Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3R2 - Toxicology ☠️ > L1: General Toxicology > Flashcards

L1: General Toxicology Flashcards

1
Q

Def of Toxicology

A

Science dealing with
- Properties
- Actions
- Toxicity
- Autopsy findings (in case of death, in relation to poisonous substances).
- Fatal dose
- Detection
- Estimation
- Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a Toxicant?

A

Specific chemical poisonous.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Categorization of toxic effects

A
  • Toxic effects are categorized according to site of poison effect.
  • In some cases, effect may occur at only one site, This site is referred to as specific target organ.
  • In other cases, toxic effects may occur at multiple sites.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of systemic toxicity

A
  • Acute toxicity
  • Subacute toxicity
  • Chronic toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Onset of Acute Toxicity

A
  • occurs almost immediately (hours/days) after an exposure.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of Acute Toxicity

A

usually a single dose or a series of doses received within one day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Onset of Subacute Toxixity

A

results from repeated exposure for several weeks or months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of Subacute Toxixity

A

This is a common human exposure pattern for some pharmaceuticals and environmental agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Onset of Chronic Toxicity

A
  • It represents cumulative damage to specific organ systems
  • takes many months or years to become a recognizable clinical disease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of Chronic Toxicity

A
  • Damage due to subclinical individual exposures may go unnoticed but with repeated subclinical exposures, cumulative damage slowly builds up until it exceeds threshold for chronic toxicity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Manners of posining

A

Suicidal (Deliberate): Overdose as self-harm.

Accidental: Most episodes of pediatric poisoning, dosage error or iatrogenic.

Homicidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are poisons classified according to?

A
  • According to their mode of action
  • According to the organs affected: (Target Organ Toxicity).
  • According to the chemical nature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classification of poisons, according to their mode of action

A
  • Poisons with local action
  • Poisons with remote action
  • Poisons with both local and remote actions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are posions with local action? and are examples for them?

A
  • They act locally producing immediate destruction of tissues with which they come in contact

e.g., corrosives (except organic acids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Def of poisons with Remote action

A

They act only after absorption without any local effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of poisons with Remote action

A

plant poisons which act mainly on CNS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Def of poisons with Local & Remote action

A

which have a local irritant action on tissues, they come in contact for some time and a remote action (on parenchymatous organs) after absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Examples of poisons with Local & Remote action

A

irritant metallic poisons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Classification of poison according to organ affected

A
  • Neurotoxic (Brain)
  • Hepatotoxic (liver)
  • Nephrotoxic (Kidney)
  • Cardiotoxic (Heart)
  • Immunotoxic
  • Respiratory System
  • Reproductive System
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Examples of Neurotoxic (brain) toxins

A
  • Alcohol
  • Lead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Examples of Hepatotoxic (Liver) toxins

A
  • Ethanol
  • Acetaminophen
  • Phosphorus
  • Carbon Tetrachloride.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Examples of Nephrotoxic (Kidney) toxins

A

Heavy metals e.g., mercury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Examples of Cardiotoxic (Heart) toxins

A

Digitalis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Examples of Immunotoxic toxins

A

Isocyanates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Examples of Respiratory System toxins

A
  • Tobacco smoke
  • Asbestos
  • Ozone.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Examples of Reproductive system toxins

A

Di-bromochloropropane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

classification of toxins, according to the chemical nature

A
  • Acids
  • Alkalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Examples of acids

A
  • Sulphuric acid
  • Nitric acid
  • Hydrochloric acid.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Examples of alkalis

A

Caustic soda
Caustic potash
Ammonium hydroxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are factors affecting the severity of toxicity?

A
  • Factors related to the person
  • Factors related to the poison
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Factors related to the person affecting severity of toxicity

A
  • Age of the person
  • Genetic factors
  • Personal hypersensitivity
  • Tolerance
  • Idiosyncrasy
  • State of health
  • Condition of the stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does age affect the severity of toxicity?

A
  • Children and old people are generally more susceptible to toxic agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why are children and people more susceptible to toxic Asians?

A

Due to decrease of detoxification power.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What can children tolerate, and what can’t they?

A

Children can tolerate action of atropine, but not morphine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Person suffering from G6PD deficiency are susceptible at therapeutic doses to hemolytic effect of some drugs like ……..

