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TOX > General Toxicology > Flashcards

General Toxicology Flashcards

1
Q

causes Toxic coma:

A

CNS depressants, Anticholinergics and toxin causing
cellular hypoxia e.g. HCN & CO.

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2
Q

causes pathologic coma

A

hepatic failure, renal failure & metabolic e.g. hypoglycemia.

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3
Q

coma scale

A

Rapid evaluation AVPU
A alert,
V verbal response,
P pain response,
U unresponsiveness

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4
Q

elevated values of anion gaps occur in

A

methanol, iron, lactic acidosis, ethylene
glycol and salicylates.
LIMES

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5
Q

Laboratory Routine studies:

A

CBC, serum electrolytes, ABG, renal & hepatic function tests & serum glucose.

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5
Q

what is the anion gap

A

the difference between the measured cations and anions in serum.
7+-4

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6
Q

duration of toxicological screening

A

urine 2-3 days after exposure
blood 6-12 hours in the blood

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7
Q

Cardiac monitoring may be especially useful in poisoning of

A

sympathomimetic agents,
cyclic antidepressants,
digitalis,
R-blockers (angiotensin II receptor blockers),

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8
Q

Laboratory investigation: Chest X-ray for

A

chemical or aspiration pneumonitis,
cardiogenic or
non-cardiogenic pulmonary edema.

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9
Q

Laboratory investigation: Abdominal X-ray for

A

ingested radio opaque toxins {(CHIPES):
Chloral hydrate,
Heavy metals,
Iron,
Phenothiazine [also packets of cocaine or heroin],
Enteric-coated
Sustained- release preparations}.

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10
Q

treatment of coma

A

Coma cocktail
Dextrose
thiamine IV to Wernicke’s encephalopathy in patiens suffering from thiamine deficiency
Naloxone: for cases with narcotic overdoes

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11
Q

treatment of convulsions

A

seizures are treated with diazepam slowly IV

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12
Q

side effects of anticonvulsant if administrated too rapidly

A

hypotension
cardiac arrest
respiratory arrest

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13
Q

contraindications of emesis

A

CCيع
* Corrosives: for fear of perforation of esophagus or stomach.
* Coma: for fear of suffocation or aspiration pneumonia.
* Convulsions: as vomiting and patient manipulation may stimulate convulsions.
* Kerosene (volatile hydrocarbons) for fear chemical pneumonitis.
* Chronic poisoning.
* Cardiac and elderly patients and vascular insufficiency.
* Infants below the age of 6 months (immature gag and airway protective reflexes).

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14
Q

Contraindications of activated charcol

A
  • Paralytic ileus and Intestinal obstruction.
  • Drowsy patient unless the airway is adequately protected or endotracheal intubations should be inserted
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14
Q

gastric lavage valuable as long as 6 hours post ingestion in some poisons as

A
  • Salicylates make aspirin cake due to sticking to stomach mucosa.
  • Barbiturate, which slow down stomach motility.
  • Morphine, which is secreted in stomach.
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15
Q

Complications of gastric lavage:

A
  • Asphyxia if the tube passes to the trachea.
  • Aspiration of stomach contents leads to aspiration pneumonia.
  • Esophageal perforation.
  • Hypertension & tachycardia as a stress reaction.
  • Electrolyte imbalance.
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16
Q

Contraindications of gastric lavage:

A

as emesis
* Coma & volatile hydrocarbons — Lavage is allowable after inserting a cuffed endotracheal tube to prevent aspiration pneumonia.
* Convulsions— Lavage can be performed under general anesthesia.
* Cardiac dysrhythmias must be controlled before gastric lavage is initiated, as insertion of the tube may create vagal response — cardiac arrest.

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17
Q

the most useful agent for the prevention of absorption of toxins.

