DISORDERS IN THE CNS CAUSED BY DRUGS Flashcards
1
Q
The common drug and toxin transformations
involve ___________, which enhance their solubility and elimination
mainly by the kidney
A
hydroxylation, deamination, oxidation, and
dealkylation
2
Q
The process of movement from plasma to brain is by
_______ or by_______
A
diffusion through capillaries
facilitated transport
3
Q
The terms opioid and narcoticanalgesic
designate drugs with actions similar to those of
_______
A
morphine.
4
Q
Opioids activate G-coupled transmembrane
receptors, meaning they influence neuronal activity
through the intermediate of cAMP; the receptor types are
denomina.te as______, _______, ______
A
mu, delta, and kappa
5
Q
Clinical effects of opioids
knowledge that these receptors are concentrated in the
thalamus and dorsal root ganglia (mu receptors,_______),
amygdala (________) and brainstem raphe (_________), and Edinger-Westphal nuclei _______
A
pain
affect
alertness
(pupillary miosis
6
Q
Receptors
in the brainstem, also of the ________type, are involved
in modulating respiratory responses to hypoxia and
hypercarbia (respiratory suppression).
A
mu
7
Q
Pts susceptible to Morphine side effects
A
myxedema,
Addison disease, chronic liver disease, and pneumonia
8
Q
___________, _________, ___________, ________, ___________ are the
we.ll-reognized clinical manifestations of acute opioid
pmsonmg.
A
Unresponsiveness, shallow respirations, slow respiratory rate (e.g., 2 to 8 per min) or periodic breathing, pinpoint pupils, bradycardia, and hypothermia
9
Q
In pts with Opiate toxicity,
The immediate cause of death is usually ________
A
respiratory
depression with consequent asphyxia
10
Q
This consists of the support of ventilation and administration of ______ or the longer-acting
______ both specific antidotes to the opiates and also
to the synthetic analgesics
A
naloxone (Narcan),
nalmefene,
11
Q
The dose of naloxone in adults
is usually ______ and repeated in larger increments (the
second dose is typically 2 mg) every 2 min to a dose of
_______ intravenously.
The
improvements in ____ and _________ and reversal
of miosis are usually dramatic.
A
0.05 mg
15 mg
circulation and respiration
12
Q
Naloxone has less direct effect on _________
however, and the patient may remain drowsy for man;
hours
A
consciousness
13
Q
Although nalmefene has a plasma half-life
of _______ compared to ______for naloxone, it has no
clear advantage in emergency practice
A
11 h,
60 to 90 min
14
Q
an antidote must be used with great caution in an addict
who has taken an overdose of opioid, because in this
circumstance, it may precipitate ______
A
withdrawal phenomena
15
Q
Nausea and severe abdominal pain, presumably because
of _________ are
other troublesome symptoms of opiate use or withdrawal
A
pancreatitis (from spasm of the sphincter of Oddi),
16
Q
The onset of opioid use is usually in adolescence,
with a peak at 17 to 18 years; fully two-thirds of
addicts start using the drugs before the age of_______
A
21
17
Q
Opioid addiction consists of three recognizable phases: 1 2 3
A
(1) intoxication, or “euphoria,”
(2) pharmacogenic dependence or drug-seeking behavior (addiction), and
(3) the propensity to relapse after a period of abstinence
18
Q
the administration of opioids
produces a sense of unusual well-being, a state that has
traditionally been referred to as ________
A
morphine euphoria.
19
Q
The
latter refers to the symptoms and signs that become
manifest when the drug is withdrawn following a period
of continued use
A
physical dependence
20
Q
opioids
activate an opioid antinociceptive system ________, ________, _________ which are opioid receptors and
are located at many different levels of the nervous system
A
(enkephalins,
dynorphins, endorphins),
21
Q
The desensitization of opioid receptors, probably mainly the ________, accounts for tolerance through a mechanism of uncoupling of the receptor from the G-protein complex.