A

vitamin K and sulphonamides.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Genetic factors affecting severity of toxicity

A

Persons suffering from glucose-6-phosphate dehydrogenase deficiency are susceptible at therapeutic doses to hemolytic effect of some drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How does personal hypersensitivity affect severity of toxicity?

A

Very small harmless doses can produce severe symptoms in sensitive patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Drugs, which are most commonly associated with personal hypersensitivity

A

Therapeutic dose of penicillin or iodine may produce anaphylaxis in hypersensitive patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe tolerance

A

where addicts can stand big dose without ill-effect, So, they have to increase the dose to get same effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What causes tolerance?

A
  • Repeated intake of substances of abuse leads to development of tolerance
  • So, they have to increase the dose to get same effect.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is idiosyncrasy?

A
  • Abnormal response to some drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Drugs associated with idiosyncrasy

A

Morphine may produce convulsions instead of depression of CNS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does state of health affect severity of success?

A

Patients suffering from liver or kidney diseases may show signs of increased toxicity of poisons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Aspects of condition of the stomach

A
  • Type of food
  • Gastric secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How does type of food affect severity of toxicity?

A
  • Fatty foods delay absorption of arsenic
  • while they increase absorption of some poisons as DDT and phosphorus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How do gastric secretions affect severity of toxicity?

A
  • Poisoning with potassium cyanide may not be fatal
  • In case of achlorhydria: as HCL in stomach is important to form severely toxic hydrocyanic acid.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How does state of the poison affect severity of Toxicity?

A

Poisons in gaseous form are more rapidly absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Factors related to the poison, affecting severity of toxicity

A
  • State of the poison
  • Routes of poison administration
  • Dose of the poison
  • Cumulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What form of poisons is most Rapidly absorbed?

A
  • Gaseous form are more rapidly absorbed
  • Followed by:
    Liquid
    Fine powder
    Big lumps.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Route of administration causes the quickest toxicity?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

General scheme for approach of a poisoned patient

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what questions should history taking in poisoning include?

A
  • Type of toxins (What)
  • Time of toxic exposure (acute versus chronic). (When)
  • Amount of toxin taken (How much)
  • Route of toxin administration (i.e. ingestion, intravenous, inhalation) (How.).
  • Manner of the toxic ingestion or exposure. (Why)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How does Dose of the poison affect severity of Toxicity?

A

The bigger the dose, the more toxic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

History taking in poisoning

A
  • History of sudden appearance of toxic manifestations in a healthy person or a group of persons after taking certain food or drink (as food poisoning, methanol and carbon monoxide toxicity).
  • History of intake a poison, financial problems, psychiatric troubles, provious altempts at suicide or threatening by somebody.
  • History of presence of bottle.of tablets or insecticide near the victim.
  • History of patients rescued from fire (CO, cyanido).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Diagnosis of poisoning

A
  • History & Circumstantial evidence
  • Clinical Examination: (General & Local)
  • Investigations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Psychiatric information in poisoning history Taking

A
  • History of psychiatric illness or previous suicide attempts.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

cumulation of poison & its relation to severity of toxicity, then give examples for some drugs that may be accummilated in this way

A
  • After repeated small doses of certain drugs which are not readily metabolized,
  • The effect of a single large dose is reached leading to poisoning e.g., digitalis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What information should history in poisoning include?

A
  • Psychiatric Information
  • Drug(s) Information
  • Unavailable Information
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Drug information in poisoning history Taking

A
  • Information about all drugs taken, including prescription, over the counter medications, vitamins, and herbal preparations.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Examples of Toxidromes

A
  • Sympathomimetic
  • Anticholinergic
  • Hallucinogenic
  • Opiod
  • Sedative - Hypnotic
  • Cholinergic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What to do if there is unavailable information in poisoning history Taking?

