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Clinical Toxicology > EXAM ONE > Flashcards

EXAM ONE Flashcards

1
Q

What is the Phone Number to the Poison Center?

A

(800) 222-1222

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2
Q

Skin Decontamination

A
  1. Contaminated skin should be washed thoroughly with SOAP and WATER
  2. Shower to wash body
  3. Clothing should be removed while bathing the skin with a stream of water
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3
Q

Some skin poisonings such as ____ require decontamination.

A

Hydrofluoric Acid

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4
Q

Ocular Irrigation

A
  1. Irrigate eyes for 15 minutes
  2. Dispose contacts
  3. Ophthalmic topical anesthetics can be used
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5
Q

When irrigating the eyes for 15 minutes, what type of liquids can be used?

A
  1. Plain water
  2. Sterile water
  3. Normal saline
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6
Q

What are the 2 techniques used to prevent GI absorption [GI Decontamination]?

A
  1. Gastric Emptying
  2. Prevention of Xenobiotic Absorption
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7
Q

What can be used for gastric emptying?

A
  1. Orogastric Lavage
  2. Syrup of Ipecac
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8
Q

What can be used for prevention of xenobiotic absorption (more common)?

A
  1. Activated Charcoal
  2. Hemodialysis
  3. Urinary Alkalinization
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9
Q

What are the 3 techniques used to Enhance Elimination [GI Decontamination]?

A
  1. Multiple Dose Activated Charcoal MDAC
  2. Hemodialysis
  3. Urinary Alkalinization
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10
Q

Define Gastric Decontamination

A

Techniques utilized to decrease xenobiotic absorption from the GI tract

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11
Q

In terms of GI decontamination, as time passes from the time of exposure the ___ of decontamination ____.

A

Effectiveness, DECREASES

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12
Q

Any potential benefit from GI decontamination is UNLIKELY after how many hours from the ingestion has elapsed?

A

2 HOURS

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13
Q

The risk of the produce increases in GI contamination as the patient’s level of ____ DECREASES.

A

Consciousness

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14
Q

Syrup of Ipecac MOA

A
  1. INDUCE EMESIS
  2. Direct effect on STOMACH and CNS
  3. Stimulates CHEMOTACTIC trigger zone
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15
Q

Syrup of Ipecac Toxicity

A

Myocardial Toxicity

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16
Q

Syrup of Ipecac should not be used in patients who are expected to rapidly deteriorate before emesis can occur, what types of poisonings would cause that?

A
  1. TCAs
  2. Beta Blockers
  3. Camphor
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17
Q

Complications of Emesis

A
  1. Aspiration
  2. Sharp Objects Ingested
  3. Dehydration/Electrolyte Imbalance
  4. Need for rapid admin of antidotes
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18
Q

Aspiration Risk with Emesis occurs when?

A

Ingestion of POORLY absorbed Hydrocarbons

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19
Q

Define Gastric Lavage

A

Pumping the Stomach

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20
Q

When is Gastric Lavage considered (rarely used)?

A
  1. Potentially life-threatening poisoning and presentation within 1 hour
  2. Potentially life-threatening poisoning with drug with anticholinergic effects and presentation with 4 hours
  3. Ingestion of sustained release preparation of significantly toxic drug
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21
Q

When is Gastric Lavage Contraindicated?

A

Corrosive ingestions or esophageal disease

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22
Q

What are the complications of Gastric Lavage?

A
  1. Increased absorption of small tablets
  2. Aspiration
  3. Esophageal Rupture
  4. Bradycardia, cardiac arrest, asystole
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23
Q

Cardiac Arrest/Bradycardia is a complication of gastric lavage with what type of drug poisonings?

A
  1. Propranolol
  2. CCBs
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24
Q

Do we recommend gastric lavage anymore, yes or no?

A

NO

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25
Q

When would you consider Activated Charcoal?

A
  1. Toxin in the Stomach
  2. Benefit outweighs Risk
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26
Q

What is the dosing of Activated Charcoal?

A

1 gram/kg
MAX: 100 grams

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27
Q

What are the indications for Activated Charcoal?