A
mu type
22
Q
With morphine,
the majority of individuals receiving______ daily for
30 days or more will show moderately severe abstinence
symptoms following withdrawal
A
240 mg
23
Q
___________ the equivalent of emotional or
psychologic dependence, refers to the substitution of drugseeking
activities for all other aims and objectives in life.
A
Habituation,
24
Q
Abstinence symptoms from _______
are less intense than those from morphine and do not
become evident until 3 or 4 days after withdrawal; for
these reasons THIS can be used in the treatment
of morphine and heroin dependency
A
methadone
25
_________ addicts are likely to
| have dilated pupils and twitching of muscles
Meperidine
26
In Europe, addicts who could not be detoxified
and kept free of drugs by any other means have been
given ________ the active ingredient in heroin,
diacetylmorphine,
27
A randomized trial conducted by Fudala
and colleagues has demonstrated the superiority over
methadone of a combination of ________ AND _______ combined with brief counseling in keeping opioid addicts in treatment and abstinent of abused drugs
buprenorphine and
| naloxone
28
Neuro cx of Opiate use
________, probably
as a result of the toxic effects of quinine in the heroin
mixtures
Amblyopia
29
Neuro cx of Opiate use
Most instances of this _______ are the result of inhalation of heated heroin vapor in a practice known as "chasing
the dragon.
leukoencephalopathy
30
An acute generalized _____with myoglobinuria
and renal failure has been ascribed to the intravenous
injection of adulterated heroin
myonecrosis
31
_________ and ________ are the sequelae of
venous thrombosis resulting from the administration of
heroin and its adulterants by the intramuscular and
subcutaneous routes.
Brawny edema and fibrosing
| myopathy (Volkmann contracture)
32
for barbiturates
T or F
The higher its lipid solubility, the
greater the drug's central nervous system potency and
the quicker and briefer its action
T
33
The action of barbiturates is to suppress neuronal
transmission, presumably by__________
at pre- and postsynaptic receptor sites, and to ___________
enhancing GABA inhibition
reduce
excitatory postsynaptic potentials
34
T or F
Pentobarbital and secobarbital
produce their effects quickly and recovery is relatively
rapid
T
35
In the case of long-acting barbiturates, such as ____________, the hypnotic-sedative effect lasts 6 h or more after an average oral dose;
with the intermediate-acting drugs such
as ___________, 3 to 6 h;
and with the short-acting drugs,
_________ and______, less than 3 h
phenobarbital and barbital
amobarbital
secobarbital and pentobarbital
36
The potentially fatal dose of phenobarbital is____g.
The lowest plasma concentration
associated with lethal overdosage of phenobarbital
or barbital has been approximately ______ and
that of amobarbital and pentobarbital, 10 mg/mL.
6 to 10
60 mg/mL`
37
flaccid coma with small reactive
pupils, hypothermia, and hypotension.
What type of toxicity
barbiturate
38
Hemodialysis or hemofiltration with charcoal may be
used in comatose patients who have ingested long-acting
barbiturates and these treatments are particularly advisable if _____ or _____has developed
anuria or uremia
39
B a rbitu rate Abst i n e n ce , o r Withd rawa l ,
Sy n d ro me
Immediately following withdrawal, the patient seemingly
improves over a period of ________, as the symptoms
of intoxication diminish
8 to 12 h
40
With
chronic phenobarbital or barbital intoxication, withdrawal
symptoms may not become apparent until ___________h after the final dose
48 to
| 72
41
In Barbiturate withdrawal
there is a greatly heightened
sensitivity to photic stimulation, to which the patient
responds with _________ or a seizure accompanied by
paroxysmal changes in the EEG
myoclonus
42
This is the oldest and one of the safest, most effective, and
most inexpensive of the sedative-hypnotic drugs.
chloral hydrate
43
T or F
Tolerance and addiction to chloral hydrate develops usually
F
_rare
44
The________ have been prescribed frequently
for the treatment of anxiety and insomnia, and they are
especially effective when the anxiety symptoms are
severe.
benzodiazepines
45
____________ is particularly
useful in the treatment of delirious patients who require
parenteral medication.