A

Activated Charcoal (AC)

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18
Q

Activated Charcoal is ineffective (poorly adsorb) in some poisons as:

A

C– Cyanide and Corrosives.
H–Heavy metals (Iron, Lead, Arsenic and Mercury).
A–Alcohols.
R—Rapid onset or absorption poisons (Cyanide and Strychnine).
C—Chlorine and iodine
Others insoluble in water (Substances in tablet form).
A–Aliphatic and poorly adsorbed hydrocarbons (petroleum distillates).
L–Lithium

CHARCOAL

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19
Q

administration of antidotes with charcol

A

antidotes should be given 1-2 hours after charcoal administration.

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20
Q

Disadvantages of ACharcoal

A
  • It may adsorb Ipecac syrup [emetic] & prevents its action so it must be given after occurrence of vomiting.
  • It may adsorb oral antidotes (N- Acetylcysteine [antidote to Paracetamol], & prevent their action. Therefore, antidotes should be given 1-2 hours after charcoal administration.
  • It may induce vomiting (gritty texture, volume administration, additives as sorbitol or a combination of them all).
  • Mechanical obstruction of airways, if aspired into lungs (slurry is not well diluted).
  • Mechanical bowel obstruction in multiple dose manners especially with decreased gut motility.
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21
Q

often administered with charcoal to
facilitate the removal of the toxin from the GIT.

A

Cathartic agent such as sorbitol

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22
Q

indications of the MDAC (multiple dose activated charcoal)

A
  • Show enterohepatic circulation (TCA, Digitalis and Barbiturates)
  • Stick to the stomach (Salicylate).
  • Slow gut motility (Barbiturates & Morphine)
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23
Q

mechanism of MDAC

A

MDAC facilitates the passage of toxin from plasma into intestine by creating concentration gradient between blood & intestinal lumen bowel fluid so it is called dialysis. gut

24
Q

examples of catharitics

A

MgSO, Mg citrate and Sorbitol.

25
Q

Contraindications of catharitics

A
  1. Paralytic ileus and intestinal obstruction.
  2. Sodium and magnesium containing cathartics should not be used in patients with fluid overload or renal insufficiency, respectively.
26
Q

adverse effects of catharitics

A
  1. Electrolyte imbalance from fluid loss, and hyperosmolarity
  2. Hypermagnesemia with renal failure patients .
  3. Abdominal cramping and vomiting may occur, especially with sorbitol.
27
Q

result of ad of catharitics to renal failure patients

A

Hypermagnesemia

28
Q

adverse effects of sorbitol

A

Abdominal cramping and vomiting

29
Q

definition of whole bowel irrigation

A

Irrigation of the entire GIT with non-absorbable isotonic electrolyte solution containing Polyethylene Glycol through nasogastric tube until the bowel has been cleaned rapidly from the poison.

30
Q

Indication of Whole Bowel irrigation

A

Poorly adsorbed drugs by Activated Charcoal

Preparations, which are slow, release e.g. Salicylates and Calcium Channel blockers.

body packers and body stuffers

31
Q

Contraindications of Whole Bowel Irrigation

A

Contraindications:
Unprotected airway or compromised airway.
Bowel obstruction, ileus, or perforation.
GIT bleeding.
Intractable vomiting.
Unstable vital signs.
Signs of leakage of illicit drug packets (e.g. tachycardia, hypertension, hyperthermia in a patient who has ingested cocaine packets), surgical consult should be obtained in this circumstance.

32
Q

definition of forced diuresis

A

Removal of the poison from the blood through increasing the glomerular filtration rate e.g. by giving diuretics and IV fluid.

33
Q

Contraindication of forced diuresis

A
  1. Electrolyte imbalance
  2. Heart failure
  3. Renal failure
  4. If the poison is not excreted by kidney
33
Q

alkalinization of urine for elimination of?

A

acidic drugs e.g. salicylates and barbiturates.

34
Q

Acidification of urine for elimination of

A

Alkaline drugs e.g. Amphetamine, Quinidine and PCP.

35
Q

used in acidification of urine

A

NH4Cl
urine pH 4.5-6.0.

35
Q

used in alkalinization of urine

A

NaHCO3
urine pH 7.5-8.0.