A
  • If history is unavailable from patient, information should be taken from family and friends.
  • Paramedics or emergency medical technicians are also good sources of information, because they may be able to furnish details, such as presence of empty pill bottles.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

clinical examination in cases of poisoning

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Examples of drugs causing Sympathomimetic Toxidrome

A

Cocaine.
Amphetamine.
Pseudo-ephedrine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Vital signs in Sympathomimetic Toxidrome

A

Hyperthermia.
Tachycardia.
Hypertension.
Tachypnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Pupils in Sympathomimetic Toxidrome

A

Mydriasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Examples of drugs causing Anticholinergic Toxidrome

A

Atropine.
Tricyclis-antidepressant.
Antibistamine,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Vital Signs in Anticholinergic Toxidrome

A

Hyperthermia.
Tachycardia.
Hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Pupils in Anticholinergic Toxidrome

A

Mydriasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Other findings in Anticholinergic Toxidrome

A

Hot, dry, red.
Blind.
Seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

other findings in Sympathomimetic toxidrome

A

Piloerection.
Hyperreflexia.
Diaphoresis.
Tremors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Examples of Drugs causing Hallucinogenic Toxidrome

A

49-Tetra-Hydrocannabinol.
Phencyclidine.
Lysergic acid diethylamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Vital Signs in Hallucinogenic Toxidrome

A

Tachycardia.
Hypertension.
Tachypnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Pupils in Hallucinogenic Toxidrome

A

Mydriasis.
Nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Other findings in Hallucinogenic Toxidrome

A

Hallucinations.
Agitation.
Disorientation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Examples of drugs causing Opiod Toxidrome

A

Opiates.
Heroin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Pupils in Opiod Toxidrome

A

Hypothermia
Bradycardia.
Hypotension.
Hypopnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Vital Signs in Opiod Toxidrome

A

Miosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Other Findings in Opiod Toxidrome

A

CNS depression.
Coma.
Antidote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Examples of drugs causing Sedative-Hypnotic Toxidrome

A

Benzodiazepines.
Barbiturates.
Alcohol, Anticonvulsant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Vital Signs in Sedative-Hypnotic Toxidrome

A

Hypothermia
Bradycardia.
Hypotension.
Hypopnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Pupils in Sedative-Hypnotic Toxidrome

A

Miosis (usually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Examples of Drugs Causing Cholinergic Toxidrome

A

Organophosphates.
Carbamates.
Mushrooms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Other Findings in Sedative-Hypnotic Toxidrome

A

Hyporeflexia.
Confusion.
Stupor.
Coma.
Antidote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Vital signs in Cholinergic Toxidrome

A

Hypothermia
Bradycardia.
Tachypnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Pupils in Cholinergic Toxidrome

A

Miosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Other Findings in Cholinergic Toxidrome

A

Lacrimation.
Salivation.
Incontinence.
Bronchospasm.
Seizures
DUMBLES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Causes of Coma

A
  • Toxic causes
  • Traumatic causes
  • Pathologic causes
  • Environmental causes
  • Hysterical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

toxic causes of Coma

A

Generalized CNS depression:
- (e.g., ethanol, opiates, and sedative-hypnotics).

Post-ictal phenomenon
- after a drug-induced seizure: (e.g. anticholinergics).

Hypoglycemia
- (e.g., insulin, oral hypoglycomic drugs).

Cellular hypoxia:
- (e.g., CO, cyanido).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Pathologic causes of Coma

A
  • Liver and renal failure.
  • Infections as encephalitis or meningitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Traumatic causes of Coma

A

Head injuries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

environmental causes of Coma

A

Hypothermia
Hyperthermia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

hysterical causes of Coma

A

No organic cause, normal vital signs, and negative investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

General lines of treatment of Coma

A
  • Care of Airway & Breathing
  • Coma cocktail
  • Control convulsions
  • Correct electrolyte, or acid-base disturbance
  • CT Scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

When is Dextrose given in cases of Coma?

A
  • It is given to all patients with depressed consciousness & hypoglycemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Dose of dextrose in cases of Coma

A
  • Child: 25 % (2 ml/kg) IV.
  • Adolescent/adult: 50 % (1 ml/kg) IV.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

When is naloxone given in cases of Coma

A

It is given to all patients with depressed respiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Dose of Naloxone in cases of Coma

A
  • Child: 0.1 mg/kg IV.
  • Adolescent/Adult: 0.4 mg IV & 0.1 mg IV “If
    suspected Opioid Abuse”.
  • If no response give up to 2 mg IV.
  • If no response, repeat the dose every 2 min. till a total dose of 10 mg.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

when is Thiamine given in cases of Coma?

