restlessness, myosis blurred vision, respiratory depression, tremor
altered mental status - confusion - coma
DUMBBELS

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11
Q

How to diagnose cholinesterase inhibition?

A

measure cholinesterase activity for organophosphate exposure by Red blood cell AChE or ButyrylChE
miosis, muscarinic signs, and SOB

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12
Q

What are carbamates?

A

Aging does not occur therefore, no permanent bond between carbamate and AChE

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13
Q

What is carbamate acute toxicity?

A

like OP toxicity
coma and respiratory failure
Shorter duration than OPs b/c reversible

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14
Q

What are delayed syndromes of AChE inhibitors?

A

NMJ dysfunction aka intermediate syndrome
delayed muscle weakness w/o cholinergic toxidrome
24-96 hours after exposure
muscle weakness leads to respiratory failure
1st sign is muscle weakness
OP cmpd induced delayed neuropathy
Drinking OH w/TOCP ginger jake developed delayed neuropathy

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15
Q

Acute/ Chronic OP exposure causes?

A

behavioral toxicity;
confusion, psychosis, anxiety, depression, and fatigue
EEG changes for weeks

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16
Q

What causes chronic toxicity of OPs?

A

occupational exposure
BuChE activity is the sensitive measure of exposure
RBC cholinesterase is like Neuronal cholinesterase
Neuronal Target Esterase Inhibition to look for delayed neuropathy

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17
Q

What is the primary cause of death for AChE inhibition?

What is the general management?

A

respiratory failure due to bronchorrea
adequate airway/drying up secretions with atropine
benzodiazepines for seizures

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18
Q

Pharmacotherapy for AChE inhibition?

A

Atropine sulfate for carbamates = competitive anatagonist at central and peripheral muscarinic receptors/crosses BBB
Pralidoxime (2-PAM) for OP’s = targets nicotinic receptors to reverse muscle weakness/reactivates cholinesterase/prevents aging of AChE

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19
Q

Antimuscarinic Therapy

A

does not reverse nicotinic effects

ex: atropine

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20
Q

What are oximes?

A

enhances phosphorylated AChE regeneration via hydrolysis

prevents aging and addresses nicotinic and muscarinic effects

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21
Q

Pralidoxime mechanism?

A

binds on anionic site of AChE by pulling off organophosphate there

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22
Q

What are Benzodiazapines?

A

given to prevent seizures from cholinergic syndrome
Ex: diazepam
can use for intubation induction
anticholinergic

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23
Q

What is decontamination?

A

remove all clothing
triple wash skin -water, soap, water and rinse with water
wear. neoprene/nitrile gloves
consider lavage for large acute ingestions
AC but protect airway to prevent vomiting

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24
Q

What are organochlorine compounds?

A

family of neuroexcitatory toxins; all neurotoxins
eggshell thinning so changed agriculture
Ex: DDT
Can bioaccumulate and potentially cause harm
Illegal in US
DDT eliminated malaria

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25
Q

For organochlorine cmpd toxicity what do you give?

A

automatically give atropine and 2 PAM & it’s safe in large doses

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26
Q

Hopewell Pesticide Spill?

A 
made Kepone(chlordecone) dumped in James River
neurotoxicity
Kepone shakes
Hepatic injury
Testicular dysfunction
27
Q

What are neurotoxins in Organic Chlorines?

A

interfere with repolarization and depolarization of neuronal membranes
results in hyperexcitability
Lindane is GABA antagonist

28
Q

Acute Toxicity of Organic Chlorines?

A

CNS stimulation - seizure - respiratory failure - death

29
Q

Chronic Toxicity of Organic Chlorines?

A

ex: hopewell epidemic
body tremor
AMS, Ataxia, weakness
DDT linked to breast cancer

30
Q

Treatment for organic chlorines?

A

supportive care
lavage for recent ingestion
AC cannot bind so not likely
benzodiazepines for seizures and for greater strength can use barbiturates or propofol

31
Q

Pyrethrins

A

extracts from Chysanthemum flower
lipohilic
sodium channel opening causing insect paralysis

32
Q

Pyrethroids

A

synthetic derivative

limited human toxicity and no bioaccumulation so more common

33
Q

Pyrethroid types?

A

Type I - simple ester bond, no cyano group
ex: permethrin
Type II - have a cyano group and more toxic

34
Q

pyrethrins and pyrethroids mechanism?

A

prolong activation of voltage gated Na channel
binds to open channel and keeps open
paralyzes insect

35
Q

Clinical effects of pyrethrin and pyrethroids?

A

most are allergic rxns

36
Q

pyrethroid type 1 clinical effects?

A

type 1 - tremors and twitching
human tox rare
selective to insects

37
Q

pyrethroid type 2 clinical effects?

