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Clinical Chemistry > Introduction To Toxicology > Flashcards

Introduction To Toxicology Flashcards

1
Q

Is the ability of the substance to produce injury upon reaching a susceptible site in/on the body

A

Toxicity

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2
Q

It is the science of poisons including not only their chemical and physical effects but for their detection and antidotes.

A

Toxicicology

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3
Q

Scientist who study this harmful effect and asses the probability of their occurrence are called ________

A

Toxicologist

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4
Q

What are the 4 major Disciplines in Toxicology

A

Mechanistic , Descriptive , Clinical and Forensic

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5
Q

One of the Discpline in Toxicology that uses results from animal experiments to predict the level of exposure to harmful to humans

A

Descriptive

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6
Q

Descriptive Discipline is also known as _________

A

Risk Assestment

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7
Q

Refers to toxic substances that are produced naturally

A

Toxins

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8
Q

Provides basis of therapy design and develop test for assestment

A

Mechanistic

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9
Q

One of the Discpline in Toxicology that study the interelationship between toxin exposure and disease state

A

Clinical Discpline

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10
Q

One of the Discpline in Toxicology concerned with medicolegal consequence of toxin exposure

A

Forensic

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11
Q

What are the 5 Sub-Discipline of Toxicology

A

Economic toxicology, Forensic Toxicology , Clinical toxicology , Environmental Toxicology, Industrial Toxicology.

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12
Q

Refers to toxic substances that are produce by or are a by product of human made activities

A

Toxicant

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13
Q

One of the Sub-Discpline in Toxicology that concerned in chemicals used in drugs, Food Additives , pesticides and cosmetics

A

Economic Toxicology

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14
Q

One of the Sub-Discpline in Toxicology that helps establish cause and effect relationships between exposure to a drug or chemical and the toxic and lethal effect result

A

Forensic Toxicology

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15
Q

Is use to describe the nature of adverse effect produced and the condition neccessary for their production

A

Toxicity

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16
Q

One of the Sub-Discpline in Toxicology that evaluate the synergestic effects of chemicals that are contaminant of food , water , soil or the air

A

Environmental Toxicology

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17
Q

One of the Sub-Discpline in Toxicology that evaluate the effects of pollutant in the working environment .

A

Industrial (Occupational) Toxicology

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18
Q

General Fxn of Toxicology

A

G-I-Q-I-C-D-P-G-M

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19
Q

Wrote the famous Treatise on Poison and their antidote

A

Moses Maimonides (1335-1204)

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20
Q

Paracelcus is Famous for his word that

A

The Dose Makes the Poison
All Substance are Poison
There is None which is not poison
The right dose differentiate poison from remedy

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21
Q

Noted as the Father of Pharmacology

A

Francoise Magendie (1783-1855)

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22
Q

French Toxicologist and Chemist, The founder of Science of Toxicology

A

Mathieu Joseph Bonaventure

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23
Q

Synthesized caffeine and recieved the nobel prize in chemistry in 1902

A

Emil Fischer 1852-1919

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24
Q

4 Basis of Classifying Poisons

A

Base on Its Analysis
Base on the organ or system considered the target site of the effect of the chemical
Mechanism of Toxicity
Manner of Exposure

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25
Q

List The 7 Classifications of Toxic Agents

A 
Heavy Metals
Solvent And Vapors
Radiation and Radioactive Materials
Dioxins/Furans
Pesticide 
Plant Toxins
Animal Toxins
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26
Q

What are the 2 types of Exposure

A

Acute Exposure and Chronic Exposure

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27
Q

An exposure in which the dose is delivered in a single event and the absorption process is rapid

A

Acute Exposure

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28
Q

An exposure in which the dose is delivered at some frequency over a period of time

A

Chronic Exposure

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29
Q

Measurement of Toxicity is related to ;

A 
Characteristic and Condition of Exposure
Route of Administration
Time and Frequency of Exposure
Dose Delivered
Physical and Chemical form of the substance
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30
Q

Give 4 Routes of Administration

A

Pulmonary , GIT/Oral , Parenteral, Topical

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31
Q

Give the 6 Parenteral Route

A 
Intravenous
Subcutaneous
Intramuscular
Intradermal
Intraperitoneal
Intraspinal
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32
Q

Give the 2 Spectrum of toxic effects

A

Acute Effect and Chronic Effect

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33
Q

Toxic Effect that occurs or develop rapidly after a single administration

A

Acute Effect

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34
Q

Those that are manifested after the elapse of sometime

A

Chronic

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35
Q

What are 2 types of Effect base on Locus of Action

A

Local Effect and Systemic Effect

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36
Q

Effects that occur at the site of the first contact between the biologic system and the toxicant

