Exam 12: Environmental Toxicology and Antidotes Flashcards
NOAEL
No Observed Adverse Effect Level: Highest dose that doesn’t produce a statistically significant toxic effect
RfD
Reference Dose: Estimated daily exposure that is assumed to have no adverse health impact on the human population
6 Common causes of anticholinergic toxicity
- Atropine
- Scopolamine
- Antihistamines
- Antiparkinson’s (amantidine)
- Antipsychotics
- Plants (Belladonna)
Treatment for anticholinergic poisoning
Physostigmine
Treatment for seizures caused by too much of a stimulant
Benzos
Treatment for tachycardia caused by too much of a stimulant
Lidocaine
Treatment for ventricular fibrillation caused by too much of a stimulant
Lidocaine
Treatment for opioid toxicity
Naloxone
Treatment for Cholinergic syndromes
Cholinergic antagonist like Atropine
Pralidoxime is only used for Organophosphate poisoning
Mechanism of activated charcoal. Limitation?
Non-specific chelator that limits drug absorption
Doesnt work as well if a drug is rapidly absorbed
Use of Whole-bowel irrigation (actual substance that is used)
Non-absorbable polyethylene glycol
Used after large ingestion of drugs that are poorly absorbed by activated charcoal
Difference between organophosphates and carbamate insecticides
Carbamates are reversible acetylcholinesterase inhibitors (treat with atropine only)
Organophosphates are irreversible (Treat with atropine and pralidoxime)
Chlorinated insecticides mechanism
Inhibit voltage-gated Na+ channels, leading to seizures, tremors, weakness, twitches, etc.
2 Treatments for Chlorinated insecticides (DDT)
- Activated charcoal/gastric lavage
2. Anticonvulsants (slowly infused)
Pyrethrins symptoms and treatments (2)
Bronchospasm, numbness, seizures
- Charcoal/lavage
- Bronchodilators for bronchospasm
Problem with methanol
Metabolized to formaldehyde by alcohol dehydrogenase (blindness, metabolic acidosis)
Methanol treatments (2)
- Treat acidosis with bicarb
2. Fomepizole (Alcohol dehydrogenase inhibitor)
2 consequences of Ethylene glycol ingestion
- Hypocalcemic tetany
2. Oxalicaciduria - crystals
2 treatments for Ethylene glycol poisoning
- Calcium for their hypocalcemia
2. Fomepizole
Result of Diethylene glycol poisoning (treatment)
Anuric renal failure
Supportive/symptomatic care
Sources of lead poisoning
- Food/water
- Dust
- Paint chips
4 effects of lead poisoning
- Microcytic anemia
- Weak wrist and ankle extensors
- Lead encephalopathy
- Colic loss of apatite
First and second line treatments for severe lead poisoning
- Succorer
2. EDTA
Treatment for cerebral edema in lead poisoning
Dexamethasone
Why are children most at risk of lead poisoning?
They absorb up to 40% of that ingested, adults only 10%
2 effects of lead on kids
- Deteriorates their BBB
2. Low IQ, ADHD, behavior problems
Arsenic poisoning source
Rural/municipal water supplies
Arsenic acute intoxication signs/symptoms
Hemorrhagic gastroenteritis
Garlic odor on breath
Arsenic chronic intoxication signs/symptoms
Hyperkeratosis, exfoliative dermatitis
Arsenic poisoning mechanism
Binds to -SH groups on proteins and causes severe oxidative stress
Arsenic toxicity treatment
Dimercaprol
Treatment for inhalation of arsenic gas
This only occurs in miners
Supportive therapy only
Methylmercury sources
Gold mining
Fish
Grain fungicide
Signs and symptoms of mercury poisoning
Ataxia, loss of balance, sensory defects, visual defects, deafness, dysarthria
THESE ARE ALL IRREVERSIBLE
Who should avoid eating predatory fish?
Pregnant women
Canned tuna is probably safe though
Mercury in cavity fillings
They pose little hazard
Dentists ARE NOT supposed to advocate their removal
When is chelation therapy used
Severely elevated metal levels or toxicity
Chelation therapy consideration
Only reduces readily accessible pool of metal. After therapy, blood levels of the metal can rebound
Edentate Calcium Use, Side effects, tocixity
EDTA
- Lead poisoning antidote
- Chills, fever, nausea voliting
- Nephrotoxic at high dose
Penicillamine use
Wilson’s disease
also for lead poisoning
Succimer use, advantage
First orally effective chelator
Works faster than EDTA in lead poisoning
First sign of CO poisoning
Headache
CO poisoning treatment
Hyperbaric O2
Treatment for cyanide toxicity
Hydroocobalamin
Reacts to form vitamin B12
Asbestos antidote
There isn’t one
Dont get exposed
PCBs and Dioxin signs and symptoms
Chloracne, nausea, vomiting, headache
Dioxin treatment
None!!
Bisphenol A (BPA)
Leached from plastic into food and water
Exposure in utero MAY be linked to neural and behavioral defects