A
  • It is given to malnourished and chronic alcoholic patients.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Dose are thiamine in cases of Coma

A

100 mg IV or IM (is not given routinely lo children).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Causes of Convulsions

A
  • Toxic causes
  • Metabolic Causes
  • Traumatic causes
  • Pathologic causes
101
Q

Toxic causes of Convulsions

A
  • Poisons acting on cerebrum
  • Poisons acting on brain stem
  • Poisons acting on spinal cord
  • Poisons causing cerebral anoxia
102
Q

Poisons acting on cerebrum

A
  • Causing muscular hyperactivity

e.g., amphetamine, cocaine, caffeine and atropine.

103
Q

Poisons acting on spinal cord

A

Causing tonic convulsions i.e. sustained hypertonia of the muscles

  • e.g., strychnine.
104
Q

Poisons acting on brainstem

A

Causing clonic convulsions** i.o., contraction & relaxation of muscles**

  • o.g., picrotoxin and lead.
105
Q

Poisons causing cerebral anoxia

A

cyanide

106
Q

Metabolic causes of convulsions

A

Hypoglycemia, hyponatremia, hypocalcemia, or hypoxia.

107
Q

Traumatic causes of convulsions

A
  • Head trauma with intracranial injury.
  • Idiopathic epilepsy.
  • Exertional or environmental hyperthermia
108
Q

Pathological causes of convulsions

A
  • CNS infection (meningitis or encephalitis)
  • Febrile seizures in children.
109
Q

General lines of treatment of convulsions

A
  • Maintain an open airway and assist ventilation.
  • Use one or more of the following anticonvulsants
  • Specific measures
  • Consider specific antidotes.
110
Q

Drugs used in cases of convulsions

A
  • Diazepam: 1st Line of therapy:
  • Phenobarbitone 2nd Line of therapy:
  • Phenytoin: It is not indicated in management of toxic seizures.
111
Q

Specific measures in cases of convulsions

A
  • Glucose for hypoglycemia.
  • Cool Immediately for hyperthermia.
  • Fluids for dehydration.
112
Q

Types of Non-Toxic Indigestion

A
113
Q

Def of Non-Toxic Indigestion

A
  • producing little to no toxicity when ingested in small amounts.
  • They are not true poisoning and can be managed by reassurance.
114
Q

Criteria to diagnose non-toxic exposure

A

To diagnose a non-toxic exposure; all of the criteria should be present:

  • Absolute identification of the product.
  • Absolute assurance that only 1 product was ingested.
  • Absence “NO” signal word (Danger, Poison, Warning, Caution) on the container
  • A good approximation of the amount ingested.
  • Assurance that the victim is free of symptoms.
  • Ability to call back at intervals to determine that no symptoms have developed.
115
Q

What causes a patient to be asymptomatic after exposure to toxin?

A

The patient with exposure to toxin may remain asymptomatic due to:

Non-toxic substance: The substance may be nontoxic.

Insufficient amount: An insufficient amount has been ingested

Insufficient absorption: -An sufficient amount has not been absorbed

116
Q

Investigations in toxocology

A

General Investigation “Routine Investigations”:
- ECG
- Lab
- Rad

Specific Investigation “Toxicological Investigations” “Toxicology Screen”

117
Q

General lab investigations in toxicology

A
  • Blood Glucose Level.
  • Arterial blood gases
  • High anion gap metabolic acidosis (MUD PILES)
  • Liver function tests: Clotting profile for paracetamol & anticoagulants toxicities.
  • Renal functions tests: Urine analysis for rhabdomyolysis
  • Complete Blood Picture.
118
Q

High anion gap metabolic acidosis

A

MUD PILES

  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Propylene glycol
  • Iron
  • Lactic Acidosis
  • Ethanol
  • Salicylates
119
Q

Radiological Examination in toxicology

A
  • Chest X ray
  • Abdominal X ray
120
Q

When is chest x-ray done in toxicology?

A

If pulmonary edema /aspiration is suspected.

121
Q

What are drugs that causes pneumonitis or pulmonary edema?

A

MOPS

  • Meprobamate & Methadone
  • Opioids
  • Phenobarbital, Propoxyphene, Paraquat & Phosgene
  • Salicylates
122
Q

When is abdominal x-ray done in toxicology?

A

(BETA CHIP).