A

Drug ingested is adsorbed by charcoal and has significant potential for toxicity AND ___
1. Time since ingestion <1-2 hrs OR
2. Drug has significant enterohepatic recirculation OR
3. Drug delays gastric emptying and time since ingestion is <4 hrs OR
4. Drug is in a controlled release form and time since ingestion is <12-18 hrs

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28
Q

Define Whole Bowel Irrigation WBI

A

A technique that uses large volumes of iso-osmolar solution that is not absorbed

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29
Q

What is an iso-osmolar solution?

A

PEG

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30
Q

What are the 4 indications of Whole Bowel Irrigation?

A
  1. Massive ingestion of sustained release product
  2. Body packers/stuffers
  3. Substance not readily absorbed by activated charcoal
  4. Pharmacobezors
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31
Q

What is an example of sustained release product that when consumed in massive amounts can cause poisoning?

A

Bupropion

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32
Q

When is Whole Bowel Irrigation Contraindicated?

A
  1. Signs of drug absorption in a body pack/stuffer
  2. GI tract not intact
  3. Unstable airway
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33
Q

What are the Contraindications to Activated Charcoal? PHAILS

A

P: pesticides
H: hydrocarbons
A: alcohol, acid/alkali, aspiration
I: iron
L: lithium/liquids
S: solvents

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34
Q

Enhanced Elimination is used when?

A

Enhancing the elimination of a XENOBIOTIC from a poisoned patient

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35
Q

Enhanced Elimination is most commonly used in WEAK ACID drugs, why?

A

Weak acids are absorbed in the stomach, and be unionized in a pH of 1-2. When the drug passes the kidney if the pH of urine is ABOVE 7, the drug will be trapped and eliminated.

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36
Q

What type of toxicities is Enhanced Elimination induced for?

A
  1. Salicylate
  2. Barbiturate
  3. Methotrexate
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37
Q

What are the methods of Enhanced Elimination?

A
  1. Multidose Activated Charcoal
  2. Urinary Alkalinization with Sodium Bicarb
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38
Q

If performing Urinary Alkalinization for Enhanced Elimination, what should be added to the therapy regimen?

A

POTASSIUM

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39
Q

What is the MOA of Multi-Dose Activated Charcoal?

A
  1. Interrupt enterohepatic and enters-enteric recirculation
  2. AKA GUT dialysis
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40
Q

Multi-Dose Activated Charcoal MDAC is indicated for toxicity from drugs known to adsorb to AC with high enterohepatic or entero-enteric recirculation, list those drugs.

A
  1. Theophylline
  2. Phenobarbital
  3. Dapsone
  4. Carbamazepine
  5. Quinine
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41
Q

List the Toxin characteristics that allow for a xenobiotic to be cleared via Hemodialysis.

A
  1. Small volume of distribution
  2. Highly water soluble
  3. Low protein binding
  4. Low molecular weight
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42
Q

What are examples of Xenobiotics that could be cleared via Hemodialysis?

A
  1. Alcohols
  2. Lithium
  3. Salicylates
  4. Valproic Acid
  5. Theophylline
  6. Sotalol
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43
Q

What is the most frequent Adverse Effect of Hemodialysis?

A

Hypertension

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44
Q

Define Toxidrome

A

Clinical constellation of s/s that is very suggestive of a particular poisoning or category of intoxication

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45
Q

What are the 5 factors in Recognition of Toxidromes?

A
  1. Anticholinergic
  2. Cholinergic
  3. Opioid
  4. Seizure Toxidrome
  5. High Anion Gap Metabolic Acidosis Toxidrome
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46
Q

What Vital Signs are common for Anticholinergic Toxidrome?

A

Hypertension and Tachycardia

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47
Q

What CNS Symptoms are common for Anticholinergic Toxidrome?

A

Hallucinations and Agitation

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48
Q

What Metabolic Symptoms are common for Anticholinergic Toxidrome?

A

Fever, Flushing, Dry

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49
Q

What Ocular Symptoms are common for Anticholinergic Toxidrome?

