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final Flashcards

1
Q

organotoxic effect of DES, dioxin, DDT

A

can cause atrophy ad/or death of the cells of the thymus gland

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2
Q

PCB exposure may make people more prone to ____

A

allergic responses

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3
Q

PAH exposure affects who

A

anyone living or working in an urban environment

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4
Q

organotoxic effect of PAH exposure

A

decreased splenic and thymic activity

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5
Q

organotoxic effect of lead and mercury exposure

A

decreased ability to kill candida

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6
Q

supplementation of what may be protective of immune function with cadmium exposure

A

selenium

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7
Q

organ toxicity main problem with DES

A

was reproductive problems in the offspring

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8
Q

problems with the way we study xenoestrogens

A

Lacks the complex metabolic interactions in vivo in a human

Shows whether the compound bind to the ER-alpha or ERbeta but not all estrogenic activity is mediated by receptors

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9
Q

female fertility organotoxic effects/compounds

A

Decreased with PAHs, chemotherapeutic agents, solvents, BPA, and particulate matter

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10
Q

male fertility organotoxic effects/compounds

A

organophosphates and heavy metals affect sperm

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11
Q

____ look like thyroid

A

PCBs

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12
Q

Some of the basic supportive supplements

A

Vit. C
Fiber
Selenium
zinc

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13
Q

Supplements that help increase glutathione production

A

-Glutathione itself - not well absorbed orally
-Cysteine (NAC, L cysteine)
-Cruciferous veggies
-Dietary fiber
-Undenatured whey protein
-Onions and garlic

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14
Q

benefits of low temp sauna on detox

A

Inc lipolysis, excretion of things stores in adipose

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15
Q

Theory behind colon hydrotherapy as tx

A

Inc lipolysis, excretion of things stores in adipose

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16
Q

Testing for acetylcholinesterase pesticide exposure:

which test?
what are we looking for in each?

A

best to do both whole blood and plasma.

whole blood - “true” cholinersterase; identical to whats found in synapses

plasma - pseudocholinesterase

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17
Q

EDTA

best for what metal
oral/IV
SEs

A

metal - Hg (higher binding affinity but poor chelator) > Pb

route - IV

SEs - hypotension, hypoglycemia, and hypocalcemia

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18
Q

DMSA

best for what metal
oral/IV
SEs

A

metal - Pb > Hg

route - Oral (still poor) IV not available

SEs - GI distruabcnes, elevation of liver enzymes, def of essential elements, sulfur smelling urine

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19
Q

DMPS

best for what metal
oral/IV
SEs

A

metal - Hg (mercury)

route - oral

SEs - dec essential minerals, CV reactions/fall in BP, elevation of liver enzymes, allergic reactions (MUCUOUS MEMBRANE ERUPTIONS -STOP)

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20
Q

Why do you need to avoid seafood (esp shellfish) for a week prior to challenge testing?

A

This may cause false elevation of arsenic (half-life of 7 days) or mercury. Methyl Hg clears the body in approximately 70 days.

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21
Q

good candidate for stool testing

A

pediatric patients

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22
Q

pros of hair testing

A

-Good for evaluating methylmercury
-Detects recent exposure
-Hair levels can be higher because it won’t be reexchanged back with the body
-Cheap and easy

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23
Q

cons of hair testing

A

-No indication of body burden
-Highly vulnerable to external contamination
-No standard procedure
-Not reliable for elemental Hg, Cd, Pb

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24
Q

blood lead levels

A

children: <5µg/dL; tx isn’t initiated until levels >45µg/dL

Adults: <20µg/dL

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25
Q

Is there a good test to determine ACCURATE body burden of heavy metals?

A

NO SINGLE TEST EXISTS FOR ACCURATE DETERMINATION OF THE TOTAL BODY HEAVY METAL BURDEN (these tests show how much metal is leaving the body and not how much is IN the body)

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26
Q

What tests should be done BEFORE doing any specialty testing?