Diazepam
46
____________has a central place in the treatment o f panic
attacks and other anxiety states, and as an adjunct in
some depressive illnesses
Alprazolam
47
______a specific pharmacologic antagonist
of the CNS effects of benzodiazepines, rapidly but
briefly reverses most of the symptoms and signs of
benzodiazepine overdose
Flumazenil,
48
In chronic benzodiazepine users, the gradual tapering
of dosage over a period of _______minimizes the
withdrawal effects.
1 to 2 weeks
49
MOA of anti-psychotic drugs
blocking the postsynaptic
mesolimbic dopamine receptors of which there
are four subtypes, termed D1 through D4 on neuronal
membranes
50
The _______receptors are located mainly
in the frontal cortex, hippocampus, and limbic cortex,
and the______ receptors are in the striatum
D2
D1
51
The newer "atypical" antipsychotic drugs, exemplified
by________ apparently achieve the same degree of D2
and D3 blockade in the temporal and limbic lobes while
exhibiting substantially less antagonistic activity in the
striatum-accounting also for their lesser parkinsonian
side effects.
clozapine,
52
8 CLASSES OF ANTI-PSYCH
1.
2.
3.
( 4) the rauwolfias alkaloids;
(5) an indole derivative, loxapine, and a unique dihydroindolone, molindone;
(6) a diphenylbutylpiperidine, pimozide;
(7) dibenzodiazepines, typified by ______
(8) a benzisoxazole derivative, _______
1) the phenothiazines;
(2) the thioxanthenes;
(3) the butyrophenones;
clozapine and olanzapine; and
risperidone
53
they are particularly favored in controlling the
| confusion and psychosis of parkinsonian patients
clozapine
54
_____ may be useful in the treatment
of haloperidol-refractory cases of Gilles de la Tourette
syndrome
Pimozide
55
```
This group comprises
chlorpromazine (Thorazine),
promazine (Sparine),
triflupromazine (Vesprin),
prochlorperazine (Compazine),
perphenazine (Trilafon),
fluphenazine (Permitil, Prolixin),
thioridazine (Mellaril),
mesoridazine (Serentil), and
trifluoperazine (Stelazine
```
Phenoth iazines
56
The phenothiazines have had their widest application
in the treatment of the major psychoses, namely
_____ and, to a lesser extent, ________
schizophrenia
bipolar psychosis
57
Side effects of Phenothiazines
cholestatic type of jaundice,
agranulocytosis, seizures, orthostatic
hypotension, skin sensitivity reactions, mental
depression, and, most importantly, immediate or delayed
extrapyramidal motor disorders
58
The ____________ is the most extreme complication of Phenothiazones
neuroleptic
| malignant syndrome
59
5 EPS syndromes associated with Phenothiazines
1. parkinsonian syndrome
2. Acute dyskinetic and dystonic reactions
3. Akathisia
4. Tardive dyskinesias
5. neuroleptic malignant syndrome
60
Suppression of dopamine
in the ____________
is presumably the basis of the parkinsonian signs
striatum (similar to the effect of loss of
| doparninergic nigral cells that project to the striatum)
61
_______which is an inner restlessness reflected
by a persistent shifting of the body and feet and an
inability to sit still, such that the patient paces the
floor or jiggles the legs constantly
Akathisia,
62
Of
all the phenothiazines, ________has a tendency to
cause akathisia. This disorder often responds to oral
propranolol.
molindone
63
It has much the same therapeutic effects as the
phenothiazines in the management of acute psychoses
and shares the same side effects as the phenothiazines,
but exhibits little or no adrenergic blocking action
Butyrophen ones
64
Butyrophenones is also one of the main drugs for the
treatment of _______
______is the only member of this group
Gilles de la Tourette syndrome
Haloperidol (Haldol)
65
acute dystonic spasms usually
respond to cessation of the offending drug and to the
administration of_______
diphenhydramine
66
Administration of antiparkinsonian drugs of the _________________ may hasten
recovery from some of the acute symptoms
```
anticholinergic type (trihexyphenidyl,
procyclidine, and benztropine)
```
67
T or F
Oral, lingual, and laryngeal dyskinesias of the tardive
type are affected relatively little by any antiparkinsonian
drugs.