  • Barium
  • Enteric coated tablets
  • Iricyclic antidepressants
  • Antihistamines
  • Chloral hydrate, Cocaine
  • Calcium
  • Heavy metals
  • lodides
  • Phenothiazines, Potassium
123
Q

Samples for toxicology screen

A

Samples are taken from:
- Blood & Urine “Most Indicated”
- Vomitus, Gastric Lavage & Stool “May Indicated”

124
Q

Value of toxicology screen

A

The most important evidence of poisoning is by chemical analysis.

125
Q

Categories of toxicology screen

A
  • Blood levels
  • Urine screen
  • Specific tests
126
Q

Blood levels of 3A & 3I toxicology screen

A
  • Alcohols “Ethanol & Mothanol”
  • Inotropic “Digoxin & Theophylline”
  • Iron
  • Analgesic “Paracetamol & Salicylates”
  • Anti-Epileptics “Carbamazepine, Phenobarbital”
  • Immunosuppressant “Methotrexate”
127
Q

urine screen

A

In cases of suspected substance of abuse: ABC

  • Amphetamine
  • Benzodiazepines & Barbiturates
  • Cannabis & Cocaine
  • Opioids, Tramadol, Pregabalin, & Synthetic Cannabinoids.
128
Q

Specific tests toxicology screen

A

Carboxyhemoglobin levels “if carbon monoxide poisoning is suspected”

129
Q

General lines of treatment of poison patient

A
130
Q

How to prevent further exposure to the poison?

A
131
Q

Emergency & supportive treatment

A
132
Q

What is the greatest contributor to death from drug overdose and poisoning?

A

Respiratory failure

133
Q

How to maintain Airway opening & clearance?

A
  • Airway opening
  • Airway clearance
  • Maintain airway opened
134
Q

What maneuver is used for airway opening?

A

Triple airway maneuver: (Head tilt, jaw thrust, mouth opening)

135
Q

Airway opening if there is any suspicion of neck injury

A

Place the patient in left lateral position with head downwards which allows tongue to fall forwards and vomitus or secretions to drain out of the mouth.

136
Q

Airway clearance

A
  • Finger sweep technique to remove any F.B. or denture
  • Suctioning of the mouth and oropharynx to remove secretions.
137
Q

How to maintain opened airway?

A

Either by oro or nasopharyngeal airway

138
Q

What are toxic causes of respiratory failure?

A

Central Causes:
- opiates, barbiturates, alcohols.

Peripheral Causes
- Airway obstruction
- Neuromuscular block
- Paralysis of respiratory muscles: BOSP

139
Q

Peripheral causes of toxic respiratory failure

A
  • Airway obstruction
  • Neuromuscular block
  • Paralysis of respiratory muscles: BOSP
140
Q

Central causes of toxic respiratory failure

A

opiates, barbiturates, alcohols.
Peripheral

141
Q

Toxic causes of airway obstruction

A
142
Q

What toxins cause Laryngeal spasm?

A

cyanide poisoning

143
Q

What toxins cause oedema of the airway?

A

irritant fumes or gas such as chlorine inhalation.

144
Q

What toxins cause bronchospasm?

A

organophosphates compounds.

145
Q

What toxins cause excessive secretions?

A

organophosphate or carbamate toxicity.

146
Q

What toxins cause Pneumonia?

A
  • From aspiration of Gastric Contents, or hydrocarbons such as Kerosene.
147
Q

What toxins cause Pulmonary edema?

A

Organophosphates.

148
Q

What are toxins that caused neuromuscular block?

A

Neostigmine and physostigmine.

149
Q

Methods of breathing support

A
  • 02 mask (Face mask) or bag valve mask (Ambu bag) or Endotracheal intubation (ETT)
  • Pulse oximeter to assess 02 saturation:
150
Q

What are toxins that caused paralysis of respiratory muscles?

A

BOSP

  • Botulinum toxins
  • Organophosphates
  • Snake bites
  • Post convulsive muscle exhaustion.
151
Q

What are advantages of endotracheal intubation?

A
  • It protects airway and prevents aspiration and obstruction.
  • It allows for mechanically assisted ventilation.
  • Some emergency drugs can be given through it e.g., naloxone, atropine and opinophrine.
152
Q

Basics of circularatory support

A
153
Q

What to do if there is no pulse?

