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Toxicology > Lecture 2 > Flashcards

Lecture 2 Flashcards

Decontamination, Elimination, Antidotes

1
Q

If symptoms have already occured?

A

Means absorption has already occurred and its efficacy decreases with time

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2
Q

What is the concept of activated charcoal>?

A

Toxicant-Ac complex is not systemically abosrbed, toxicant and it is excreted

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3
Q

What is activated charcoals adsorptivity attributed to?

A

Highly porous structure

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4
Q

Adsorption of drugs and toxins occurs through ___

A

weak intermolecular forces

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5
Q

Activated charcoal becomes ____ effective with use

A

less

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6
Q

___ and ___ compound bind more avidly than ___ ___ ___

A

Non ionized, organic compounds, dissociated, inorganic ones

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7
Q

What agents are adsorbed by AC? (10)

A
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8
Q

What medications are NOT adsorbed by AC? (9)

A
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9
Q

What is the typical dosing of AC in <1

A

1g/kg

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10
Q

What is the dosing of AC in 1-12 yo

A

25-50g

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11
Q

What is the dosing of AC in >12 yo

A

25-100

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12
Q

When can we provide AC in context of the poison absorption

A

Within 1 hour of ingestion

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13
Q

If a patient has ingested a potentially toxic amount of poison up to 1 hour following ingestion

A

Insufficient data to support or exclude the use of AC more than 1 hour passed since ingestion

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14
Q

What are some other dosage forms of AC we can provide?

A
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15
Q

What are some factors that increase AC appropriateness?

A

Alert, cooperative, and adsorb

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16
Q

What are the contraindications of AC?

A

Toxicant known not to adsorb AC
Unprotected airway
Ingestion of hydrocarbon
Risk of GI perf
Endoscopy required

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17
Q

Examples of hydrocarbons

A
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18
Q

What is the risk of GI perforation products?

A
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19
Q

What is emesis?

A

Vomitting

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20
Q

What are some complications of AC?

A

Vomitting
Constipation/diarrhea.
Pulmonary aspiration
Black stool

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21
Q

When should we reserve gastric lavage for?

A
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22
Q

What is a whole bowel irrigation?

A

Cleanses bowel with large amounts of peg solutions to minimize drug absorption and expel intraluminal contents

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23
Q

When is WBI an option?

A

Whole bowerl irrigation: Expediting the gastrointestinal luminal clearance, drug smugglers lololol

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24
Q

There is a ___ of WBI being succesful in body packers

A

98%

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25
Q

WBI ___ lithium concentration

A

Decreases

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26
Q

Are there an established indications of WBI?

A

No

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27
Q

What is the theoretical benefit of drug

A
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28
Q

What are the contraindications of whole bowel irrigation

A
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29
Q

What are some of the complications of PEG-ES? (5 main points)

A
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30
Q

What are the other methods of decontamination? (3)

A

Surgery, kayexalate for lithium
Cholestyramine (Dont need to know the names)

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31
Q

A Vd of ___ is considered large

A

> 1 L/Kg, only a small portion of total dose is in the plasma

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32
Q

What are the intracorporeal elimination methods?

A

Multiple dose activated charcoal

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33
Q

What are the Extracorporeal? elimination methods?

A

Hemodialysis, Hemofiltration. Hemoperfusion

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34
Q

MDAC ___ absorption to the tissues when large amount of xenobiotics are ingested and dissolution is delayed OR when reabsorption can be prevented by lowering concentration of free toxic substance in the intestinal lumen

A

Decreases

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35
Q

For the MDAC how is dosing determined?

A

The amount and dosage form of xenobiotic

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36
Q

MDAC is enhanced in (5)

A

Carbamazepine. Dapsone, phenobarbital, quinine, theophyline

37
Q

What are the main CI of MDAC?

A

Multi dose activated charcoal is CI in

38
Q

What are the complicaitons of MDAC?

A

Reduciton of therapeutically used xenobiotics as the therapeutic xenobiotic may bind to the AC

39
Q

What is the indication of MDAC?

A

Drugs with long t1/2 small Vd and those that undergo enterhepatic recirculation

40
Q

What is hemodialysis?

A

uses diffusion through a concentration gradient

41
Q

What is hemofiltration?

A

Uses convection through a pressure gradient

(Helps to remove large molecules)

42
Q

What is hemoperfusion?

