L7 Toxicology

Question 1

True or False: drugs that are normally eliminated through first order kinetics can switch to zero order if you have a ton of it?

Answer 1

True

Question 2

CO, cyanide and lead bind ________ (directly/indirectly) to cell components like lipids, proteins, and nuclei acids

Answer 2

directly

Question 3

What are the two types of cell death

Answer 3

Necrosis- caused by external factors

Apoptosis- programmed cell death

Question 4

Can you do gastric lovage after 4 hours?

Answer 4

No, and not if its been 30 minutes for a corrosive material

Question 5

What drug do you use to chelate arsenic, gold, mercury and acute lead

Answer 5

Dimercaprol

Question 6

What drug do you use to chelate copper?

Answer 6

Penicillamine

Question 7

What metal does deferoxamine chelate?

Answer 7

Iron

Question 8

What metal does Calcium disodium edetate ( EDTA) chelate?

Answer 8

Lead

Question 9

What drug is given to inactivate acetaminophen?

Answer 9

Acetylcysteine

Question 10

When would you use atropine as an antidote

Answer 10

For organophosphates (AChE inhibitors)

Question 11

When would you use sodium nitrite, sodium thiosulfate and amyl nitrite as an antidote

Answer 11

Cyanide

Question 12

When would you use ethanol as an antidote/

Answer 12

Methanol or ethylene glycol poisoning

Question 13

When would you use fomepizole as an antidote?

Answer 13

Ethylene glycol

Question 14

How does bleach cause harm?

Answer 14

Oxidative stress

Question 15

Should you use emesis or lavage for bleach?

Answer 15

No

Question 16

How does ethylene glycol hurt you?

Answer 16

Alters calcium homeostasis

Converted to oxalic acid by ADH (kidney damage)

Question 17

How do you treat ethylene glycol toxicity?

Answer 17

Gastric lavage

IV ethanol

Fomepizole

Question 18

How would you treat botulism,

Answer 18

Emesis/lavage/cathartic

Draw blood to measure concentration

ABE (equine trivalent antitoxin)

Question 19

What are the symptoms of organophosphate toxicity

Answer 19

SLUD

Salivation, Lacrimation, urination, defecation

Question 20

What is the treatment for organophosphates?

Answer 20

Atropine** specific for OP’s

Lavage/emesis

2-PAM to reactive AChE

Question 21

How do organochlorines (DDT, dieldrin) cause toxicity?

Answer 21

Inactivation of the sodium channel

Question 22

What kind of toxin has well documented bioaccumulation/biomagnificataion?

Answer 22

Organochlorine pesticides (DDT, dieldrin)

Question 23

What are the symptoms of organochlorines (DDT, dieldrin)

Answer 23

Tremors, convulsions (remember it inactivated sodium channels)

Cancer, lymphoma, Parkinson’s for chronic exposure

Question 24

What is the treatment for organochlorine pesticides (DDT, dieldrin)

Answer 24

None

Question 25

How does TCDD (chlorophenoxy compound) cause toxicity?

Answer 25

Agonist for aryl hydrocarbon and induces gene expression

Question 26

How do we find TCDD?

Answer 26

We go to Lowe’s to buy an herbicide(2,4-d) and it ends up being contaminated with TCDD

Question 27

How does paraquat harm us

Answer 27

Oxidative stress

Question 28

What are the symptoms of paraquat toxicity?

Answer 28

Hematemesis, ocular toxicity (RED EYES), Pulmonary edema, Parkinson’s

Question 29

How do you treat paraquat?

Answer 29

Lavage, cathartic, charcoal, nothing really specific

Question 30

What toxin is used in fire extinguishers and dry cleaning?

Answer 30

Carbon tetrachloride (CCl4)/chloroform

Question 31

How do halogenated hydrocarbons like CCl4 harm you?

Answer 31

Metabolized by CYP450s to free radicals that then cause apoptosis

Question 32

What are the symptoms of halogenated hydrocarbons (CCl4) toxicity?

Answer 32

CNS depression Liver and kidney damage Cancer Cardiac arrrythmias

Question 33

How do you treat CCl4/ halogenated hydrocarbon toxicity/

Answer 33

Remove contaminated clothing (fire extinguishers spray this)

Question 34

How do mineral acids/corrosives hurt you?

Answer 34

Oxidative stress Bleeding in GI tract Hypovolemic sjhock from bleeding

Question 35

How do you treat mineral acid/corrosives exposure

Answer 35

NO lavage or emesis Milk of magnesia Dilution

Question 36

How does arsenic hurt you?

Answer 36

Binds to SH groups on metabolic enzymes Oxidative stress Alter gene expression

Question 37

Who absorbs lead the most?

Answer 37

Children, who also have immature BBB

Question 38

What exposure is associated with symptoms like wrist drop and ankle drop?

Answer 38

Lead

Question 39

What is the chelator specific to lead poisoning?

Answer 39

Edetate calcium disodium | Forms organic lead which crosses BBB, but is still less harmful than inorganic lead

Question 40

How does iron poisoning cause injury?

Answer 40

Oxidative stress

Question 41

How do you treat iron poisoning?

Answer 41

Deferoxamine Lavage (within 1st hour)

Question 42

What kind of poisoning causes a dark line on the gums and erythrocyte stippling?

Answer 42

Lead

Question 43

What are Kayser-Fleischer rings and what are they associated with?

Answer 43

copper deposits on the cornea, copper poisoning

Question 44

What is Wilson’s disease

Answer 44

Genetic disorder in which body can’t eliminate copper

Question 45

How do you remove excess copper form the body?

Answer 45

Penacillamine

Question 46

What toxin turns blood cherry red?

Answer 46

CO Converts hemoglobin into carboxyhemoglobin

Question 47

What toxin gas smells like almonds

Answer 47

Cyanide

Question 48

What toxin affects cytochrome -oxidase in the mitochondria? Affects energy production

Answer 48

Cyanide

Question 49

What is the treatment for cyanide?

Answer 49

RAPID administration of nitrites, sodium thiosulfate, and rhodanese

Question 50

We treat cyanide with sodium thiosulfate that adds a sulfate group onto cyanide. What tupe of reaction is this?

Answer 50

Phase II. Makes it easier to eliminate

Question 51

What is rhodanese

Answer 51

It’s an enzyme we all have in our mitochondria that converts cyanide into thiocyanide (adds sulfate- Phase II)