T
68
_______ in doses of 50 to 100 mg tid has
been useful in a few of the cases of postphenothiazine
dyskinesia
Amantadine
69
For severe and recalcitrant cases, particularly those
involving axial dystonias and similar disabling features,
Fahn recommends administration of the dopaminedepleting drug _____
tetrabenazine (similar but faster in action
| and less toxic than reserpine) .
70
This is the most dreaded complication o f phenothiazine
and haloperidol use; rare instances have been reported
after the institution or the withdrawal of L-dopa and
similar dopaminergic agents, as well as a few instances
reported with the newer antipsychosis drugs
N e u roleptic M a l i g n a nt Synd ro m e
71
NMS syndrome
_______ and other signs of sympathetic overactivity, high serum________ values (up to 60,000 units), and, in some cases, renal failure because of myoglobinuria
hyperthermia, rigidity, stupor, unstable blood pressure, diaphoresis,
creatine kinase (CK)
72
Drug used to control nausea that causes NMS
Promethazine
73
If treatment of the neuroleptic malignant syndrome
is started early, when consciousness is first altered and
the temperature is rising, ___________will terminate the condition in a few hours.
bromocriptine in oral doses of
| 5 mg tid (up to 20 mg tid)
74
In NMS Tx,
If oral medication can no longer be taken
because of the patient's condition, __________ may be lifesaving
dantrolene, 0.25 to
| 3.0 mg intravenously,
75
One pitfall is to m istake neuroleptic malignant syndrome
| for ________
worsening of the psychosis and inadvisably administer
| more antipsychosis medication
76
Four classes of drugs-_______________-are
| particularly useful in the treatment of depressive illnesses.
the MAO inhibitors, the tricyclic
| compounds, the serotonergic drugs, and lithium
77
_________ is located on the outer surface
of the mitochondria in neurons and is used in the
catabolism of catecholamines
Monoamine oxidase
78
In the gut and liver, the isoenzyme __________normally serves to deaminate phenethylamine, tyramine, and tryptamine-all of which are products of protein catabolism
MAO-A
79
Inhibition of
MAO-A allows these dietary amines, which have an
amphetamine-like action, to enter the systemic circulation
in increased quantities, thus r____________
eleasing norepinephrine
| from sympathetic nerve endings
80
Patients taking MAO-A inhibitors must be warned
| against the use of________________ (see later), as well as sympathomimetic amines and hJramine-containing foods.
phenothiazines, CNS stimulants, and
| tricyclic and serotoninergic antidepressants
81
They block the reuptake of amine
neurotransmitters, both norepinephrine and serotonin.
Blocking this amine pump mechanism (called the presynaptic plasma transporter), which ordinarily terminates synaptic transmission, permits the persistence of neurotransmitter substances in the synaptic cleft
TCA
82
They have activity as reuptake
inhibitors of norepinephrine and serotonin
which have a preferential
effect on reuptake of norepinephrine.
tertiary amines
secondary amines
83
Tertiary or secondary?
imipramine, amitriptyline and doxepin, trirnipramine
3
84
desipramine, amoxapine, maprotiline,
| nortriptyline, protriptyline
2
85
T or F
The side
effects of the tricyclic drugs are more frequent and far less
serious than those of the MAO inhibitors.
F
less frequent
86
T or F
The tricyclic drugs should not
be given with an MAO inhibitor; serious reactions have
occurred when small doses of imipramine were given to
patients who had discontinued the MAO in the previous
days or week
T
87
Mortality from TCA overdose is mostly a result of cardiac
rhythm disturbances, particularly _______, and
impaired _________
tachyarrhythmias
conduction (atrioventricular block).
