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Clinical Toxicology > Introduction PT. 2 > Flashcards

Introduction PT. 2 Flashcards

1
Q

An abnormal, undesirable harmful, or effect to the well-being that is indicated by some measurable endpoint.

A

ADVERSE EFFECT

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2
Q

Chromosomal breakage resulting in rearrangement of pieces of chromosomes.

Loss, addition or rearrangement of chromosomes.

A

CLASTOGENESIS

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3
Q

Chemical with molecular weights of less than 1000 and generally react with endogenous carrier molecules to become antigens before they exhibit immunogenicity.

A

HAPTENS

A well-known example of a hapten is urushiol, which is the toxin found in poison ivy.

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4
Q

Heritable changes in genetic material that are limited to the effects on the nucleic acid.

Vinca alkaloids; Bromine containing cmpds.

A

MUTAGENESIS

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5
Q

Toxicity associated with any chemical substance.

A

INTOXICATION

on purpose

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6
Q

A clinical toxicity secondary to accidental exposure.

A

POISONING

Not on purpose

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7
Q

An intentional exposure with intent of causing self-injury or death.

A

OVERDOSE

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8
Q

Are drugs that have almost exclusively harmful effects

A

POISON

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9
Q

This means that a chemical will produce injury to one kind of living matter without harming another form of life, even though the two may exist close together.

A

SELECTIVE TOXICITY

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10
Q

Study of malformations induced during development conception to birth

A

TERATOLOGY

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11
Q

Synonymous with harmful in regard to the effects of chemicals

Or it relates to poisonous or harmful effects on the body

A

TOXIC

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12
Q

Refers to toxic substances produce naturally

A

TOXIN

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13
Q

Log dose that can produce 50% mortality in a population

Dose that is required to kill half the members of a tested population after a specified test duration

A

LD50 OR MEDIAN LETHAL DOSE

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14
Q

The ability of a chemical agent to cause injury in a given situation or setting

A

HAZARD

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15
Q

It is defined as the expected frequency of the occurrence of an undesirable effect arising from exposure to a chemical or physical agent.

A

RISK

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16
Q

Amount of exposure to a given agent that is deemed safe for a period of time.

A

THRESHOLD LIMIT VALUE (TLV)

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17
Q

Suggests that there should be a dose or exposure level below which harmful or adverse effects are not seen in a population

A

THRESHOLD DOSE

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18
Q

Quantity of agent that can kill an organism

A

LETHAL/FATAL DOSE

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19
Q

Denotes the altered pharmacodynamics of a drug when given in toxic dosage, since normal receptors and effector’s mechanisms may be altered.

A

TOXICODYNAMICS

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20
Q

Applied to the pharmacokinetics of toxic doses of chemicals, since the toxic effects of an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material

A

TOXICOKINETICS

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21
Q

Is defined as the apparent
volume into which a substance is distributed.

A

VOLUME OF DISTRIBUTION (VD)

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22
Q

REMEMBER

A drug with a high Vd has a propensity to leave the plasma and enter the extravascular compartments of the body, meaning that a higher dose of a drug is required to achieve a given plasma concentration. (High Vd-> More distribution to other tissue).

A

Conversely, a drug with a low Vd has a propensity to remain in the plasma meaning a lower dose of a drug is required to achieve a given plasma concentration. (Low Vd-> Less distribution to other tissue).

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23
Q

LARGE VD >5L/kg

  • Antidepressants
  • Antimalarials
  • Narcotics
  • Propranolol
  • Antipsychotics
  • Verapamil
A

LARGE VD >5L/kg

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24
Q

SMALL VD <5L/kg

  • Salicylates
  • Phenobarbital
  • Lithium
  • Valproic Acid
  • Warfarin
  • Phenytoin
A

SMALL VD <5L/kg

25
Q

A measure of the volume of plasma that is cleared of drug per unit time.

A

CLEARANCE

  • Zero order (have a rate constant and half-life that is independent of the reactants’ concentrations)
  • First order (have rate constants that are affected by the concentration of the reactants)

Total clearance is the sum of clearances by excretion by the kidneys and metabolism by the liver.

26
Q

NOTE: ABOUT CLEARANCE

In planning detoxification strategy, it is important to know the contribution of each organ to total clearance.

For example, if a drug is 95% cleared by liver metabolism and only 5% cleared by renal excretion, even a dramatic increase in urinary concentration of the poison will have little effect on overall elimination.

A
27
Q

NOTES:

Initial approach to the poisoned patient should be essentially similar in every case, irrespective of the toxin ingested, just as the initial approach to the trauma patient is the same irrespective of the mechanism of injury.

A
28
Q

Initial approach to the poisoned patient:

This approach, which can be termed as routine poison management, essentially includes the following aspects:

A
  • Stabilization: ABC’s
  • Clinical Evaluation: Px history, Physical examination
  • Decontamination: Prevention of absorption
  • Specific antidote
  • Removal of absorbed toxin: Enhancing excretion
  • Supportive therapy: Monitoring adverse effects
  • Detoxification: Preventive education
29
Q

In the initial evaluation of a toxic patient, it is a must to remember that the most common cause of airway obstruction in the unconscious patient is ______.

A

Passive obstruction by the tongue

AIRWAYS

30
Q

For many patients, simple positioning in the ____ is sufficient to move the flaccid tongue out of the airway.

AIRWAY

A

Lateral decubitus position

31
Q

Also, it should be cleared of ____ or any other obstruction and an oral airway.

The head tilt chin lift or neck lift with jaw thrust may be the first maneuver on the unconscious poisoned patient followed by ______.