A

Mydriasis, Non-Reactive Pupil

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50
Q

List Symptoms associated with Anticholinergic Toxidrome

A
  1. Dry
  2. Decreased Bowel Sounds
  3. Non-Reactive Pupils
  4. Slightly Hyperthermic
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51
Q

List Symptoms associated with Sympathomimetic Toxidrome

A
  1. Diaphoretic
  2. Normal Bowel Sounds
  3. Reactive Pupils
  4. Very Hyperthermic
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52
Q

Anticholinergic Toxidrome Mnemonic

A

Dry as a Bone
Red as a Beet
Blind as a Bat
Mad as a Hater
Hot as Hades

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53
Q

List the Agents that are known to cause Anticholinergic Toxidrome

A
  1. Atropine
  2. Antihistamines
  3. Antipyschotics
  4. Antiepileptics (carbamazepine)
  5. Benztropine (cogentin)
  6. Antispasmodics (dicyclomine)
  7. Muscle Relaxants (cyclobenzaprine)
  8. Tricyclic Antidepressants (amitriptyline)
  9. Plants (belladonna alkaloids)
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54
Q

What is the treatment for Anticholinergic Toxidrome Symptoms: Agitation, Tachycardia, and Seizures?

A

Benzodiazepines

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55
Q

What is the treatment for Anticholinergic Toxidrome that UNSTABLE agitated delirium, severe tachycardia, or hyperthermia even with benzos given?

A

Physostigmine

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56
Q

Physostigmine must be given in the ICU, but when is it’s use contraindicated?

A

For TCA Overdose

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57
Q

What are the Nicotinic Symptoms for Cholinergic Toxidrome?

A

M: mydriasis
T: tachycardia
W: weakness
H: hypertension
H: hyperglycemia
F: fasciculations

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58
Q

What are the Muscarinic Symptoms for Cholinergic Toxidrome?

A

D: diarrhea
U: urination
M: miosis
B: bradycardia
B: bronchorrhea
B: bronchospasm
E: emesis
L: lacrimation
S: swelling

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59
Q

List the Agents that are known to cause Cholinergic Toxidrome

A
  1. Organophosphate Insecticides
  2. Nerve Gas Agents
  3. Carbamate Insecticides
  4. Clitocybe and Inocybe Mushrooms
  5. Medical ACh Inhibitors (donepezil)
  6. Muscarinic Agonists (pilocarpine)
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60
Q

What is used for Cholinergic Toxidrome Treatment of Bradycardia, Bronchorrhea, and Broncospasm?

A

Atropine

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61
Q

What is used for Cholinergic Toxidrome Treatment of Seizures?

A

Benzodiazepines

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62
Q

What is used as a Reversal Agent for Cholinergic Toxidrome?

A

Pralidoxime 2-PAM

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63
Q

What are the symptoms of Opioid Toxidrome?

A
  1. CNS Depression
  2. Respiratory Depression
  3. Bradycardia
  4. Hypotension
  5. Miosis
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64
Q

What is the antidote for Opioid Toxidrome?

A

Naloxone

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65
Q

What are the Vital Signs seen in Sympathomimetic Toxidrome?

A

Hypertension, Tachycardia

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66
Q

What are the CNS Symptoms seen in Sympathomimetic Toxidrome?

A

Excitation, Agitation, Seizures, Restless, Tremor

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67
Q

What are the Metabolic Symptoms seen in Sympathomimetic Toxidrome?

A

Hyperthermia

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68
Q

What are the Illicit Drugs that can cause Sympathomimetic Toxidrome?

A
  1. Amphetamines
  2. Cocaine
  3. MDMA
  4. Cathinone
  5. Cannabinoids
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69
Q

What are the Decongestant Drugs that can cause Sympathomimetic Toxidrome?

A
  1. Pseudoephedrine
  2. Phenylephrine
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70
Q

What are the Stimulant Drugs that can cause Sympathomimetic Toxidrome?

A
  1. Adderall
  2. Concerta
  3. Phenylephrine
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71
Q

What are the Thyroid Hormones that can cause Sympathomimetic Toxidrome?

A
  1. Liothyronine T3
  2. Levothyroxine T4
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72
Q

What are the Dieting Agents that can cause Sympathomimetic Toxidrome?