A

Acute Effect

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37
Q

Effect that require absorption and distribution of the toxicant to a site distant from its entry point effect are produced

A

Chronic Effect

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38
Q

In Chronic effect that frequently involved system is the

A

CNS

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39
Q

Classification of toxicant based on their relative toxicities
Give the Toxic Ratings and There Commonly used term

A

Toxic Ratings Commonly used term
6 Super Toxic
5 Extremely Toxic
4 Very Toxic
3 Moderately Toxic
2 Slightly Toxic
1 Practically Non-Toxic

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40
Q

Practically Non-toxic Probable human LD

A

15g/kg( >1quart)

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41
Q

Slightly Toxic Probable human LD

A

5-15g/kg ( between 1pint - 1quart)

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42
Q

Moderately Toxic Probable human LD

A

0.5-5g/kg ( bet 1 oz. - 1 pint )

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43
Q

Very Toxic Probable human LD

A

50-500mg/kg ( 1 tsp -1oz.)

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44
Q

Extremely Toxic Probable human LD

A

5-50mg/kg ( 7gtts/drops - 1 tsp)

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45
Q

Super Toxic Probable human LD

A

> 5mg/kg ( a taste of > 7 drops )

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46
Q

Defined as an overdose of drugs , medicament , chemicals and biological substance

A

Poison

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47
Q

The 3 Diagnostic workup of a Px who may be a victim of poisoning

A
  1. Complete History
  2. Complete Physical examination
  3. Appropriate Laboratory Examination
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48
Q

Cases of Poisoning that generally fall into 3 categories

A
  1. Exposure to known poison
  2. Exposure to an unknown substance which may be a poison
  3. Disease of undetermined etiology in which poisoning must be considered as part of the differential Dx.
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49
Q

Used to refer to the deliberate ingestion of more than the therapeutic dose of a drug or a substance not intended for consumption, usually by an adult in a moment of distress

A

Self Poisoning/Parasuicide

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50
Q

Non-intentional ingestion overdose or exposure to drugs, medicaments or poisonous substances

A

Accidental Poisoning

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51
Q

The 7 General approach to the poisoning patient

A
  1. Emergency Stabilization
  2. Clinical Evaluation
  3. Elimination of the poison
  4. Excretion of Absorbed substance
  5. Administration of antidote
  6. Supportive therapy and observation
  7. Dispositions
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52
Q

The greatest contributor death from drug overdose is _____________

A

Loss of airway protective reflexes

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53
Q

Emergency stabilization is needed if

A

ABCDE

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54
Q

What are the 6 techniques in Clearing airways

A 
Sniffing Position
Chin Lift
Jaw Thrust
Head Down Left Sided Position
Intubation ( Orotracheal . Nasotracheal)
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55
Q

A technique in clearing airways that allows the tongue to fall forward and secretions and vomitus to drain out of the mouth

A

Head- Down Left sided positon

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56
Q

A technique in clearing airways that should not be used if there is any suspicion or neck injury

A

Sniffing Position

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57
Q

A technique in clearing airways that is used when a Px may have cervical spine injury

A

Jaw Thrust

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58
Q

Enumerate the procedures in CHIN-LIFT

A
  1. The fingers of one hand are placed under the mandible, which is gently lifted upward to bring the chin anterior
  2. The Thumb of the same hand depresses the lower lip to open the mouth
  3. The Thumb may also be laced behind the lower incisors and simultaneously, the chin is gently lifted
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59
Q

4 Indications in Orotracheal

A
  1. Inadequate oxygenation
    2 Inadequate ventilation
  2. Need to control and remove pulmonary secretion
    ( Bronchial Toilet)
  3. Need to provide airway protection in an obtunded Px or a Px with a depressed gag reflex
60
Q

2 Contraindication of Orotracheal

A
  1. Severe airway trauma

2. Cervical Spine Injury

61
Q

What are the procedure in doing Orotracheal intubation

A

S.A.L.T.

62
Q

A device that lifts the tongue off the posterior pharynx, often making it easier to mask ventilate a Px

A

Oral Airway

63
Q

This Lighted tool is vital to placing an endotracheal tube

A

Laryngoscope

64
Q

In Endotracheal tubes the average adult size is

A

7.0 to 8.0

65
Q

Give the 4 advantages of Oratracheal Intubations

A

1.Performed under direct vision
2. Insignificant risk of bleeding
3.Px need not to be breathing
spontaneously
4.Higher succes rate

66
Q

Give the 2 disadvantages of Orotracheal

A
  1. Frequently requires neuromuscular paralysis

2. Requires neck manipulation

67
Q

Nasotracheal Intubation is also called as what technique

A

Blind Technique

68
Q

An intubation where a tube is passed through the nose, larynx , vocal cords and trachea