36
Q

complications of acid diuresis

A

associated with metabolic and urinary acidosis (rhabdomyolysis & myoglobinuria — renal failure).

37
Q

definition of hemodialysis or perfusion dialysis

A

Removal of poisons from the blood to the dialysis fluid according to concentration gradient (from higher to lower) through semi permeable membrane which is either cellophane or peritoneom

38
Q

indications of hemodialysis

A

1) Renal failure and the poison is excreted by kidneys
2) Liver failure, & the poison is metabolized by the liver
3) prolonged coma
N.B. the drug must be dialyzable i.e. Low molecular weight, Low lipid solubility, Low protein binding and Water-soluble.

39
Q

adverse effects of hemodialysis

A

1) Hemorrhage
2) Venous thrombosis
3) Hypotension
4) Infection
5) Hepatitis

40
Q

complication of peritoneal dialysis

A

1)Peritonitis
2)Perforation of abdominal organs

41
Q

D of Hemoperfusion

A

The blood is pumped directly through a column containing an adsorbent material (either charcoal or exchange resins).
Then blood returns via a venous catheter free from poisons.

42
Q

indication of hemoperfusion

A

for clearing toxic substances that are poorly eliminated by dialysis non-dialyzable High molecular weight, High _ lipid
solubility, High protein binding and Low water solubility.

43
Q

adverse effects of Hemoperfusion

A

1) Hemorrhage( may be due To
heparin)
2) Hypotension
3) Hypoglycemia
4) Hypocalcemia

44
Q

Types of Antidotes:

A

i. Physio-mechanical Antidotes e.g. Activated charcoal
ii. Chemical Antidotes e.g. KmnO,1/10000 in Aluminum phosphide poisoning
iii. Physiological or pharmacological antidotes: These produce effects opposite to that of poison e.g.: Glucagon in calcium channel blockers

iv. Competitive antagonist:at receptor site: naloxone in morphine poisoning

v. Dispositional antidotes: interfere with absorption ,distribution , metabolism or excretion of the poison .

vi. Chelating agents:
These substances combine with metals forming nontoxic compounds that are easily excreted in urine e.g. Deferrioxamine (Desferal): used for chelation of iron.

45
Q

example of Physio-mechanical Antidotes

A

activated charcoal

46
Q

CCB antidotes

A

glucagon
Calcium gluconate

46
Q

example of chemical antidotes

A

KmnO4 in aluminum phosphide poisoning

46
Q

Aluminum phosphide poisoning antidote

A

KmnO4 (potassium permanganate)

47
Q

Physiological or pharmacological antidotes:

A

Glucagon in BB

48
Q

used for chelation of iron.

A

Deferrioxamine (Desferal)

49
Q

compitive antagonist (antidot)

A

at receptor site: naloxone in morphine poisoning

50
Q

1.Convulsions
2. Coma

A
  1. Diazepam.
  2. coma cocktail: Care of comatose patient: e.g. urinary catheter, avoid bed sores & care of eye
50
Q

coma cocktail:

A

dextrose
thiamine
naloxone

51
Q
  • Hypotension & shock —
  • Hypertension—
  • Arrhythmias—
A

intravenous fluids &vasopressors
antihypertensive drugs
antiarrhythmic drugs.

52
Q

Pulmonary edema—
-Pneumonia—

A

oxygen, mechanical ventilation & diuretics.
oxygen, antibiotics & antipyretic

52
Q
  • Renal failure
  • Rhabdomyolysis—
  • Met-hemoglobinemia— .
A

hemodialysis
alkalinization of urine and diuresis.
Methylene blue

53
Q
  • Hyperthermia—
  • Hypothermia—
  • Hypokalemia —
  • Hyperkalemia —
  • Metabolic acidosis —
  • Hypoglycemia — .
  • Bleeding tendencies —
A

cold foments &antipyretic
hot foments
potassium.
calcium, insulin in 5% glucose, hemodialysis.
I.V. infusion NaHCo3
glucose
vit. K or blood transfusion.

TOX (10 decks)

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