A

-CBC
-CMP
-Lipid panel
-Complete UA, urine Hcg for women
-G6PD
-TB Test

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27
Q

Exposure hx forms we reviewed

A

ASTDR
Crinnion’s History Form
QEESI

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28
Q

Depuration vs. Detoxification

A

Detoxification - The process of transforming a toxic substance into a nontoxic substance

Depuration –
The action or process of freeing something of impurities; This is the preferred term for the removal of xenobiotics by the body

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29
Q

what is a xenobiotic

A

Exogenous compounds that are foreign to the body that the body must bio transform and excrete

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30
Q

ways of absorption

A

-simple diffusion
-passage through pores (facilitated diffusion)
-specialized transport systems

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31
Q

Major sites of absorption (ingestion, inhalation, dermal absorption)

A

GI tract (ingestion)
-Small intestine

Lungs (inhalation)
-Gasses, VOCs, small particulate

Skin (dermal absorption)
- Impenetrable to all but highly lipid soluble compounds/solvents unless skin barrier is compromised (eczema, soaking/hydrated for a long time)

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32
Q

Major storage sinks

A

Liver and kidney
Fat - Pesticides
Bone
- Aluminum
- Cadmium
- Lead

33
Q

What are some of our barriers

A

Blood brain barrier
Placental barrier

Exclude water soluble, not lipid soluble

34
Q

What is the main idea of biotransformation?

A

Conversion of lipid soluble xenobiotic into polar water soluble for excretion

35
Q

review the effect of starvation on NADPH and why starvation (fasting) is not a good idea for biotransformation

A

in starvation, NADPH for biotransformation can only be produced at the expense of gluconeogenesis

36
Q

Main CYP in the liver

A

CYP 3A4

37
Q

which of the following inhibitors and which are inducors?

heavy metals
trauma
obesity

A

all inhibitors

38
Q

explain the circadian clock of glutathione production

A

In animals GSH production (cysteine dependent) is on a circadian clock: nadir at about 6 pm

GSH cycles between oxidation, being cycled back by glutathione reductase; if a heavy metal is present, then replenishment cannot occur, leading to GSH deficiency

39
Q

Routes of excretion

A

Urinary
Biliary
Pulmonary

40
Q

How do Toxins cause immune deficits?

A

Hypersensitivity reactions, including allergy

Autoimmunity

41
Q

Th1 cells secrete

A

IL2, INFgamma, TNFbeta

42
Q

Th1 functions

A

Cell mediated immunity, phagocyte protective responses

43
Q

Th1 response occurs following

A

infxn by intracellular bacteria and some viruses

44
Q

Th1 dominant =

A

proinflammatory, perpetuate AI responses

45
Q

Th2 cells secrete

A

IL4, IL5, IL10, IL13

46
Q

Th2 functions

A

Ab production, eosinophil activation, inhibition of macrophage function

47
Q

Th2 response occurs following

A

Infestations by GI nematodes

48
Q

Th2 dominant =

A

eosinophilic responses in atopy, pregnancy (modifies th1 response)

49
Q

effect of mercury on immunity

A

increased autoimmunity
diminished capacity to kill candida

50
Q

t cell deficiency can manifest as

A

chronic infections due to
- Protozoan parasites
- Fungi (candida)
- Viruses (EBV, CMV, varicella, herpes)
- Bacteria (mycobacteria, listeria)

51
Q

b cell deficiency can manifest as

A

acute infections with pyogenic bacteria

chronic infections such as osteomyelitis and klebsiella

52
Q

what type of patient is more at risk of immunotoxic effects of PCB exposure

A

asthmatic/allergic children

53
Q

immunotoxins

A

DES
TCDD (dioxin)
PCBs
PBB
DDT
PAHs
VOC

54
Q

what is an endodrine disruptor?

A

a chemical that interferes with the body’s endocrine system and can produce adverse responses

55
Q

what is a xenoestrogen?

A

a type of endocrine disruptor that imitates estrogen. It can be of natural or synthetic origin

56
Q

ex of phytoestrogens

A

Genistein and daidzein from soy

Coumestans (coumestrol from clover)

Lignans (enterodiol and enterolactone)

57
Q

ex of estrogenic compounds

A

Chlorinated pesticides

Bisphenol A

58
Q

what classes of herbs are supportive for depuration?