A

Perform cardiopulmonary resuscitation

154
Q

When to begin continuous ECG monitoring?

A

This is essential for comatose patients and cardiotoxicity.

155
Q

When is a Foley’s catheter introduced?

A
  • It is placed in bladder if patient is seriously ill (shocked, convulsing or comatose).
  • Obtain urine for routine and toxicologic testing and measure hourly urine output.
156
Q

Disability assessment

A
  • Once ABC is addressed, neurological status should be assessed, mainly level of consciousness, Pupil, Random blood sugar (RBS).
157
Q

What is Stupor?

A

It is a grade of unconsciousness in which patient can be aroused (awakened) only by painful stimuli.

158
Q

What is Coma?

A

It is a state of prolonged unconsciousness in which patient cannot be aroused by painful stimuli.

159
Q

Levels of consciousness AVPU Scale

A
160
Q

Reed’s classification of level of consciousness

A
161
Q

Types of decontamination

A
  • Skin decontamination
  • Eye decontamination
  • Lungs decontamination
  • GIT Decontamination
162
Q

indications of skin decontamination

A

Corrosives:
- To prevent skin injury.

Toxins:
That are readily absorbed through the skin:
- To prevent systemic absorption.

As: Organophosphates Insecticides, Paraquat, Phenol & Oxalic Acid.

163
Q

Steps of skin decontamination

A
164
Q

Indications of eye decontamination

A

Corrosive and Hydrocarbon solvents:

  • That can rapidly damage the cornea.

Toxins:
- That are readily skin absorption, can also be absorbed through conjunctiva.

165
Q

Steps of eye decontamination

A
166
Q

Indications of lung decontamination

A

Irritating gases and fumes:
- As chlorine gas.

Toxins:
- That are absorbed through respiratory tract (Inhalation): As CO, Cyanide, Hydrogen Sulphide & Organophosphates Insecticides.

167
Q

Steps of lung decontamination

A
168
Q

Method of GIT decontamination

A
  • Emesis.
  • Cathartics.
  • Gastric Lavage.
  • Whole Bowel Irrigation.
  • Activated Charcoal (Local Antidote).
169
Q

Emesis as a method of decontamination

A

currently abandoned.

170
Q

Def of Cathartics

A

Substances that enhance passage of materials through the GIT, thus decrease time of contact belween poison and absorptive surface of stomach and intestine.

171
Q

Types of Cathartics

A
  • Osmotic Cathartics
  • Irritant cathartics
172
Q

examples of Osmotic cathartics

A

Magnesium Sulfate & Sorbitol.

173
Q

MOI of Osmotic cathartics

A
  • These are substances that increase osmotic pressure in the intestinal lumen
  • Thus causing fluid to be drawn into lumen causing evacuation.
174
Q

Dose of Osmotic cathartics

A

1-2 g/kg “Sorbitol”.

175
Q

Examples of Irritant cathartics

A

Castor oil

176
Q

MOI of Irritant cathartics

A

They act by stimulation of motility

177
Q

Dose of Irritant cathartics

A

60-100ml

178
Q

cautions during using of Irritant cathartics

A
  • In fat soluble toxic substances because they increase their absorption.
  • As yellow phosphorus, CCI4 and chlorinated insecticides.
179
Q

Contraindications of cathartics

A
  • GIT hemorrhage.
  • Recent bowel surgery.
  • Intestinal obstruction and ileus.
  • Renal failure for risk of magnesium load.
180
Q

Complications of cathartics

A
  • Dehydration particularly in children and elderly
  • Electrolyte imbalance.
181
Q

Indications of Gastric Lavage

A
  • A significant amount of Ingested Toxic Substance within. 1.hour.
  • It is usually used for extremoly toxic substances.
  • When patient is unable to protect their own airway, intubate
    before proceeding.
182
Q

Procedure of Gastric Lavage

A
  • Place large boro orogastric or nasogastric tubo.
  • Confirm placement.
  • Warm normal saline is instilled in aliquots until stomach contents are clear.
183
Q

Technique of Whole Bowel Irrigation

A

Using a gastric tube, give a surgical bowel-cleansing solution containing a non absorbable polyethylene glycol until rectal effluent is clear.

