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MIDTERMS LECTURE Flashcards

1
Q

Contact providing opportunity of obtaining a poisonous dose

A

EXPOSURE

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2
Q

Different toxic responses may arise from different:

A
  • Routes of exposure- ways how did you expose
  • Frequencies of exposure- everyday ba?
  • Duration of exposures- (acute (reversible) vs. chronic (irreversible) )
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3
Q

Types of exposure

A
  1. Intentional- cigarette smoker
  2. Non-intentional- nonsmoker and 2nd hand smoker
    *Toxicology studies involve intentional exposures
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4
Q

ROUTES OF ENTRY OF EXPOSURE

A

a. Inhalation
b. Oral or by ingestion
c. Percutaneous or by injection
d. Dermal or ocular absorption

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5
Q

ROUTES OF EXPOSURE OF TOXICANTS

A

 IV/IM
 Inhalation
 Intradermal
 Topical
 Subcutaneous

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6
Q

_________ is defined as the length in time when a toxic substance is exposed to a person or how frequent it had caused its toxicity.

A

Duration

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7
Q

TYPES OF DURATION OF EXPOSURE

A

 Short term (Acute)- a single exposure lasting less than 24 hours
 Long term (Chronic)- exposures are essentially for the lifetime of the species
 Repeated

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8
Q

2 TYPES OF REPEATED DURATION OF EXPOSURE

A

o Sub-chronic: Repeated exposures of less than a lifetime (e.g., 3 months)
o Sub-acute: Repeated for up to 30 days

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9
Q

ENUMERATE COCAINE SIDE EFFECTS (Brain, throat, lungs, systemic, nose, teeth, skin, heart)

A

Brain
- Increased risk of stroke
- reduce attention
-lethargy
-insomnia
Lungs
-dyspnea
-asthma
-chest pain
-bronchospasm
Throat
-horse voice
-soreness
Systemic
-eosinophilia
-fever
Nose
-rhinorrhea (discharge)
Teeth
-Bruxism (abrasion)
Heart
- increase heart infarction
Skin
-Pruritus

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10
Q

Type of exposure that toxic symptoms are expressed after repeated applications for a timeframe less than half the life expectancy of the organism- but more often than a single dose or multiple doses applied for only a short time

A

Sub chronic exposure

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11
Q

Exposure classes (toxicants in food, air, water, and soil as well as toxicants characteristic of domestic and occupational settings). Give examples of toxicants in food and soil

A

TOXICANTS IN FOOD
- Salmonella
- Shigellosis
- Vibrio Cholera
- Typhoid fever
- E.coli
- Cyanide
- Amiba Virus
Toxic in Soils
- Tetanus
- Fungal Infection

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12
Q

Example of systemic exposures

A
  • rabies (affects in brain)
  • Johnson Powder (Talc)
    = Mesothelioma cancer in lungs (Because of asbestos)
    Ex: can get in long term exposure like construction worker
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13
Q

Example of local exposures

A

Example: Cosmetics (affected only in one area)

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14
Q

How many certain general symptoms suggested the possibility of a number of poisons, (local exposure)

A

13

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15
Q

1) Sudden death (ABC)

A

aconitine, barium compounds and cyanide

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16
Q

2) Eyes (EMPAC)

A

ergot, morphine, pilocarpine, atropine and cocaine

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17
Q

4) Mouth (APA)

A

atropine, pilocarpine and ammonia

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18
Q

5) Skin (APSAAA)

A

atropine, pilocarpine, strong acids (burning sensation) and alkalies (melting sensation), cyanosis produced by aniline, acetanilide

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19
Q

6) GIT (MEFp)

A

metals, ergot and food poisons

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20
Q

7) Cardiovascular system (QDER)

A

quinidine, digitalis, ephedrine and reserpine

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21
Q

8) Liver (CTC)

A

carbon tetrachloride and chloroform

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22
Q

9) Kidney (PS)

A

phenol and sulphonamides

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23
Q

10) Nerves (AA)

A

peripheral neuritis due to antimony and arsenic

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24
Q

11) Skeletal muscle (CF

A

curare and flaxedil

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25
Q

12) Blood changes (BH)

A

anaemia by benzene, haemolysis due to saponins, leukopenia by benzene

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26
Q

13) CNS (SPBEA)

A

strychnine, picrotoxin, barbiturates, ether, alcohol

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27
Q

EXPOSURES THAT REDUCE LIFE EXPECTANCY BY 8 MIN. GIVE 5 ONLY

A
  • Smoking 1.4 cigarettes
  • Living 2 months with a cigarette smoker
  • Eating 100 charcoal-broiled steaks
  • 1 X-Ray (in a good hospital)
  • Eating 40 tablespoons of peanut butter
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28
Q

SPETRUM OF UNDESIRED EFFECTS (5)

A
  1. Allergic reactions (chemical allergies)
  2. Idiosyncratic reactions
  3. Immediate vs. delayed toxicity
  4. Reversible vs. irreversible toxicity
  5. Local vs. systemic toxicity
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29
Q