88
What class of drug?
paroxetine (Paxil),
fluoxetine (Prozac), and sertraline (Zoloft)
SSRI
89
_______
has also been used with benefit in a group of autistic
children
Fluoxetine
90
The symptoms o f a_____________ that results
from excessive intake of the above listed drugs or from
the concurrent use of MAO inhibitors include confusion
and restlessness, tremor, tachycardia, hypertension,
clonus and hyperreflexia, shivering, and diaphoresis
"serotonin syndrome"
91
In serotonin syndrome,
The treatment is by discontinuation of the
medication, reduction of temperature and hypertension,
__________ to control agitation, and in severe
cases, the addition of ________, a 5-HT 2A receptor
blocker.
benzodiazepines
cyproheptadine
92
Lithium:
Its value is much more certain in treatment of the _________ of bipolar disorder and prevention of recurrences of ________ than it is in treatment of anxiety and depression
manic phase
cyclic mood shifts
93
```
With blood levels of lithium in the upper therapeutic
range (therapeutic 0.6 to 1 .2 mEq/L), it is not uncommon
to observe a :
1.
2.
3.
4.
5.
```
fast-frequency action tremor or asterixis,
together with nausea, loose stools, fatigue, polydipsia,
and polyuria
94
T or F
Discontinuing lithium in the intoxicated patient,
which is the initial step in therapy, results in
immediate disappearance of toxic symptoms
F
does not result in immediate
95
___________analeptics
(CNS stimulants) and in addition have significant hypertensive,
respiratory-stimulant, and appetite-depressant
effects.
```
The amphetamines (d-amphetamine, d-l-amphetamine, pemoline,
methamphetamine, methylphenidate)
```
96
Other indications of amphethamines
They are effective in the management of narcolepsy, for the control of obesity, the abolition
of fatigue, and the treatment of hyperactivity in children
97
Pathophysio of ICH and SAH in Amphetamine use
vasospasm and arteritis
98
A sense of well-being, euphoria, loquacity, and
| restlessness are the familiar effects of what drug
Cocaine
99
MOA of cocaine
it blocks the presynaptic reuptake of biogenic amines,
| thus producing
100
withdrawal syndrome FROM cocaine
insomnia,
restlessness, anorexia, depression, hyperprolactinemia,
and signs of dopaminergic hypersensitivity
101
Cocaine and amphetamines also, on occasion, produce
a state of generalized__________ leading to multiple
cortical infarctions and posterior white matter changes
that are evident on imaging studies, essentially a form of
_______
vasospasm
hypertensive encephalopathy
102
______, ________and other manifestations
of ________ may develop within several hours of
cocaine use.
Anxiety, paranoia, psychosis
103
Examples of psychoactive or
| psychotomimetic drugs or as hallucinogens and psychedelics.
lysergic acid diethylamide (LSD), phenylethylamine derivatives (mescaline or peyote), psiloct;bin, certain indolic derivatives, can nabis (marijuana),
phencyclidine (PCP),
104
this agent the CB1 receptor, mainly on gabanergic neurons in the hippocampus, amygdala, and cortex.
Activation of the receptor inhibits the release of oligopeptide neurotransmitters and monoamines
Marijuana
105
These agents bind even more
avidly to cannabinoid receptors than does the original
drug and produce a heightened stimulant effect
S y n t h et i c C a n n a b i n o i d s
106
In Tetanus,
a single dose of ________ should be given along with a 10-day course of
1.
2.
3.
antitoxin (3,000 to 6,000 U of tetanus immune
human globulin)
penicillin ( 1 .2 million U of procaine penicillin daily), metronidazole (500 mg q6h intravenously or 400 mg rectally), or tetracycline (2 g daily) .
107
In Tetanus,
The _______
are the most useful drugs for both sedation and muscle
relaxation;
benzodiazepines
108
In Tetanus,
_________or more can be given
in frequent divided doses if ventilatory support is
available; alternatively _______ can be
used in a continuous intravenous infusion
diazepam 120 mg / d
midazolam or propofol
109
Failure of these measures to control the tetanic
paroxysms requires that intravenous administration of
neuromuscular blocking agents such as _______ or _______ be used to abolish all muscle activity;
pancuronium
| or vecuronium
110
All persons should be immunized against tetanus
and receive a booster dose of toxoid every _________-a
practice that is frequently neglected in the elderly
10 years
111
Injuries
that carry a threat of tetanus should receive toxoid if
the patient has not received a booster injection in the
preceding year, and a second dose of toxoid is needed
_________ later.
6 weeks
112
T or F
An attack of tetanus does not
confer permanent immunity and persons who recover
should be actively immunized.