184
Q

Contraindications of Gastric Lavage

A

In cases of:

  • Corrosives
  • Sharp objects
  • Large pills.
185
Q

Indications of Whole Bowel Irrigation

A
  • Ingestion of large dose of iron or lithium or “Other drugs poorly adsorbed to activated charcoal”.
  • Ingestion of Large amount of sustained release or enteric coated tablets.
  • Ingestion of foreign bodies or drug filled packets or condoms.
186
Q

Contraindications of Whole Bowel Irrigation

A
  • lleus or intestinal obstruction.
  • Comatose or convulsing patient unless airway is protected by endotracheal tube.
187
Q

AE of Whole Bowel Irrigation

A

Nausea, regurgitation and pulmonary aspiration.

188
Q

MOI of Activated Charcoal

A
  • Almost irreversibly adsorbs drugs and chemicals, preventing absorption
189
Q

Indications of Activated Charcoal

A
  • Consider for all significant toxic ingestions except poorly binds substances “PGAIS”
190
Q

Dose of Activated Charcoal

A
  • Give 50 g (adults) or 1 g/kg (children) as a singlo oral doso placed in a cup for self-administration.
  • Prepared with a ratio 1:4 charcoal to water
    “Goal is to have a charcoal to toxin ratio > 10:1”.
  • Mixing with ice cream improves palatability for children.
  • In intubated patient, AC may be given via oro- or nasogastric tube.
191
Q

Contraindications of Activated Charcoal

A
192
Q

Principle of Enhanced Elimination

A
  • It is used in drug intoxication when renal route is a main route to its total clearance.
  • Forced diuresis may increase glomerular filtration rato and ion trapping by urinary pH manipulation may enhance elimination of polar drugs.
  • It is used in case of healthy kidney,
193
Q

Types of Enhanced Elimination

A
  • Urinary Manipulation
  • Hemodialysis
  • Hemoperfusion
  • Hemofiltration
  • Peritoneal Dialysis
  • Repeated Dose Activated Charcoal (Gut Dialysis)
194
Q

Types of Urinary Manipulation

A
  • Urinary alkalization
  • Urinary acidification
195
Q

Uses of Urinary alkalization

A
196
Q

Uses of Urinary acidification

A
197
Q

What characters should a toxin have to undergo Hemodialysis?

A
198
Q

Indications of Hemodialysis

A
199
Q

Why are Drug size, water solubility and protein binding not important limiting factors in cases of hemoperfusion procedure?

A

Because drug or toxin is in direct contact with adsorbent material

200
Q

Advantages of Hemoperfusion

A

For most drugs, hemoperfusion can achieve greater clearance rates than hemodialysis.

201
Q

Disadvantages of Hemoperfusion

A

Systemic anticoagulation is required, often in higher doses than for hemodialysis and thrombocytopenia is a common complication.

202
Q

Indications of Hemoperfusion

A
203
Q

Principle of Hemofiltration

A

It can remove compounds with large molecular weight through porous membrane.

204
Q

Indications of Hemofiltration

A
205
Q

Advantages of Peritoneal Dialysis

A

It is easier to perform than hemodialysis or hemoperfusion and does not require anticoagulant.

206
Q

Substances not amenable to significant extracorporeal removal include ……

A
207
Q

Disadvantages of Peritoneal Dialysis

A
  • However, it can be performed continuously, 24 hours a day,
  • 24-hour peritoneal dialysis with dialysate exchange every 1-2 hours is approximately equal to four hours of hemodialysis.
208
Q

Indications of Repeated Dose Activated Charcoal (Gut Dialysis)

A
209
Q

Dose of Repeated Dose Activated Charcoal (Gut Dialysis)

A
210
Q

Route of adminstration of Repeated Dose Activated Charcoal (Gut Dialysis)

A

It is given orally or via gastric tube

211
Q

Types of Antidotes

A
  • Antagonists
  • Competitors
  • Chelators
  • Inactivators
212
Q

Principle of action of Antagonist

A
  • Substance which antagonizes action of the poison
213
Q

Examples of Antagonists

A

Atropine
- antagonizes muscarinic action of organophosphate’s insecticides.

Pilocarpine
- antagonizes the peripheral action of atropine.