A

Nasotracheal

69
Q

2 Advantage of Nasotracheal Intubation

A
  1. May be performed in a conscious patient without requiring neuromuscular paralysis
  2. Better tolerated once place
70
Q

4 Disadvantage of Nasotracheal Intubation

A
  1. Perforation of the nasal mucosa with epistaxis
  2. Stimulation of Vomiting in an obtunded Px
  3. Px must be breathing simultaneously
  4. Difficult in infants anatomically because of anterior epiglottis
71
Q

Clinical Evaluation is composed of

A

A. History

B. Physical Examination

72
Q

Hypothermia is a condition in which the Px has a rectal temp of ____

A
73
Q

Hypothermia may be due to overdose of

A

B.O.C.A.S

74
Q

Things that are noted in History in Clinical Evaluation

A
  1. Time of Exposure
  2. Mode of Exposure
  3. Intake of other substance
  4. Circumstances prior to poisoning
  5. Current medication
  6. Past Medical History
  7. Any Home Remedy Taken
75
Q

Hyperthermia is a condition when the rectal temp is ____

A

> 40°C

76
Q

Hyperthermia maybe due to overdoseo of :

A 
Antihistamine
Amphetamines
Cocaine
Anticholinergic
Isoniazid
77
Q

A common finding in alcohol intoxication and salicylates toxicity

A

Hypoglycemia

78
Q

Hypocalcemia is commonly seen in :

A

Dancing Firecrackers
Jatropa Seed Ingestion
Complications of severe animal bites and stings

79
Q

Physical Examination in Clinical Evaluation

A
  1. Evaluate general status of a Px
  2. Examine Px skin
  3. Px breath/odor
  4. Auscultate
  5. Listen To Px heart
  6. Check The abdomen
  7. Do a complete neurologic examination
80
Q

Substances that causes Tachycardia

A

CO, HCN , Organophosphates

,Ethanol

81
Q

Substance that causes Bradycardia

A

Digitalis

82
Q

Substances that causes Hypertension

A

Cocaine
Caffeine
Amphetamine
Nicotine

83
Q

Substances that causes Hypotension

A

Antidepressant
Heroine
Opiates
Sedative-Hypnotics

84
Q

Patients breath / Odor with CN poisoning

A

Bitter almonds

85
Q

Patients breath / Odor in Px with Diabetic Ketoacidosis

A

Fruity

86
Q

Patients breath / Odor with Sulfur Dioxide , Hydrogen Sulfide poisoning

A

Rotten Egg

87
Q

Patients breath / Odor with Organophosphate and arsenic poisoning

A

Garlic

88
Q

An instrument/Tool use to complete neurologic examination

A

Glasgow Coma Scale

89
Q

The Glasgow Coma Scale comprises three test namely

A

Eyes , Verbal and Motor

90
Q

The lowest possible GCS

A

3 ( Coma or Death )

91
Q

The highest possible GCS

A

15 ( Fully Awake person)

92
Q

What are the 5 Methods in Eliminating Poison

A
  1. External Decontamination
  2. Empty The Stomach
  3. Limit Gastrointestinal Absorption
    4.Dialysis and Hemoperfusion
    5 Whole Bowel Irrigation
93
Q

Differences in reponse to toxicant in a population is due to :

A 
Genetics 
Gender
Age
Nutritional Status
Health Condition
Previous/Concurrent Exposure to other substances
94
Q

3 ways in doing External Decontamination

A
  1. Discard Px clothing
  2. Bathe or shower the Px
  3. Copious irrigation with water in eye contamination
95
Q

2 ways in Emptying the stomach

A
  1. Emesis

2. Gastric lavage

96
Q

A substance that is use in Limit Gastrointestinal Absorption

A

Activated charcoal lavage

97
Q

Where does Lead and Fluoride stored

A

Bones

98
Q

Biotransformation Occur on what organs

A

Liver ( Major ) , Lungs , Kidneys and intestines

99
Q

How much is the average concentration of CO in the atmosphere

A

0.1ppm

100
Q

In heavy traffic the concentration of CO may exceed

A

100ppm

101
Q

In CO what are the organs mostly affected

A

Brain and Heart

102
Q

a solvent in paint removers in metabolized to CO

A

Methylene Chloride

103
Q

The affinity of CO to Hgb

A

210-250 times that of O2

104
Q

Mechanism of Toxicity of CO

A

CO bind to Hgb with an affinity of 210-250
Inhibits Cytochrome oxidase
Binds to Myoglobin

105
Q

Net Effects of CO

A

Tissue Hypoxia
Anaerobic Metabolism
Lactic Acidosis

106
Q

A normal non-smoking adult has COHb level of ?

A
107
Q

Smokers has COHb level of

A

5-10 % depending on the habit

108
Q

CO is excreted through what organ ?

A

Lungs

109
Q

At room air the CO half life is

A

4 to 6 hrs

110
Q

Half life of CO when breathing 100% O2

A

40-80 mins

111
Q

Half Life of CO with Hyperbarci O2 therapy

A

15-30mins

112
Q

Principle signs of CO intoxication

A

Hypoxia

113
Q

Clinical Presentation of CO poisoning

A
  1. Psychomotor Impairment
  2. Headache and tightness of the terporal area
  3. Confusion and Loss of Visual Activity
  4. Tachycardia , Tachypnea , syncope and coma
  5. Deep coma , convulsion , shock and respiratory failure
114
Q

Give the COHb % and Estimated CO concentration with these symptoms None or Mild Headache

A

5% , 35 ppm

115
Q

Give the COHb % and Estimated CO concentration with these symptoms Slight headache dyspnea on vigorous exertion

A

10% , 50ppm ( 0.005%)

116
Q

Give the COHb % and Estimated CO concentration with these symptoms throbbing headache dyspnea with moderate exertion

A

20% , 100ppm ( 0.01%)

117
Q

Give the COHb % and Estimated CO concentration with these symptoms Severe headache, irratability, fatigue , dimness of vision

A

30% , 200ppm (0.02%)

118
Q

Give the COHb % and Estimated CO concentration with these symptoms Headache , Tachycardia, Confusion , Lethargy , Collapse

A

40-50% , 300-500ppm

( 0.03% - .05% )

119
Q

Give the COHb % and Estimated CO concentration with these symptoms Coma, Convulsion

A

60-70% ,

800ppm-1200ppm(0.08%-.12%)

120
Q

Give the COHb % and Estimated CO concentration with these symptoms rapidly fatal

A

80% , 1900ppm ( .19%)

121
Q

Immediate Dangerous to Life or Death in CO is

A

1500ppm ( .15%)

122
Q

Several exposure to 1000ppm or .1% may result to what

A

50% saturation of COHb and fatal Poisoning

123
Q

Dx in CO poisoing

A

History of Exposure
Cherry Red skin
Bright red venous blood
Measurement of COHb

124
Q

Specific drug and antidote in CO poisoning

A

Administer OXYGEN in the highest possible concentration

125
Q

CO poisoning Enhance elimination

A

Hyperbaric Oxygen which provides 100% OXYGEn under 2-3 atm pressure

126
Q

4 Synonyms of HCN

A
  1. CYCLON
  2. Formonitrile
  3. HDNC Hydridonitridocarbon
  4. Hydrocyanic Acid (prussic)
127
Q

Mechanism of Toxicity in HCN

A
  1. Binds to the Cytochrome A and by inhibiting reoxidation
  2. Inhibit Electron Transport
    Prevents cellular respiration and Decrease ATP production
    3.Produce severe metabollic acidosis
  3. Cyanohemoglobin which cannot transport oxygen
128
Q

Clinical Presentation

A 
Initially ( Tachypnea )
Respiratory depression and cyanosis
Hypotension
Convulsion
Coma
Death will occur in minutes at signifcant amt.
129
Q

A treatment for HCN poisoning using inhalation

A

Amyl Nitrite

130
Q

A treatment for HCN poisoning using Intravenous administration

A

Sodium thiosulfate and Sodium nitrite

131
Q

A treatment for HCN poisoning using Oral administration

A

Hydroxycobalamine

132
Q

Odor of Formaldehyde

A

Pungent Odor

133
Q

how much concentration of Formalin is there as disinfectant and tissue fixativee

A

37-40%

134
Q

Formalin as a Disinfectant and tissue fixative contains how many concentrations of methanol

A

6-15%

135
Q

In Formalin methanol acts as

A

Stabilizer

136
Q

Give 5 Uses of Fomarldehyde

A
  1. Use as disinfectant in hemodialyzers
  2. Sporocidal
  3. Preparation of Vaccines
  4. Preservatives
  5. Irritant
137
Q

Mechanism of Toxicity of Formaldehyde

A

Causes precipitation of proteins and will cause coagulation necrosis in exposed tissue

138
Q

PEL of Formaldehyde

A

1ppm

139
Q

IDLH of Formaldehyde

A

2ppm

140
Q

How much vol will it take to result death in 37% formalin

A

30ml

141
Q

Formate intoxication due to formaldehyde alone be given with _____

A

Folic Acid

142
Q

What causes cutaneous bullae

A

Barbiturates and CO poisoning

143
Q

What causes diaphoresis

A

Organophosphate , salicylates , and amphetamine toxicity

144
Q

what causes flushing

A

alcohol , CN and CO

145
Q

what causes dry skin and hyperpyrexia

A

atrophine , anticholinergic agents

Clinical Chemistry (8 decks)

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