T
113
The faucial-pharyngeal
form of the disease, which is the most common clinical
type, is characterized by the formation of an inflammatory
exudate of the throat and trachea
D i p htheria
114
In Diphtheria,
It begins locally, with _______ between the fifth and
twelfth days of illness
```
palatal paralysis (nasal voice,
regurgitation, and dysphagia)
```
115
In Diphtheria,
Ciliary body paralysis with loss of accommodation and blurring of vision but with preserved light reaction usually appears in the ________ (the opposite of the Argyll Robertson reaction)
second or third week
116
What distinguished Diphtheria from other forms of polyneuropathy?
The early oropharyngeal symptoms, the ciliary
paralysis with relatively retained pupillary response to
light, and subacute evolution of a delayed symmetrical
sensorimotor peripheral neuropathy distinguish
diphtheria from other forms of polyneuropathy
117
Diphtheria the toxin reaches the Schwann cells in
the most vascular parts of the peripheral nervous system
within _________h of infection but its metabolic effect on
cell membranes extends over a period of weeks.
24 to 48
118
Tx of Diphtheria
There is no specific treatment for the neurologic
complications of diphtheria. It is generally agreed
that the administration of antitoxin within ________ of the
earliest symptoms of the primary diphtheritic infection
lessens the incidence and severity of the peripheral
nerve complications
48 h
119
Site of infection of botulism
presynaptic membrane
120
MOA of botulism
The toxin interferes with the release of acetylcholine from peripheral motor nerves at the neuromuscular synapse.
121
Sx of botulism
Symptoms usually appear within _____ of
ingestion of the tainted food. Anorexia, nausea, and
vomiting occur in most patients
12 to 36 h
122
In Botulism,
EMG findings:
here is reduced amplitude of evoked muscle potentials and an increase in amplitude with rapid repetitive nerve stimulation (the opposite of what is found in myasthenia gravis)
123
Initial Tx for Botulism
An initial dose of ________is given intravenously after intradermal testing for sensitivity to horse serum, followed by daily doses of______ intramuscularly until improvement begins.
10,000 U
50,000 U
124
Initial Tx for Botulism
_____ or ________are given to eradicate the
organism in a wound (but are not as useful if the
exogenous preformed toxin has been ingested).
Penicillin or metronidazole
125
_____________ has been
somewhat useful in reversing the weakness of limb and
extraocular muscles
Guanidine hydrochloride (50 mg/kg)
126
the _________ envenomation,
are neurotoxic, producing pupillary dilatation,
ptosis, ocular palsies, ataxia, and respiratory paralysis
coral snake
127
These develop over a
period of 3 to 6 weeks. The child becomes anorectic,
less playful and less alert, and more irritable. These
symptoms may be misinterpreted as a behavior disorder
or a manifestation of mental retardation. Intermittent
vomiting, vague abdominal pain, clumsiness, and ataxia
may be added.
What metal poisoning?
Lead
128
CSF picture of lead poisioning
the CSF is under increased pressure
with manifest papilledema, and there may be a slight
lymphocytic pleocytosis and elevated protein but normal
glucose values.
129
In Lead poisoning:
Lead lines at the _________and ______ of red cells are seen but are too inconstant to be relied on, but basophilic stippling of bone marrow erythroblasts is uniformly
increased.
metaphyses of long bones
basophilic stippling
130
Impairment of heme synthesis, which is
exquisitely sensitive to the toxic effects of lead, results
in the increased excretion of _____ and _______
```
urinary coproporphyrin
(UCP) and of delta-aminolevulinic acid (ALA).