A

more potent/toxic
acute lung injury
CS syndrome= choreoathetosis and salivation
paresthesias, salivation, nausea, vomitng, AMS, seizures

38
Q

pyrethrins and pyrethroids treatment?

A 
supportive care
skin decontamination by washing
AC for ingestion
BZD for seizures
Vitamin E oil for cutaneous paresthesias
39
Q

herbicides?

A

regulates plant growth
mainly weed killer
most widely sold pesticide in world

40
Q

Bipyridyl compounds

paraquat and diquat

A

nonselective contact herbicides
paraquat = most toxic pesticide (100% death for intentional poisoning)
Diquat still fatal but less toxic

41
Q

Paraquat and Diquat mechanism?

A

both highly irritating and corrosive - direct injury
generate Reactive Oxygen Species - damages lipid membranes
Redox Cycling =

42
Q

clinical manifestation of paraquat and diquat?

A 
GI symptoms
nausea and vomiting 
oral and throat pain b/c corrosive
necrosis of mucous membranes
respiratory symptoms mainly w/ paraquat
AKI
MSOF and death
43
Q

paraquat and diquat treatment?

A 
supportive care
resuscitate
giving O2 makes injury worse b/c redox cycling
decontamination
fullers earth or  AC
44
Q

chlorphenoxy herbicides?

A

dioxin
agent orange is nerve agent
carcinogenic
chloracne

45
Q

agent orange

A

chlorphenoxy herbicide defoliant
has dioxin
plant growth hormone analogue
cancer and birth defects

46
Q

what are other herbicides?

A 
glyphosate
anilide derivatives:
propanil, acetochlor
cause methemoglobinemia
treat with methylene blue
47
Q

what is glyphosate?

A

kills weed which compete with crops
used around world b/c no sever effect like paraquat
doesn’t inhibit ACh

48
Q

glyphosate Toxicity?

A 
inhibits 5-e-3-p synthase
interferes with amino acids
human toxicity mech not understood
technically an OP but does not inhibit ACh
surfactant coformulation = more toxic
49
Q

clinical effects of glyphosate?

A

stomach pain, nausea, vomiting, diarrhea
MSOF
treatment: supportive care

50
Q

fumigants

A

nonspecific pesticides so can kill rodents, nematodes, insects, weeds, fungi
most common exposure = inhalation
heavier than air so sinks down does not dissipate

51
Q

list of fumigants?

A

phosphides/phosphine
methyl bromide
sulfuryl fluoride (vikane) - sucks up calcium in body

52
Q

phosphides and phosphine fumigant?

A

metal phosphides
cheap and effective
seed viability unaffected
mixed with grain/food storage
mixed with moisture releases phosphine gas(PH3)
smells like mown hay and no immediate effect

53
Q

epidemiology of phosphides and phosphine?

A

increased incidence of poisoning
high rate of mortality
suicide attempts

54
Q

physical properties of phosphides and phosphine

A

aluminum phosphide: greenish gray tablets, garlic odor
zinc phosphide: dark gray powder, rotten fish odor
gaseous PH3: colorless, decaying fish or garlic odor
heavier than air

55
Q

phosphides and phosphine mechanism of action?

A

non competive inhibition of cytochrome c oxidase (mitochondria electron transport chain)
blocks oxidative phosphorylation

56
Q

phosphide and phosphine clinical effects

A

tachycardia, SOB, tachypnea,

smell of garlic or rotting fish on breath

57
Q

phosphides and phosphine treatment

A 
remove from source
give O2
use PPE
remove clothes
decontaminate with water
AC in 1 hour
supportive care
58
Q

methyl bromide

A 
fumigation poisoning
colorless odorless gas
heavier than air
exposure by inhalation
dermal and oral apsorption
rapid distribution to tissue
59
Q

methyl bromide fumigant mechanism?

A

cytotoxic - directly damages cells and dna
alkylating
inhibits microsomal metabolism and protein synthesis in animal models

60
Q

methy bromide fumigant clinical effects

A

ARDS leads to respiratory failure and death
skin and mucous membrane irritant
CNS effects

61
Q

methyl bromide fumigant treatment

A 
ppe for provider protection
remove from source
remove clothing
decontaminate with water or saline
supportive care
62
Q

fungicides

A

dithiocarbamates
metabolized to carbon disulfide
causes neuropathy
disulfiram like rxns (asian flush from impairment of OH metabolism)

63
Q

molluscicides

A 
kills gastropod pests like snails and slugs
includes: 
carbamates
metal 
metaldehyde
64
Q

Rodenticides

A

BRATS PANIC
anticoagulant rodenticides most common in US
clinical effects: bleeding, bruising
Testing: elevation of coagulation parameters

Implications of human poisoning (10 decks)

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