A

Blood passes through adsorbent substance (large molecule, plasma removed and treated)

43
Q

What is Hemodiafiltraiton?

A

Combines hemodialysis and hemofiltration

44
Q

What is the difference between hemodialysis and hemofiltraiton?

A
45
Q

What is hemoperfusion?

A

BLood passes through a cartridge containing sorbet (AC)

46
Q

Ionized drugs ____ cross the lipid bilayer

A

cannot

47
Q

Alkalization of the urine helps clear weak acids by trapping the xenobiotic in the tubular lumen’s and ________ it to be passively reabsorbed into the blood stream

A

not allowing

48
Q

Alkalinizaiton by

A

Sodium bicarbonate

49
Q

What are the CI of alkalinzation?

A

Renal failure, heart failure

50
Q

What are the complications of alkalinization?

A
51
Q

What are the indications of alkalinization?

A

Moderate to severe salicylate poisoning who do not meet the criteria for hemodialysis

52
Q

What are the 4 types of antidotes?

A

Receptor antagonists
Chemical/Chelator
Dispositional
Unclassified

53
Q

What are some receptor antagonist exmaples?

A

Atropine, Vitamin K

54
Q

What are some examples of chemical Chelator?

A

Forms compounds of lesser toxicity that is removed

55
Q

What is dispositional?

A

Ethanol, fomepizole

56
Q

What is atropine?

A

Acetyl cholinesterase inhibitors

57
Q

What is the general principle of antropine?

A

Prevents breakdown of acetylcholine thereby increasing acetylcholine available to stimulate cholinergic receptors

58
Q

Atropine pathway

A

Parasympthathetic blockers

Decreases salivia

59
Q

Atropine is reversed by?

A

Physostigmine

60
Q

What is deferoxamine used for?

A

When serum levels of iron is >90umol/L

61
Q

How does Deferoxamine work?

A

Acts as a chelator and binds free iron to for ferrixoamine which is renally excreeted

62
Q

What is the complications of Deferoxamine?

A
63
Q

What is Digifab?

A

DIgoxine-specific antibody fragments

64
Q

How does Digoxin work?/

A

Blocks NA/K atpase pump which allows for calcium to accumulate and allow for better contraction

65
Q

What is Digifab?

A

Antibody fragment

66
Q

Each vial of digifab binds

A

0.5mg

67
Q

Average # of vials of digifab needed for acute toxicity is

A

10

68
Q

Average # of vials needed for chronic toxicity is (Digifab)

A

6

69
Q

What are the complications of digifab?

A

Inotropic effect of digoxin decreases may need to be treated with inotropes or vasodilators.

70
Q

What is Idarucizumab/praxbind

A

Reverses dabigatran

71
Q

What is praxbind>?

A

Idarucizumab

72
Q

Reversal of anticoagulant effects of dabigatran can result in

A

life-threatening bleeding

73
Q

WHat is the precautions of idarucizumab>

A

Contains 4g of sorbitol which can have serious adverse effects

74
Q

Toxic alcohols

A

Ethylene glycol, methanol, isopropranol

75
Q

Lethal dose of ethylene glycol is?

A

1.4mL/kg

76
Q

Lethal dose of methanol?

A

1-2ml/Kg

77
Q

ethylene glycol and methanol are not toxic

A

Kinda true, the metabolites are what are toxic

78
Q

Why do we use ethanol for ethylene glycol and methanol overdose?

A

So they are not metabolized and ethanol is metabolized

79
Q

Ethanol has a ___ affinity for alcohol dehydrogenase

A

15.5x

80
Q

Good slide to review

A
81
Q

Ethanol has ___ more affinity than ethylene glycol

A

67x

82
Q

What enzymes metabolize methanol?

A

Alcohol deydrogenase
Aldehyde dehydrogenase

83
Q

What enzymes metabolize ethylene glycol

A

Aldehyde dehydrogenase
Lactate dehydroganse

84
Q

What is the toxic compound sof ethylene glycol>

A

Glycoaldehyde, glycolic acid, oxalic acid

85
Q

What are the toxic metabolites or methanol?

A

Formaldehyde, formic acid

86
Q

Review

A
87
Q

Why do we want to give hemodialysis for patients once alcohol dehydrogenase?

A
88
Q

The relative affinity of fomeprizole for human ADH is ___ greater than that of methanol and ethylene glycol and ___ than that of ethanol

A

80 000, 8000

89
Q
A

Toxicology (3 decks)

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