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toxicology > final > Flashcards

final Flashcards

1
Q

what solvents are straight or branched-chain compounds often present in mixtures?

A

Aliphatic hydrocarbons, such as hexane.

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2
Q

methylene dichloride, chloroform, carbon
tetrachloride, chlorinated ethylenes.
are what types of solvents

A

Halogenated aliphatic hydrocarbons.

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3
Q

what solvents are used in antifreeze

A

Ethylene and propylene glycols (PG)

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4
Q

methyl cellosolve is what type of solvent

A

Glycol ether

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5
Q

———- results from chronic, low- level exposure characterized by nonspecific symptoms (e.g., headache, fatigue, mood disturbances, and sleep disorders) with or without changes in neuropsychological function.

A

chronic solvent encephalopathy (CSE)

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6
Q

what are toxic effects and TWA (ppm) of benzene

A

Leukemia / 0.5

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7
Q

what are toxic effects and TWA (ppm) of carbon disulfide

A

CNS, neuropathy / 10

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8
Q

what are toxic effects and TWA (ppm) of carbon hydrochloride

A

Liver / 5

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9
Q

Narcosis (CNS depression) is related to the —— and is not related to their chemical structure

A

solubility of these solvents in lipid

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10
Q

a solvent, such as ——-, may potentiate the adverse effects of others by enhancing their bioactivation

A

benzene

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11
Q

—–solvent may reduce the toxicity of benzene by competitively inhibiting the bioactivation enzyme systems

A

toluene

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12
Q

1- what are solvents that lead to liver disease

2- liver lesions are caused by which reactive metabolites of these solvents

A

1- ethanol and chlorinated hydrocarbons

2-
-carbon tetrachloride → tricholoromethyl
-chloroform → phosgene
-bromobenzene → epoxides

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13
Q

——— toxicity to kidneys from direct cytotoxicity, and blocking of the proximal tubules with the formation of crystals of its metabolite, calcium oxalate

A

Ethylene glycol

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14
Q

what are lower levels vs higher levels toxic effects of kidney toxicity

A

-Lower levels: tubular functions, such as glycosuria, amino aciduria, and polyuria
-Higher levels: cell death along with elevated BUN and anuria

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15
Q

CCl4 is toxic to kidneys upon ——- and to liver upon ——–.

A

CCl4 is toxic to kidneys upon inhalations and to liver upon ingestion

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16
Q

1- what solvents cause CNS toxicity and what are their metabolites

2- what are CNS toxicity effects

A

1- n-hexane and methyl n-butyl ketone → 2,5-hexanedione

2- Polyneuropathy (motor weakness and numbness) and distal axonopathy pathologically

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17
Q

what type of solvents are known to cause liver cancers

A

chlorinated hydrocarbons.

also Dioxane which also produces nasopharyngeal cancers

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18
Q

what solvent may damage the retina through its metabolite and affects mainly the part that is responsible for central vision

A

methanol

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19
Q

what solvent may induce cardiac arrhythmia, probably as a result of sensitization of the myocardium to epinephrine. This is one of the reasons why it has been discontinued as a general anesthetic

A

Chloroform

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20
Q

what solvent is safe and used as food additives

A

propylene glycol
w LD50 (32 - 18 mL/kg)

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21
Q

what gas forms carboxyhemoglobin when mixed with Hg

A

Carbon Monoxide (CO)

also binds to cytochrome oxidase

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22
Q

which gas causes smooth muscle relaxation Hypoxemia, tissue hypoxia, no cyanosis, CO-Hb is cherry red in color

A

Carbon Monoxide

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23
Q

what HbCO% blood levels show no symptoms ?

A

-less than 10%

-btw 10-30: headache, dizziness, excertional dyspnea.
-btw 30-50: confusion, N/V, syncope, tachypnea

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24
Q

what’s the most common side effect of chronic low level exposure to CO

A

memory disturbances

other symptoms:
-tiredness and lethargy
-irritability
-visual impairment
-increased incidence of heart disease on atherosclerosis

25
Q

what is antidote to CO toxicity

A

100% oxygen with hyperbaric chambers

26
Q

what gas is a more potent cytochrome oxidase inhibitor than cyanide

A

Hydrogen sulfide

27
Q

what gas is (Neurotoxin)-causes peripheral neuropathy- damage cranial nerve.

A

Hydrogen sulfide

28
Q

what is the concentration of hydrogen sulfide that leads to death (respiratory arrest)

A

> 1000 ppm

29
Q

what gas causes metabolic acidosis secondary to anaerobic metabolism, hypoxemia and muscle hypoxia

A

hydrogen sulfide (H2S)

30
Q

what gas is known to be neurotoxin, causes peripheral neuropathy (cranial nerve damage)

A

hydrogen sulfide (H2S)

31
Q

what is the antidote to Hydrogen sulfide (H2S)

A

-nitrates (in addition to O2 and life support)

-nitrates are antidotal ( cyanide antidote kit) by inducing Meth-Hb - providing a large available source of ferric- heme which has a greater affinity for H2S than does cytochrome oxidase, sequestering sulfide ions freeing cytochrome oxidase

32
Q

what process causes tachycardia and tachypnea due to cyanide toxicity ?