A

lymphagogues**
alteratives
hepatics
nutritives

59
Q

benefit of siber with toxin exposure

A

Helps support the body’s innate processes of elimination.

binds to wastes excreted by liver

keeps bowels moving regularly without irritation

60
Q

Contraindications for water fasting

A
  • Emaciation
  • Anemia
  • Porphyria
  • Significant malnutrition
  • Medium chain acyl-CoA dehydrogenase deficiency
  • Long-term in children or pregnant women
  • Lactation
  • Moderate to severe renal insufficiency
  • Disordered Eating
61
Q

Phase 1 of biotransformation goals/outcomes

A

BIOACTIVATION: Creates a bioactivated intermediate or metabolite (oxidation, reduction, hydrolysis)

In some cases makes substrate less toxic, more water soluble, and easier to excrete

In some cases makes substrate more chemically reactive, often toxic, compound.

62
Q

Phase 2 of biotransformation goals/outcomes

A

CONJUGATION- Creates a safer, non-toxic water-soluble compound > Bio inactivation

Usually faster than Phase I when co-factors are replete

FURTHER REDUCTION TO LESS TOXIC, MORE HYDROPHILLC COMPOUNDS USING TRANSFERASE ENZYMES AND COFACTORS

63
Q

how does an inducer work in biotransformation

A

Increase enzyme expression > increase transformation activity

64
Q

how does an inhibitor work in biotransformation

A

Inhibition of activity due to THREE reasons:

-2+ compounds competing for same enzyme
-Depletion of nutrients/co-factors
-Selective inhibition of enzyme by pharmaceutical or compound

65
Q

Health Problems associated with Ozone

A

Even at low levels, chronic ozone exposure can cause structural injury to the lung and chronic inflammation

HEENT: Eye irritation, Throat irritation

Resp tract: Can worsen: Asthma, Bronchitis, Emphysema
-Sxs: Coughing, Wheezing, Burning sensation, SOB

66
Q

health effect of nitrogen oxides

A

Respiratory
-Airway inflammation
-Increased resp. sxs in sensitive individuals (e.g. asthma)

Immune
-Lowers resistance to influenza

67
Q

health effect of PAHs

A

increased plasma estradiol levels in males
-Suggesting a xenoestrogenic affect and potentially interacting with the HPA axis

Cancer

Birth defects in mice

68
Q

health effects benzene

A

Causes cells not to work effectively

Bone marrow suppression - Anemia

Immune system -
Lower levels of antibodies

69
Q

health effects of particulate matter

A

HEENT
-Eye irritation

Resp.
-Agg. asthma
-Chronic bronchitis
-Decreased lung fxn
-Increased resp. sxs: irritation of the airways, coughing or difficulty breathing

Cardio
-Inc. risk of MI
-Irregular heartbeat

70
Q

health effects of elemental mercury

A

Primary health effects are when it is breathed in as a vapor

BIG TAKE-AWAY: mostly NEURO-Cognitive Sxs

71
Q

health effects of methylmercury

A

Health effects can result from mother’s consumption of fish and shellfish - Impaired neurological development

Sx
BIG TAKE-AWAY: mostly NEURO-Cognitive Sxs

72
Q

health effects of inorganic compounds

A

damage to GI tract, nervous system, and kidneys

sx
- skin rashes and dermatitis
-mood swings
-memory loss
-mental disturbance
-muscle weakness

73
Q

health effects of lead

A

can adversely affect:
Nervous system
Kidney function
Immune system
Reproductive and developmental systems
Behavioral problems
Learning deficits
Lowered IQ
CV System
-HTN
-Heart disease

Affects the oxygen carrying capacity of the blood - Displaces iron in hemoglobin

74
Q

where in the body does lead accumulate?

A

bones

75
Q

health effects of sulfur dioxide

A

Short term exposure (5min -24hrs.)
Bronchoconstriction
Increased asthma sxs

Esp. imp. For asthmatics at inc. ventilation rates (exercising or playing)

76
Q

who is most at risk of effects of sulfur dioxide?

A

those with frequent ER visits - kids, elderly, asthmatics

77
Q

which soil pesticide is most toxic?

A

organophosphates

78
Q

most serious health concerns from nitrate/nitrite fertilizers

A

acute acquired methemoglobinemia

Nitrate alters the iron in hemoglobin from the ferrous to the ferric state → which forms methemoglobin (abN hemoglobin) → blood loses its ability to carry oxygen to tissues

79
Q

bioaccumulation v biomagnification

A

Bioaccumulation = accumulation of a toxic chemical in the tissue of ONE particular organism.

Biomagnification = the increased concentration of a toxic chemical the higher an animal is on the food chain.

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