AIRWAY

A
  • vomitus
  • endotracheal intubation.
32
Q

A soft, flexible tube is passed through the nose and into the trachea using a “blind” technique.

A

NASOTRACHEAL

33
Q

The tube is passed through the mouth into the trachea under “direct” vision

A

OROTRACHEAL

34
Q

DISADVANTAGES
● Perforation of the nasal mucosa, with epistaxis (nose bleed)
● Patient must be breathing spontaneously.
● Anatomically more difficult in infants because of anterior epiglottis.

ADVANTAGES
● May be performed in a conscious patient without requiring paralysis.
● Once placed, it is better tolerated than orotracheal tube.

A

NASOTRACHEAL

35
Q

DISADVANTAGES
● frequently requires neuromuscular paralysis, creating risk of fatal respiratory arrest if intubation is unsuccessful
● requires neck manipulation, which may cause spinal cord injury after neck trauma

ADVANTAGES
● performed under direct vision, making accidental esophageal intubation unlikely
● insignificant risk of bleeding
● patient need not be breathing spontaneously
● higher success rate than that with nasotracheal route

A

OROTRACHEAL

36
Q

The major cause of morbidity of poisoned and drugged patient is _______ difficulties

A

BREATHING

37
Q

NOTES

Patients may have one or more of the following complications:
* Ventilatory failure,
* Hypoxia (low O2 level), or
* Bronchospasm

BREATHING

A
38
Q

Breathing should be assessed by?

A
  • Observation and
  • Oximetry and, if in doubt,
  • By measuring arterial blood gases (ABG)
39
Q

Patients with respiratory insufficiency should be ____ and ____

A

intubated; mechanically ventilated

40
Q

Administer supplemental oxygen as indicated based on arterial PO2. Intubation and assisted ventilation may be required.

If carbon monoxide poisoning is suspected, give 100% oxygen.

MANAGEMENT

A

Correct hypoxia

41
Q

Obtain frequent sputum samples and initiate appropriate antibiotic therapy when there is little evidence of infection.

MANAGEMENT

A

Treat Pneumonia

42
Q

There is no basis for prophylactic antibiotic treatment of aspiration- or _____.

MANAGEMENT

A

chemical-induced pneumonia

43
Q

Although some physicians recommend _____ for chemical-induced pneumonia, there is little evidence of their benefit.

MANAGEMENT

A

corticosteroids

44
Q

It may result from the following:
* Direct irritant injury from inhaled gases or pulmonary aspiration of petroleum distillates or stomach contents.
* Pharmacologic effects of toxins e.g. organophosphate or carbamate insecticides or beta-adrenergic blockers.
* Hypersensitivity or allergic reactions

A

Bronchospasm

45
Q

Treatment of Bronchospasm

A
  1. Administer supplemental oxygen.
  2. Remove the patient from the source of exposure to any irritant gas or other offending agent.
  3. Immediately discontinue any beta-blocker treatment.
  4. Administer bronchodilators: Aerosolized ß2 stimulant (eg, albuterol 2.5 in nebulizer)
46
Q

If this is not effective, and particularly for beta blocker induced wheezing, give _____, ___ mg/kg IV over ___ minutes.

This* is referring to Tx of Bronchospasm

A

aminophylline; 6; 30

47
Q

For patients with bronchospasm and bronchorrhea caused by organophosphate or other anticholinesterase poisoning, give _____

A

atropine

48
Q

The circulation should be assessed by continuous monitoring of the following:

A
  1. pulse rate,
  2. blood pressure,
  3. urinary output, and
  4. evaluation of peripheral perfusion
49
Q

An intravenous line should be placed and blood drawn for _________ and other routine determinations.

A

serum glucose

50
Q

___________ in the toxic patient must be addressed as quickly as possible in order to avoid the sequelae of shock

A

Hypotension

A fluid challenge of 100-200 mL of a crystalloid solution (10-20 mL/kg in pediatrics) is often given at this time while urine output is monitored (0.5-1 mL/kg/hour).

51
Q

If the patient’s mental status is altered or if hypotension exists, four essentials are administered.

A

Thiamine, Oxygen, Naloxone, & Glucose

T-O-N-G

52
Q

This can be especially effective in Px with limited glycogen stores (e.g. neonates and patients w/ cirrhosis)

Drugs to be utilized in toxic Px with altered mental status

A

25-50g of dextrose IV to reverse the effects of drug-induced hypoglycemia (adult) 1mL/kg and diluted 1:1 (child)

Extravasation into the extremity of this hyperosmolar solution can cause VOLKMANN’S contractures

53
Q

Prevent WERNICKE’s encephalopathy

Drugs to be utilized in toxic Px with altered mental status

A

50-100mg of IV thiamine

a water soluble vitamin with low toxicity; rare anaphylactoid reactions have been reported

54
Q

Specific opioid antagonist without any agonist properties

Drugs to be utilized in toxic Px with altered mental status

A

Initial dosage of Naloxone

55
Q

Useful for carbon monoxide, hydrogen, sulfide, and asphyxiants

Drugs to be utilized in toxic Px with altered mental status

A

Oxygen, utilized in 100% concentration

While oxygen is antidotal for carbon monoxide intoxication, the only relative toxic contraindication is in paraquat intoxication (in that it can promote pulmonary fibrosis).

56
Q

______ are due to intentional suicidal overdose by an adolescent or adult.

A

Acute poisoning

57
Q

Childhood deaths due to ________ of a drug or toxic household product.

A

accidental ingestion

58
Q

REMEMBER

Careful management of:
* Respiratory failure
* Hypotension
* Seizure
* Thermoregulatory disturbances

… will result in an improved survival of patients who reach the hospital alive

A

Clinical Toxicology (3 decks)

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