A
  1. Ephedrine
  2. Caffeine
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73
Q

Define Body Packer

A

Professional carries of well packed illicit drugs

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74
Q

Define Body Stuffer

A

Swallowing or Inserting relatively small amounts of loosely wrapped drug because of fear of arrest

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75
Q

What are the Supportive Treatment Measures in Sympathomimetic Toxidrome?

A
  1. Cooling
  2. IV Fluids
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76
Q

What are the Supportive Treatment Measures in Sympathomimetic Toxidrome?

A
  1. Cooling
  2. IV Fluids
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77
Q

What is given for agitation, restlessness, tachycardia, palpitations, hypertension in Sympathomimetic Toxidrome?

A

Benzodiazepines

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78
Q

If there is no response to Benzodiazepines for Dysrhythmia in Sympathomimetic Toxidrome, what protocol must be used?

A

ACLS

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79
Q

If there is no response to Benzodiazepines for HTN in Sympathomimetic Toxidrome, what must be avoided?

A
  1. AVOID Vasodilator Nitroprusside
  2. AVOID Beta Blockers ALONE
  3. AVOID Monotherapy Alpha Stimulation
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80
Q

Seizure Differential OTIS

A

O: organophosphates
T: tricyclic antidepressantts
I: insulin, isoniazid
S: sulfonylureas, salicylates, sympathomimetics

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81
Q

Seizure Differential CAMPBEL

A

C: camphor, CO, cyanide
A: anticholinergics
M: methanol, methylxanthines , mushrooms
P: PCP, propranolol, plants
B: bupropion, benzodiazepine withdrawal
E: ethanol withdrawal, ethylene glycol
L: lead, lindane, lithium, lidogaine

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82
Q

High Anion Gap Differential CAT

A

C: cyanide, CO
A: aspirin, alcoholic ketoacidosis
T: theophylline, toluene

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83
Q

High Anion Gap Differential MUDPILES

A

M: methanol, metformin
U: uremia
D: diabetic ketoacidosis
P: paracetamol, phenformin
I: iron, isoniazid, ibuprofen
L: lactic acidosis
E: ethanol
S: starvation

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84
Q

What is ABCTR and it’s role in approaching an unknown overdose?

A

A: Airway
B: Breathing
C: Circulation
T: Temperature
R: Rhythm

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85
Q

What is the concern with Airway?

A

If the patient is vomiting, roll them of their side to not block the airway

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86
Q

What is the concern with Breathing?

A
  1. Respiratory Failure
  2. Ventilatory
  3. Hypoxia
  4. Cellular Inhibitors
  5. Hypercarbia
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87
Q

Define Ventilatory

A

No air moving

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88
Q

Define Hypoxia

A

No gas crossing to the blood

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89
Q

Define Cellular Inhibitors

A

no oxygen being used

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90
Q

What is the concern with Circulation?

A
  1. BP, HR, Rhythm
  2. Hypotension
  3. Perfusion
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91
Q

Define Preload Hypotension

A

Volume Loss and Venodilation

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92
Q

Define Afterload Hypotension

A

Loss of Sympathetic Tone

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93
Q

When Diagnosing a Poisoning, what 4 things must be considered?

A
  1. History
  2. Clinical Lab Toxicology
  3. Labs
  4. Recognition of Toxidrome
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94
Q

What happens to the QRS in a TCA Overdose?

A

It becomes WIDER, aka takes longer to get conduction through the ventricles

95
Q

What is the formula for Anion Gap?

A

(Na+) - [(Cl-) + (HCO3)] = Anion Gap

96
Q

What is a normal Anion Gap range?

A

8-12 mEq/L

97
Q

What is the formula for Osmolality?

A

2(Na+) + glucose/18 + BUN/2.8

98
Q

What is the normal range for Osmolality?

A

290 mOsm/L or less

99
Q

What is Osmolar Gap?

A

Different between calculated and observed

100
Q

What is the normal range for Osmolar Gap?

A

<10 mOsm/L

101
Q

What are the causes of Osmolar Gap?

A
  1. Ethanol
  2. Methanol
  3. Isopropanol
  4. Ethylene Glycol
102
Q

What is the difference between pCO2 and HCO3?

A

pCO2 = partial pressure of carbon dioxide
HCO3 = plasma bicarb concentration

103
Q

Define Acid Base Balance

A

Defines the interaction between the metabolic and respiratory systems of the body

104
Q

What is the Henderson/Hasselbach Equation?

A

pH = 6.1 + log [(HCO3)/(pCO2 x 0.03)]

105
Q

What are the units of pCO2?

A

mmHg

106
Q

What are the units HCO3?

A

mEq/L

107
Q

What are the units CO2?

A

mEq/L

108
Q

What is the normal pH of Blood Gas?

A

7.35-7.45

109
Q

What is the normal range of pCO2 in Blood Gas?

A

35-45 mmHg

110
Q

What is the normal range of HCO3 in Blood Gas?

A

20-26 mEq/L

111
Q

What is Base Excess BE?

A

A convention to tell how abnormal the HCO3 is

112
Q

A low pCO2 hyperventilating suggests what?

A

Respiratory Alkalosis

113
Q

How to calculate BE?

A

Subtract calculated HCO3 from theoretical normal

114
Q

What do BE values mean?

A

Neg Number = below normal
Pos Number = above normal

115
Q

What are the steps in recognizing the types of respiratory depression?

A
  1. Assess the Metabolic
  2. Assess the Respiratory
  3. Is there Compensation
116
Q

Below BE = what?

A

Metabolic Acidosis

117
Q

Above BE = what?

A

Metabolic Alkalosis

118
Q

Below Normal pCO2 = what?

A

Respiratory Alkalosis

119
Q

Above Normal pCO2 = what?

A

Respiratory Acidosis

120
Q

What is a toxin that can cause metabolic acidosis and quick breathing?

A

Salicylate Toxicity

121
Q

What are the qualities of Normal Saline?

A

154 mEq/L sodium and chloride
pH 5.5

122
Q

What liquids are used for resuscitative fluids?

A
  1. Normal Saline
  2. 5% Phasmanate
  3. 25% Albumin
  4. Lactated Ringer
123
Q

What are the qualities of 5% Plasmanate?

A

5% plasma proteins/88% albumin
145 mEq/L sodium
0.25 mEq/L potassium
100 mEq/L chloride

124
Q

What are the qualities of 25% Albumin?

A

130-160 mEq/L sodium

125
Q

What are the qualities of Lactated Ringer?

A

130 mmol/L sodium
109 mmol/L chloride
28 mmol/L lactate
4 mmol/L potassium
1.5 mmol/L calcium

126
Q

What are the 4 Categories of Chemical Weapons?

A
  1. Blister Agent
  2. Choking Agent
  3. Blood Agent
  4. Nerve Agent
127
Q

Blister agents are Vesicants, name 2 known examples

A
  1. Mustard Gas H
  2. Lewisite
128
Q

Name 3 known Choking Agents

A
  1. Phosgene CG DP- industrial chemical
  2. Methyl Isocanate
  3. Anhydrous Ammonia - most available, its a fertilizer
129
Q

Name 2 known Blood Agents

A
  1. Hydrogen Cyanide AC
  2. Cyanogen Chloride
130
Q

Name 3 known Nerve Agents

A
  1. Tabun GA
  2. Sarin GB
  3. Soman GD
131
Q

What is the MOA of Nerve Agents?

A

Inhibit AChE just like organophosphates

132
Q

High Solubility Irritant Gases, name 2 agents and where it affects the body

A
  1. Isocyanate
  2. Anhydrous Ammonia: common fertilizer
    AIRWAYS
133
Q

Medium Solubility Irritant Gases, name the agent and where it affects the body

A
  1. Chlorine
    AIRWAYS, BRONCHI, ALVEOLAR
134
Q

Low Solubility Irritant Gases, name the agent and where it affects the body

A
  1. Phosgene
    ALVEOLAR, BRONCHI
135
Q

What is used in Cyanide Treatment?

A

Hydrocoalblamin
–> + cyanide = cyanocobalamin aka Vitamin B12

136
Q

If you give Atropine for Mascarininc s/s from Nerve Agents, what must be given with it?

A

2-PAM

137
Q

If you give 2-PAM for nicotinic/muscarinic s/s from Nerve Agents, what can it do?

A

Reverse neuromuscular blockage

138
Q

What are the historical sources of lead in U.S. history?

A
  1. Mining
  2. Lead Paint
  3. Gasoline (EPA mandates removal now)
139
Q

What are the contemporary sources of lead in the U.S.?

A
  1. Herbal Remedies
  2. Cheap Jewelry
  3. Retained Bullets
  4. Stained Glass
  5. Clay Pots
  6. Indoor Firing Ranges
140
Q

What are 2 considerations in the relationship of health?

A
  1. Medical Diagnosis
  2. Statistical or Epidemiologic Diagnosis
141
Q

What are individual symptoms of lead poisoning compared to a epidemiological risk?

A
  1. Anemia >40
  2. Colic >50
  3. Lead Lines
  4. Peripheral Neuropathies
  5. Encephalopathy >70
142
Q

What is the nemesis of Lead?

A

Hemoglobin

143
Q

Lead Encephalopathy MOA

A
  1. Cells unable to maintain homeostasis
  2. Apoptosis
  3. Edema
  4. Blood Flow decreases
144
Q

What population studies are used to understand the clinical impact of Lead?

A
  1. Multiple Regression
  2. Multiple Comparisons
  3. Variables not Independent
145
Q

What is the main treatment MOA for Lead Poisoning?

A

Chelation

146
Q

What levels of Lead Poisoning would you consider therapy?

A

> 70 mcg/dL = medical emergency
45-70 mcg/dL = oral chelation
<45 mcg/dL = no benefit chelator

147
Q

List the 4 Chelator Agents

A
  1. Calcium Disodium EDTA = IV serious cases
  2. BAL British AntiLewisite = IM
  3. d-Penicillamine
  4. Succimer/Dimercaptosuccinic Acid
148
Q

Define Acrodynia

A

Mercury Poisoning

149
Q

What are the S/S of Acrodynia?

A
  1. Sweating
  2. Swollen Red feet/hands
  3. Painful to Touch
  4. Desquamating
150
Q

How to define Acrodynia?

A

Urine - Random Heavy Metal Screen

151
Q

List 2 forms of Mercury Hg

A
  1. Mercuric Nitrate - convert hide into felt
  2. Calomel/Mercurous CI - medical creams
152
Q

Mercury Poisoning binds to SH groups in proteins, where does acute and chronic poisoning take place in the body?

A

Acute = Renal and GI
Chronic = Neurological

153
Q

We all ingest Arsenic mostly in water, but is arsenic toxic?

A

NO, but Arsenic TRIOXIDE IS TOXIC

154
Q

What are the symptoms of Iron Poisoning?

A
  1. Shock
  2. Acidosis
155
Q

When should you treat iron poisoning?

A

Iron >500 mcg/dL and merits CHELATION

156
Q

What is the 5th leading cause of death almost those >65 years?

A

Drug Related Problem

157
Q

Over ___% of prescription medications are taken by the elderly >65 years.

A

30%

158
Q

___% of OTC medications are consumed by older people.

A

40-50%

159
Q

Increased likelihood of significant ___ ___ interactions with increased number of medications

A

drug-drug

160
Q

Define AGS Beers Criteria

A

List of approximately >130 medications and doses considered to be potentially inappropriate for the elderly

161
Q

Use of Medications from the Beers Criteria are associated with what?

A
  1. Decreased quality of life
  2. Increased risk of hospitalizations
  3. Prolongation of hospitalizations
162
Q

What 3 Drug Classes are known to cause adverse drug events in elder >65 yrs?

A
  1. Anticoagulants
  2. Diabetes Agents
  3. Opioid Analgesics
163
Q

What are the PK Absorption changes in Aging?

A
  1. Decreased first pass effect with oral admin
  2. HF impacts absorption
  3. Percutaneous, subcutaneous, and IM absorption unknown, expected delayed
164
Q

What are the PK Distribution changes in Aging?

A
  1. Body Composition Changes
165
Q

What are the PK Metabolism changes in Aging?

A
  1. Liver Size, Blood Flow DECLINE with age
  2. Phase 1 Metabolic Pathways diminish
166
Q

What are the Phase 1 Metabolic Pathways that diminish?

A
  1. Oxidation
  2. Reduction
  3. Hydrolysis
167
Q

Are the Phase 2 Metabolic Pathways diminished with age, yes or no?

A

NO

168
Q

What are the PK Elimination changes in Aging?

A
  1. Lose 10% of renal function
169
Q

What are the Pharmacodynamic Changes of Aging?

A
  1. Alterations in receptor affinity
  2. Alterations in receptor number
  3. Enhanced or diminished post receptor response
170
Q

Hypochlorite Solutions

A

-Bleach Products
-Irrigate affected area with water

171
Q

Formulation of Chloride Gas

A

Bleach + Acid

172
Q

Treatment for Chloride Gas and Chloramine Gas

A
  1. Fresh Air
  2. Supplemental Air
  3. Steroids
  4. Bronchodilators
173
Q

Formulation of Chloramine Gas

A

Bleach + Ammonia

174
Q

Where do Detergent poisonings occur?

A
  1. Skin
  2. GI tract
  3. Pulmonary tract
175
Q

What pH causes for an Acidic Poisoning?

A

pH <7, any product

176
Q

What is the MOA of Acidic Poisoning?

A

Denatured proteins clump together to form Coagulum, –> cardiovascular/skin necrosis

177
Q

What pH causes for a Basic Poisoning?

A

Any product pH >7

178
Q

What are common agents that causes Basic Poisoning?

A
  1. Oven Cleaners
  2. Drain Clog Removers
179
Q

What is the MOA of Basic Poisoning?

A

Denatured fat treats a weat/soapy substance -> slimy skin

180
Q

How does Hydrofluoric Acid cause poisoning?

A
  1. Liberation of fluoride ions > complex with positive ions
  2. Salt complex causes tissue injury decreased Ca and Mg, and increased K
  3. Causes dysrhythmias
181
Q

How does Hydrocarbons cause poisoning?

A
  1. GABA Receptor Agonist
  2. Destroys surfactant, leads to respiratory distress, hypoxia, pulmonary edema
  3. GI Irritation
182
Q

Halogenated Hydrocarbons have what increased risk?

A

Increased risk of sudden sniffing death syndrome

183
Q

Methylene Chloride is metabolized to what?

A

Carbon Monoxide

184
Q

Toulene can cause ____ acidosis.

A

Metabolic

185
Q

Where does poisoning occur with Hydrogen Peroxide?

A
  1. Local tissue injury
  2. Gas formation
186
Q

Where does poisoning occur with Boric Acid?

A

Good GI/Poor Dermal Absorption

187
Q

Shampoos are what?

A

Irritants

188
Q

Conditioners are what?

A

Irritant, Emollient/Laxative

189
Q

Mousse/Gel are what?

A

Irritant, Emollient/Laxative

190
Q

Relaxers are what?

A

Corrosive

191
Q

What symptoms are seen with Dyes Poisoning?

A
  1. Vomiting
  2. Painful Swelling of Mouth/Throat
192
Q

Permanents (hair product) are what?

A

Corrosive

193
Q

Nail Polish/ Polish Remover is what?

A

Minor Irritant

194
Q

Acetone a common nail polish remover is known to cause what?

A

Drowsiness

195
Q

Acetonitrile found in nail glue remover is known to cause what?

A

Cyanide Toxicity

196
Q

Toothpaste main AE from massive ingestion is what?

A

N/V/D

197
Q

Denture Cleaners are what?

A

Irritant

198
Q

Mouthwash is what?

A
  1. Eye Irritant
  2. Intoxication
199
Q

What is ingredients found with Fluoride Toxicity?

A
  1. Sodium Fluoride 128
  2. Sodium Monofluorophosphate 37
  3. Fluoride Ion 218
200
Q

What is the equation for mg/kg dosing when dealing with fluoride content?

A

(concentration [%])(amount ingested [oz])(constant)/ patient weight [kg]

201
Q

Calculate the recommendation for a child 11.4 kg who had a massive ingestion of Fluoride: 1/2 of 4oz tube of NaF 0.15%

A

(0.15)(2)(128)/11.4 = 3.37 mg/kg
Give the child 4-6 ounces of milk

202
Q

What is the threshold for emergency room referral with fluoride toxicity mg/kg?