```
131
In the dx of Plumbism
The diagnosis can be confirmed by promoting lead
excretion with _____________. Excretion of over 500
mg in 24 h is indicative of plumbism
calcium disodium edetate (CaNa 2
ethylenediarninetetraacetic acid [EDTA]), given in three
doses (25 mg/kg) at 8-h intervals
132
The measurement of
_______ in the blood is another reliable
means of determining the presence and degree of lead
exposure
zinc protoporphyrin (ZPP)
133
The seriousness of lead
encephalopathy is indicated by the fact that most of the
children who become stuporous or comatose remain
_______despite treatment.
mentally retarded
134
PATHOLOGY of Plumbism
There are also _____ changes in arteries and arterioles and in some places, perivascular infiltrates of lymphocytes and mononuclear cells.
Hyperplastic
135
In the Tx of Plumbism
In cases of acute encephalopathy, combined chelation therapy with ________ and _________
This is followed by a course of________ (40 mg/kg, not exceeding 1 g/ d
2,3-dimercaptopropanol (British anti-Lewisite [BAL]; 12 to 24 mg/kg) and CaNa2
EDTA (0.5 to 1 .5 g/m 2 body surface area) for 5 to 7 days
oral penicillamine
136
_______, frequently precipitated by an intercurrent
infection or by alcohol intoxication, is characterized by
severe, poorly localized abdominal pain, often with
rigidity of abdominal muscles but without fever or
leukocytosis.
Lead colic
137
The diagnostic tests for plumbism in children are
generally applicable to adults, with the exception of
__________ which are of no value in the latter.
bone films,
138
What type of poisoning?
Insomnia, irritability,
delusions, and hallucinations are the usual clinical
manifestations, and a maniacal state may develop. The
hematologic abnormalities of inorganic lead poisoning
are not found, and chelating agents are of no value in
treatment
Organic lead poisoning
139
______ exerts its toxic effects by reacting with the
sulfhydryl radicals of certain enzymes necessary for
cellular metabolism. The effects on the nervous system
are those of an encephalopathy or peripheral neuropathy.
Arsenic
140
Polyneuropathy in Arsenic poisoning, temporal pattern?
distal sensorimotor areflexic syndrome developed subacutely
141
Pathology of Arsenic poisoning:
dying back pattern of myelin and
axons with macrophage and Schwann cell reactions and
chromatolysis of motor neurons and sensory ganglion
cells.
142
transverse white
lines, 1 to 2 mm in width, above the lunula of each
fingernail in Arsenic poisoning
Mee's lines
143
PAthology of ARsenic poisoning
capillary
necrosis and of pericapillary zones of degeneration,
which, in turn, are ringed by red cells (brain purpura)
144
The diagnosis of arsenical poisoning depends on the
| demonstration of increased levels of arsenic in the ______ and _____
hair
| and urine
145
Tx for Mn toxicity
The neurologic abnormalities have not responded to
| treatment with chelating agents
146
In the chronic dystonic
form of manganese intoxication, dramatic and sustained
improvement has been reported with _________
L Dopa
147
Sx of tremor of the extremities, tongue, and lips; mental confusion; and a progressive cerebellar syndrome, with
ataxia of gait and arms, intention tremor, and dysarthria
Mercury poisoning
148
Mercury poisoning
The pathologic changes are characterized by a striking
degeneration of the _______ of the cerebellar
cortex, with relative sparing of the ________ and
neuronal loss and gliosis of the calcarine cortex and to a
lesser extent of other parts of the cerebral cortex
granular layer
Purkinje cells
149
The term__________
was coined to describe the timidity, memory loss, and
insomnia that were said to be characteristic of chronic
intoxication with Mercury
erethism
150
Acute exposure to inorganic mercury in larger
amounts is even more corrosive to the gastrointestinal
system and produces _______
nausea, vomiting, hematemesis,
abdominal pain, and bloody diarrhea, as well as renal
tubular necrosis.
151
```
A painful neuropathy of children ________ has
been traced to mercury exposure from interior latex paint,
to calomel (mercurous chloride),
```
(acrodynia)
152
In the treatment of chronic mercury
poisoning, __________has been the drug of choice,
because it can be administered orally and appears to
chelate mercury selectively, with less effect on copper,
which is an essential element in many metabolic processes.
penicillamine