A

cyanide stimulation of chemoreceptors in the carotid and aortic bodies

33
Q

what gas irreversibly combines with the ferric ion of cytochrome oxidase to form a stable complex

A

Cyanide

(H2S is still a more potent cytochrome oxidase inhibitor than cyanide)

34
Q

what agents is the new approach used for cyanide poisoning

A

hydroxocobalamin (vitamin B12)
-combines with cyanide to form cyanocobalamin (Vitamin B12) and the vitamin is excreted by the kidney.

35
Q

Enhancement of elimination of cyanide: Hemodialysis may be of value in patients who have developed high ——–

A

thiocyanate (a less toxic compound from cyanide metabolism)

36
Q

Assessment of the vital signs and the effectiveness of respiration and circulation are the initial concerns during which step of supportive care

A

Clinical stabilization (first step)

37
Q

Estimating the —- of the exposure to the poison is frequently the most difficult aspect of the clinical history in the setting of treatment of the poisoned patient

A

timing

38
Q

in what step of clinical evaluation does the physician determine the mental status of the patient ?

A

Physical Examination
-in addition to determining possible additional causes such as trauma or central nervous system infection

39
Q

in what step of clinical evaluation does the physician determine the toxidromes ?

A

during the physical Examination

40
Q

what poisons smell like
(1) bitter almonds,
(2) eggs,
(3) garlic respectively ?

A

(1) cyanide
(2) hydrogen sulfide and mercaptans
(3) arsenic, OP, DMSO, thallium

41
Q

what does an elevated anion gap indicate ?

A

Na – (Cl + HCO3) > 12 indicates metabolic acidosis

-A normal anion gap is <12. When there is laboratory evidence of metabolic acidosis, the finding of an elevated anion gap would suggest systemic toxicity from a relatively limited number of agents (alcohol, methanol and toluene) MUD PILES

42
Q

metabolic acidosis (anion gap >12) indicates toxicity of:

A

methanol, alcohols (ethanol ketoacidosis, toluene, iron, lactic acid…)

43
Q

elevated osmol gap (>10) indicates toxicity of:

A

osmotically active substance (methanol, ethanol, ethylene glycol, and isopropanol)

44
Q

what are the most useful radiographs ordered in a case of overdose or poisoning

A

-chest and abdomen radiographs
-computed tomography (CT) study of the head

45
Q

what poisons appear as radiopaque liquid in the gut lumen

A

-lead (in paint)
-halogenated hydrocarbons (chloroform and carbon tetrachloride)

46
Q

The detection of drug induced non-cardiac pulmonary edema through PLAIN RADIOGRAPHY is associated with serious intoxication with ——-

A

salicylates and opioid agonists

47
Q

Significant exposure to ——detected through PLAIN RADIOGRAPHY, has been associated with CT lesions of the brain consisting of low density areas in the cerebral white matter and in the basal ganglia

A

carbon monoxide (CO)

48
Q

which method of Prevention of Further Poison Absorption has been limited due to cardio and neurotoxicity risks, as well as lower effectiveness at removing the toxicant than desired

A

induction of emesis with syrup of ipecac

49
Q

Acute renal failure and
acid–base and electrolyte disturbances
are associated with which method of Enhancement of Poison Elimination

A

-acidification of the urine

-that’s why this method IS NOT USED.

50
Q

what are the agents (poisons) for which hemodialysis has been shown effective as a treatment modality for poisoning.

A

alcohols, antibiotics, boric acid, metformin, paraldehyde, meprobamate

51
Q

Protein binding does not significantly interfere with removal by ——.

A

hemoperfusion

52
Q

(1) which poison treatment is uncommon and mostly confined to inadvertent drug overdose in a neonate or premature infant due to its risks and complications?

(2) what are those risks and complications?

A

(1) Plasma Exchange or Exchange Transfusion or pheresis.

(2) allergic type reactions / infectious complications / hypotension.

53
Q

Multiple dose Activated Charcoal (MDAC) is thought to produce its beneficial effect by interrupting the ——-circulation of drugs

A

enteroenteric–enterohepatic

54
Q

The technique of serial oral administration of activated charcoal involves continuing oral administration of activated charcoal beyond the initial dosage every ——-hours.

A

2 to 4 hours

55
Q

what are agents for which activated charcoal has been shown as an effective means of enhanced body clearance

A

Carbamazepine, Dapsone, Digoxin, Salicylates, Theophylline, BARB, Nadolol..

56
Q

what are the antidotes to the following agents:
(1) digoxin
(2) organophosphate insecticides
(3) cyanide

A

(1) chelating agents or Fab fragments
(2) atropine anticholinergic at the receptor level
(3) sodium nitrite which interacts with biological systems (hemoglobin to form methemoglobic)

57
Q

which antidote is used to pharmacologically antagonize at the receptor level

A

atropine anticholinergic used for organophosphate insecticides

58
Q

which antidote acts by chemically reacting with biological systems to increase detoxifying capacity for the toxin

A

sodium nitrite
for cyanide poisoning
to cause formation of methemoglobin, which serves as an alternative binding site for the cyanide ion, thereby making it less toxic to the body

toxicology (4 decks)

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