A

> 8 mg/kg

203
Q

Moth balls are what?

A

GI Irritant

204
Q

T/F, you can safely monitor ingestion of <1 mothball at home.

A

True

205
Q

Camphor is what?

A
  1. CNS Stimulant
  2. GI/Ocular irritant
206
Q

Camphor can cause what symptoms with toxicity?

A

CNS Stimulant = Seizures

207
Q

Where do Button Batteries most commonly proceed to that does not lead to serious toxicity?

A

Stomach

208
Q

If Button Batteries are ingested it is a medical emergency, yes or no?

A

YES

209
Q

Desicants (Silica Gel/Ageless Oxygen) toxicity can be managed at home, yes or no?

A

YES

210
Q

Define Forensic Toxicology

A

The study of the harmful effects of chemicals on living organisms and its application to the law

211
Q

Regulatory Importance of Forensic Toxicology

A

Concerned with heath hazards, risl

212
Q

Workplace Importance of Forensic Toxicology

A

Concerned with occupational risk/impairment/liability

213
Q

Judicial Importance of Forensic Toxicology

A

Concerned with criminal/civil injury or death

214
Q

Public Health Importance of Forensic Toxicology

A

Concerned with epidemiological assessment

215
Q

Define Human Performance Toxicology

A

Effects of legal and illegal drugs on skills acquisition, learning, and performance

216
Q

What are established criteria for recognizing effects of of human performance toxicology?

A
  1. Field Sobriety Tests
  2. Drug Recognition Experts
  3. Predicting/Interpreting behaviors
217
Q

What are 3 Sectors to consider in Forensic Drug Testing?

A
  1. Military
  2. Criminal/Civil Justice System
  3. Private Sector (employment/sports/TDM)
218
Q

What is the oldest form of toxicology?

A

Postmortem Toxicology

219
Q

Why is Postmortem Toxicology complex?

A
  1. Diversity of drugs/poisons
  2. Quantity/quality of specimen
  3. Extractions
  4. Interpretation
220
Q

What are the 2 Questions that are most important in a Medical Examiner’s Office?

A
  1. Cause of Death COD
  2. Manner of Death MOD
221
Q

What are Causes of Death?

A
  1. Natural disease
  2. Injury
  3. Drug/Poison
222
Q

What are Manners of Death?

A
  1. Natural
  2. Accident
  3. Suicide
  4. Homicide
  5. Unknown
223
Q

Living Assumptions are Normal ADME, what falls under these assumptions

A
  1. Medical Conditions
  2. Illness
  3. Injury
224
Q

In Deceased personnel, what ends and what begins?

A
  1. Breathing ceases
  2. Blood flow ceases
  3. Digestion slowly ceases
  4. Metabolism slowly ceases
  5. Decomposition starts
225
Q

Define Postmortem ADME

A

A: incomplete distribution
D: postmortem redistribution
M: endogenous and microbial
E: not so much

226
Q

For present forensics, which part of postmortem ADME is the MOST important and LEAST controlled?

A

D: redistribution

227
Q

Postmortem Redistribution is influenced by what?

A
  1. Drug Chemistry
  2. Drug PK
  3. Distribution Mechanism
228
Q

Postmortem, where is the blood collected and why?

A

Femoral Vein, because no distribution occurs there

229
Q

Define Antemortem

A
  1. Blood/Serum
  2. Urine
  3. Oral Fluid
  4. Breath
  5. Sweat
  6. Hair
  7. Nails
    Before Death
230
Q

What is the testing approach for Postmortem?

A
  1. Testing
  2. Screening
  3. Confirmation
231
Q

Screening is the preliminary identification of drug/drug classes what are the 2 possible results?

A
  1. Negative
  2. Positive
232
Q

Confirmation in postmortem provides what?

A

Greater sensitivity and specificity of drug/metabolite

233
Q

What is the difference between Antemortem and Postmortem?

A

Antimortem: what you see is what you get
Postmortem: convoluted due to decomposition

Clinical Toxicology (1 decks)

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