214
Q

Principle of Competitors

A
  • A substance which competes with poisons at sites of their action preventing them from exerting their effects.
  • They are characterized by having similar chemical formula to poison.
215
Q

Examples of Narcotic antidotes

A
  • Naloxone (Narcan, N-ally) oxymorphine)
  • Nalmefene (Revex)
  • Nallorphine (N-allyl morphine, lethidrone)
216
Q

Examples of Competitors

A
  • Narcotic analgesics
  • Ethyl Alcohol
217
Q

Characters of Naloxone (Narcan, N-ally) oxymorphine)

A
  • It acts as a pure antagonist.
  • It is potent with no depressant action on CNS.
  • It provides both a therapeutic & diagnostic modality for opioid poisonings.
218
Q

Characters of Nalmefene (Revex)

A
  • It acts as a pure antagonist.
219
Q

Characters of Nallorphine (N-allyl morphine, lethidrone)

A
  • It acts as agonist-antagonist
220
Q

Characters of Ethyl alcohol as an antidote

A
  • It is the antidote for methanol poisoning.
  • It competes with the enzyme alcohol dehydrogenase, → so methanol doses do not change into toxic formaldehyde and formic acid.
221
Q

Principle of Chelators

A

A substance which unites with the absorbed poison forming soluble less toxic and easily excreted complex.

222
Q

Examples of Chelators

A
  • All antidotes of heavy metals are chelators
223
Q

Principle of Inactivators

A

A substance which unites with poison to form non-toxic complex

224
Q

Examples of Inactivators

A

Hydroxocobalamin (Vil. B.12a): It unites with cyanide forming cyanocobalamin (Vit. B12).

225
Q

Antidote of acetaminophen

A

N-Acetylcystoine (Mucomyst).

226
Q

Antidote of anticholinergics

A

Physostigmine

Caution: may cause seizures, asystole, cholinergic crisis”.

227
Q

Antidote of OCP (Anticholinestrases) & Carbamates

A

OCP
- Atropine
- Pralidoxime

Carbamates
- Atropine

228
Q

Antidote of benzodiazepines

A

Flumazenil

229
Q

Antidote of Beta-adrenergic blockers

A

Glucagon

230
Q

Antidote of CO toxicity

A
  • Oxygen.
  • Hyperbaric O2 in severe cases.
231
Q

Antidote of CCBs

A

Calcium chloride
Glucagon

232
Q

Antidote of Digitalis

A

Fab antibodies (Digi-bind).

233
Q

Antidote of Heavy metals

A
  • BAL (dimercaprol), EDTA, Penicillamine, DMSA, Unithiol & DMPS
234
Q

Antidote of Iron

A

Deferoxamine.

235
Q

Antidote of Methemoglobinemia agents

A

Methylene blue.

236
Q

Antidote of Methanol & Ethylene glycol

A
  • Ethanol, Folate.
  • Fomepizole.
237
Q

Antidote of opiods

A

Naloxone.

238
Q

```

Antidote of warfarin & Super warfarin

A

Vit. K.

239
Q

Def of the principle One pill can kill in children

A
  • Drugs with potential for severe toxicity if one or two tablets ingested by a 10-kg toddler
240
Q

Types of One pill can kill in children

A
241
Q

Cardiac Indications for ICU Admission

A
  • Cardiac arrhythmias.
  • QRS duration > 0.12 s.
  • Systolic BP < 80 mm Hg.
  • Second or third degree atrioventricular block.
  • Anticholinergic cardiac toxicity.
242
Q

Indications for ICU Admission

A

For All Patients Who Present with Poisoning or Potential Exposure to A Toxic Substance

  • Neurological
  • Cardiac
  • RESP
  • Metabolic & Electrolytes
243
Q

Neurological Indications for ICU Admission

A
  • Toxin-induced seizures
  • Unresponsiveness to verbal stimuli or Glasgow coma scale score ≤12.
244
Q

Respiratory

Respiartory Indications for ICU Admission

A
  • PaCO2 > 45 mm Hg.
  • Need for endotracheal intubation
245
Q

Metabolic & Electrolytic Indications for ICU Admission

A
246
Q

Disposition of intoxicated patients

A
247
Q

When to transfer the patient

A
248
Q

we are DONE ✅

A

🫡

Y3R2 - Toxicology ☠️ (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions