Introduction To Toxicology Flashcards
Is the ability of the substance to produce injury upon reaching a susceptible site in/on the body
Toxicity
It is the science of poisons including not only their chemical and physical effects but for their detection and antidotes.
Toxicicology
Scientist who study this harmful effect and asses the probability of their occurrence are called ________
Toxicologist
What are the 4 major Disciplines in Toxicology
Mechanistic , Descriptive , Clinical and Forensic
One of the Discpline in Toxicology that uses results from animal experiments to predict the level of exposure to harmful to humans
Descriptive
Descriptive Discipline is also known as _________
Risk Assestment
Refers to toxic substances that are produced naturally
Toxins
Provides basis of therapy design and develop test for assestment
Mechanistic
One of the Discpline in Toxicology that study the interelationship between toxin exposure and disease state
Clinical Discpline
One of the Discpline in Toxicology concerned with medicolegal consequence of toxin exposure
Forensic
What are the 5 Sub-Discipline of Toxicology
Economic toxicology, Forensic Toxicology , Clinical toxicology , Environmental Toxicology, Industrial Toxicology.
Refers to toxic substances that are produce by or are a by product of human made activities
Toxicant
One of the Sub-Discpline in Toxicology that concerned in chemicals used in drugs, Food Additives , pesticides and cosmetics
Economic Toxicology
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
Forensic Toxicology
Is use to describe the nature of adverse effect produced and the condition neccessary for their production
Toxicity
One of the Sub-Discpline in Toxicology that evaluate the synergestic effects of chemicals that are contaminant of food , water , soil or the air
Environmental Toxicology
One of the Sub-Discpline in Toxicology that evaluate the effects of pollutant in the working environment .
Industrial (Occupational) Toxicology
General Fxn of Toxicology
G-I-Q-I-C-D-P-G-M
Wrote the famous Treatise on Poison and their antidote
Moses Maimonides (1335-1204)
Paracelcus is Famous for his word that
The Dose Makes the Poison
All Substance are Poison
There is None which is not poison
The right dose differentiate poison from remedy
Noted as the Father of Pharmacology
Francoise Magendie (1783-1855)
French Toxicologist and Chemist, The founder of Science of Toxicology
Mathieu Joseph Bonaventure
Synthesized caffeine and recieved the nobel prize in chemistry in 1902
Emil Fischer 1852-1919
4 Basis of Classifying Poisons
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
List The 7 Classifications of Toxic Agents
Heavy Metals Solvent And Vapors Radiation and Radioactive Materials Dioxins/Furans Pesticide Plant Toxins Animal Toxins
What are the 2 types of Exposure
Acute Exposure and Chronic Exposure
An exposure in which the dose is delivered in a single event and the absorption process is rapid
Acute Exposure
An exposure in which the dose is delivered at some frequency over a period of time
Chronic Exposure
Measurement of Toxicity is related to ;
Characteristic and Condition of Exposure Route of Administration Time and Frequency of Exposure Dose Delivered Physical and Chemical form of the substance
Give 4 Routes of Administration
Pulmonary , GIT/Oral , Parenteral, Topical
Give the 6 Parenteral Route
Intravenous Subcutaneous Intramuscular Intradermal Intraperitoneal Intraspinal
Give the 2 Spectrum of toxic effects
Acute Effect and Chronic Effect
Toxic Effect that occurs or develop rapidly after a single administration
Acute Effect
Those that are manifested after the elapse of sometime
Chronic
What are 2 types of Effect base on Locus of Action
Local Effect and Systemic Effect
Effects that occur at the site of the first contact between the biologic system and the toxicant
Acute Effect
Effect that require absorption and distribution of the toxicant to a site distant from its entry point effect are produced
Chronic Effect
In Chronic effect that frequently involved system is the
CNS
Classification of toxicant based on their relative toxicities
Give the Toxic Ratings and There Commonly used term
Toxic Ratings Commonly used term
6 Super Toxic
5 Extremely Toxic
4 Very Toxic
3 Moderately Toxic
2 Slightly Toxic
1 Practically Non-Toxic
Practically Non-toxic Probable human LD
15g/kg( >1quart)
Slightly Toxic Probable human LD
5-15g/kg ( between 1pint - 1quart)
Moderately Toxic Probable human LD
0.5-5g/kg ( bet 1 oz. - 1 pint )
Very Toxic Probable human LD
50-500mg/kg ( 1 tsp -1oz.)
Extremely Toxic Probable human LD
5-50mg/kg ( 7gtts/drops - 1 tsp)
Super Toxic Probable human LD
> 5mg/kg ( a taste of > 7 drops )
Defined as an overdose of drugs , medicament , chemicals and biological substance
Poison
The 3 Diagnostic workup of a Px who may be a victim of poisoning
- Complete History
- Complete Physical examination
- Appropriate Laboratory Examination
Cases of Poisoning that generally fall into 3 categories
- Exposure to known poison
- Exposure to an unknown substance which may be a poison
- Disease of undetermined etiology in which poisoning must be considered as part of the differential Dx.
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
Self Poisoning/Parasuicide
Non-intentional ingestion overdose or exposure to drugs, medicaments or poisonous substances
Accidental Poisoning
The 7 General approach to the poisoning patient
- Emergency Stabilization
- Clinical Evaluation
- Elimination of the poison
- Excretion of Absorbed substance
- Administration of antidote
- Supportive therapy and observation
- Dispositions
The greatest contributor death from drug overdose is _____________
Loss of airway protective reflexes
Emergency stabilization is needed if
ABCDE
What are the 6 techniques in Clearing airways
Sniffing Position Chin Lift Jaw Thrust Head Down Left Sided Position Intubation ( Orotracheal . Nasotracheal)
A technique in clearing airways that allows the tongue to fall forward and secretions and vomitus to drain out of the mouth
Head- Down Left sided positon
A technique in clearing airways that should not be used if there is any suspicion or neck injury
Sniffing Position
A technique in clearing airways that is used when a Px may have cervical spine injury
Jaw Thrust
Enumerate the procedures in CHIN-LIFT
- The fingers of one hand are placed under the mandible, which is gently lifted upward to bring the chin anterior
- The Thumb of the same hand depresses the lower lip to open the mouth
- The Thumb may also be laced behind the lower incisors and simultaneously, the chin is gently lifted
4 Indications in Orotracheal
- Inadequate oxygenation
2 Inadequate ventilation - Need to control and remove pulmonary secretion
( Bronchial Toilet) - Need to provide airway protection in an obtunded Px or a Px with a depressed gag reflex
2 Contraindication of Orotracheal
- Severe airway trauma
2. Cervical Spine Injury
What are the procedure in doing Orotracheal intubation
S.A.L.T.
A device that lifts the tongue off the posterior pharynx, often making it easier to mask ventilate a Px
Oral Airway
This Lighted tool is vital to placing an endotracheal tube
Laryngoscope
In Endotracheal tubes the average adult size is
7.0 to 8.0
Give the 4 advantages of Oratracheal Intubations
1.Performed under direct vision
2. Insignificant risk of bleeding
3.Px need not to be breathing
spontaneously
4.Higher succes rate
Give the 2 disadvantages of Orotracheal
- Frequently requires neuromuscular paralysis
2. Requires neck manipulation
Nasotracheal Intubation is also called as what technique
Blind Technique
An intubation where a tube is passed through the nose, larynx , vocal cords and trachea
Nasotracheal
2 Advantage of Nasotracheal Intubation
- May be performed in a conscious patient without requiring neuromuscular paralysis
- Better tolerated once place
4 Disadvantage of Nasotracheal Intubation
- Perforation of the nasal mucosa with epistaxis
- Stimulation of Vomiting in an obtunded Px
- Px must be breathing simultaneously
- Difficult in infants anatomically because of anterior epiglottis
Clinical Evaluation is composed of
A. History
B. Physical Examination
Hypothermia is a condition in which the Px has a rectal temp of ____
Hypothermia may be due to overdose of
B.O.C.A.S
Things that are noted in History in Clinical Evaluation
- Time of Exposure
- Mode of Exposure
- Intake of other substance
- Circumstances prior to poisoning
- Current medication
- Past Medical History
- Any Home Remedy Taken
Hyperthermia is a condition when the rectal temp is ____
> 40°C
Hyperthermia maybe due to overdoseo of :
Antihistamine Amphetamines Cocaine Anticholinergic Isoniazid
A common finding in alcohol intoxication and salicylates toxicity
Hypoglycemia
Hypocalcemia is commonly seen in :
Dancing Firecrackers
Jatropa Seed Ingestion
Complications of severe animal bites and stings
Physical Examination in Clinical Evaluation
- Evaluate general status of a Px
- Examine Px skin
- Px breath/odor
- Auscultate
- Listen To Px heart
- Check The abdomen
- Do a complete neurologic examination
Substances that causes Tachycardia
CO, HCN , Organophosphates
,Ethanol
Substance that causes Bradycardia
Digitalis
Substances that causes Hypertension
Cocaine
Caffeine
Amphetamine
Nicotine
Substances that causes Hypotension
Antidepressant
Heroine
Opiates
Sedative-Hypnotics
Patients breath / Odor with CN poisoning
Bitter almonds
Patients breath / Odor in Px with Diabetic Ketoacidosis
Fruity
Patients breath / Odor with Sulfur Dioxide , Hydrogen Sulfide poisoning
Rotten Egg
Patients breath / Odor with Organophosphate and arsenic poisoning
Garlic
An instrument/Tool use to complete neurologic examination
Glasgow Coma Scale
The Glasgow Coma Scale comprises three test namely
Eyes , Verbal and Motor
The lowest possible GCS
3 ( Coma or Death )
The highest possible GCS
15 ( Fully Awake person)
What are the 5 Methods in Eliminating Poison
- External Decontamination
- Empty The Stomach
- Limit Gastrointestinal Absorption
4.Dialysis and Hemoperfusion
5 Whole Bowel Irrigation
Differences in reponse to toxicant in a population is due to :
Genetics Gender Age Nutritional Status Health Condition Previous/Concurrent Exposure to other substances
3 ways in doing External Decontamination
- Discard Px clothing
- Bathe or shower the Px
- Copious irrigation with water in eye contamination
2 ways in Emptying the stomach
- Emesis
2. Gastric lavage
A substance that is use in Limit Gastrointestinal Absorption
Activated charcoal lavage
Where does Lead and Fluoride stored
Bones
Biotransformation Occur on what organs
Liver ( Major ) , Lungs , Kidneys and intestines
How much is the average concentration of CO in the atmosphere
0.1ppm
In heavy traffic the concentration of CO may exceed
100ppm
In CO what are the organs mostly affected
Brain and Heart
a solvent in paint removers in metabolized to CO
Methylene Chloride
The affinity of CO to Hgb
210-250 times that of O2
Mechanism of Toxicity of CO
CO bind to Hgb with an affinity of 210-250
Inhibits Cytochrome oxidase
Binds to Myoglobin
Net Effects of CO
Tissue Hypoxia
Anaerobic Metabolism
Lactic Acidosis
A normal non-smoking adult has COHb level of ?
Smokers has COHb level of
5-10 % depending on the habit
CO is excreted through what organ ?
Lungs
At room air the CO half life is
4 to 6 hrs
Half life of CO when breathing 100% O2
40-80 mins
Half Life of CO with Hyperbarci O2 therapy
15-30mins
Principle signs of CO intoxication
Hypoxia
Clinical Presentation of CO poisoning
- Psychomotor Impairment
- Headache and tightness of the terporal area
- Confusion and Loss of Visual Activity
- Tachycardia , Tachypnea , syncope and coma
- Deep coma , convulsion , shock and respiratory failure
Give the COHb % and Estimated CO concentration with these symptoms None or Mild Headache
5% , 35 ppm
Give the COHb % and Estimated CO concentration with these symptoms Slight headache dyspnea on vigorous exertion
10% , 50ppm ( 0.005%)
Give the COHb % and Estimated CO concentration with these symptoms throbbing headache dyspnea with moderate exertion
20% , 100ppm ( 0.01%)
Give the COHb % and Estimated CO concentration with these symptoms Severe headache, irratability, fatigue , dimness of vision
30% , 200ppm (0.02%)
Give the COHb % and Estimated CO concentration with these symptoms Headache , Tachycardia, Confusion , Lethargy , Collapse
40-50% , 300-500ppm
( 0.03% - .05% )
Give the COHb % and Estimated CO concentration with these symptoms Coma, Convulsion
60-70% ,
800ppm-1200ppm(0.08%-.12%)
Give the COHb % and Estimated CO concentration with these symptoms rapidly fatal
80% , 1900ppm ( .19%)
Immediate Dangerous to Life or Death in CO is
1500ppm ( .15%)
Several exposure to 1000ppm or .1% may result to what
50% saturation of COHb and fatal Poisoning
Dx in CO poisoing
History of Exposure
Cherry Red skin
Bright red venous blood
Measurement of COHb
Specific drug and antidote in CO poisoning
Administer OXYGEN in the highest possible concentration
CO poisoning Enhance elimination
Hyperbaric Oxygen which provides 100% OXYGEn under 2-3 atm pressure
4 Synonyms of HCN
- CYCLON
- Formonitrile
- HDNC Hydridonitridocarbon
- Hydrocyanic Acid (prussic)
Mechanism of Toxicity in HCN
- Binds to the Cytochrome A and by inhibiting reoxidation
- Inhibit Electron Transport
Prevents cellular respiration and Decrease ATP production
3.Produce severe metabollic acidosis - Cyanohemoglobin which cannot transport oxygen
Clinical Presentation
Initially ( Tachypnea ) Respiratory depression and cyanosis Hypotension Convulsion Coma Death will occur in minutes at signifcant amt.
A treatment for HCN poisoning using inhalation
Amyl Nitrite
A treatment for HCN poisoning using Intravenous administration
Sodium thiosulfate and Sodium nitrite
A treatment for HCN poisoning using Oral administration
Hydroxycobalamine
Odor of Formaldehyde
Pungent Odor
how much concentration of Formalin is there as disinfectant and tissue fixativee
37-40%
Formalin as a Disinfectant and tissue fixative contains how many concentrations of methanol
6-15%
In Formalin methanol acts as
Stabilizer
Give 5 Uses of Fomarldehyde
- Use as disinfectant in hemodialyzers
- Sporocidal
- Preparation of Vaccines
- Preservatives
- Irritant
Mechanism of Toxicity of Formaldehyde
Causes precipitation of proteins and will cause coagulation necrosis in exposed tissue
PEL of Formaldehyde
1ppm
IDLH of Formaldehyde
2ppm
How much vol will it take to result death in 37% formalin
30ml
Formate intoxication due to formaldehyde alone be given with _____
Folic Acid
What causes cutaneous bullae
Barbiturates and CO poisoning
What causes diaphoresis
Organophosphate , salicylates , and amphetamine toxicity
what causes flushing
alcohol , CN and CO
what causes dry skin and hyperpyrexia
atrophine , anticholinergic agents