4 TYPES OF EFFECTS

A

1 Local effect
2. Systemic effect
3. Cumulative effect
4. Poisonous effect

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30
Q
  • The site of action takes places at the point of contact
A

Local Effect

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31
Q
  • The site: skin, mucous membrane of the eyes, nose, mouth, throat or anywhere the along the respiratory or gastrointestinal system
A

Local Effect

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32
Q
  • The toxic substance has been absorbed and distributed throughout the body
A

Systematic Effect

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33
Q
  • Over a period of time, the material is only partially excreted and the remaining quantities are gradually collected.
A

Cumulative Effects

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34
Q
  • The retained toxic compound accumulates and becomes great enough to cause pathological response.
A

Cumulative Effects

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35
Q

Cumulative Effects examples:

A
  • Silica dust
  • Asbestos
  • Smoker
  • Drinking soda
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36
Q
  • A toxic substance is absorbed and distributed by the blood stream throughout the body
A

Poisonous Effect

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37
Q
  • Absorption reaches a point where it causes impairment of physiological function
A

Poisonous Effect

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38
Q

EFFECTS OF TOXICANTS

A

o Carcinogen
o Mutagen
> Vurkih- causes inflammation of neck
> Papillomaviruses- causes warts
o Reproductive hazard
> nabaog
o Teratogenic
> Pregnant women experiences (Focomelia)

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39
Q

DEFINITIONS
LD- ?
ED-?

A

LD- lethal dose
ED- Effective dose

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40
Q

LD & ED OF Therapeutic Margin

A

TM = LD50% - ED50%

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41
Q

LD & ED OF Margin of Safety:

A

MOS = LD5% - ED95%

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42
Q

LD & ED OF Safety Index

A

SI = LD5%/ED95%

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43
Q

LD & ED OF Therapeutic Index

A

TI = 50%/ED 50%

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44
Q

RELATIVE TOXICITY CLASSIFICATION

A

Extremely Topic= Taste (1 grain)
Highly Topic= 1 tsp
Moderately Toxic= 1 oz
Slightly Toxic= 1 pt
Practically nontoxic= 1qt
Relatively harmless= >1qt

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45
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Sugar (sucrose)

A

3 quarts

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46
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Alcohol (ethyl alcohol)

A

3 quarts

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47
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Salt (sodium chloride)

A

1 quart

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48
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Herbicide (2, 4-D)

A

One half cup

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49
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Arsenic (arsenic acid)

A

1-2 teaspoon

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50
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Nicotine

A

One half spoon

51
Q

DEFINE THE LETHAL OF EACH CHEMICAL; Food poison (botulism)

A

Microscopic

52
Q

What are the 4 Types of Toxic Effects

A

Organ Damage- ozone, lead
Mutagenesis- UV light
Carcinogenesis- benzene, asbestos
Teratogenesis- Thalidomide

53
Q

Enumerate all the TARGET ORGAN TOXICITY (clerrksi)

A

 Central Nervous System – lead
 Liver - ethanol, acetaminophen
 Eye - UV light (sunlight)
 Respiratory Tract - tobacco smoke, asbestos, ozone
 Reproductive System – dibromochloropropane
 Kidney – metals
 Skin - UV light, gold, nickel
 Immune System – isocyanates

54
Q

DOSE UNITS ENUMERATE ALL THE LD50 DOSE (mg/kg) of the agents

A

Ethyl alcohol= 7060
Sodium Chloride= 3000
Naphthalene= 1760
Ferrous Sulfate= 1500
Aspirin= 1000
Formaldehyde= 800
Ammonia= 350
Dextromethorphan Hydrobromide= 350
Caffeine= 192
Phenobarbital= 150
Chlorpheniramine Maleate= 118
DDT= 100
Strychnine Sulfate = 2
Nicotine= 1
Dioxin= 0.0001
Botulinus Toxin= 0.00001

55
Q

Enumerate all the Screening Tests (4)

A
  1. Physical tests
  2. Crystal tests
  3. Chemical spot tests
  4. Chromatography
56
Q

Test for boiling point, melting point, density, and refractive index

A

Physical test

57
Q

Test for treatment with a chemical reagent to produce crystals

A

Crystal tests

58
Q

Test for treatment with a chemical reagent to produce color changes

A

Chemical spot tests

59
Q

Test for (thin-layer or gas)–used to separate components of a mixture

A

Chromotography

60
Q

Test toxicity for eyes

A

Draize test

61
Q

Under measures of toxicity mortality means?

62
Q

Under measures of toxicity teratogenicity means?

A

ability to cause birth defects

63
Q

Under measures of toxicity carcinogenicity means?

A

ability to cause cancer

64
Q

Under measures of toxicity mutagenicity means?

A

ability to cause heritable change in the DNA

65
Q

The amount (dose) of a chemical which produces death in 50% of a population of test animals to which it is administered by any of a variety of methods

66
Q

The concentration of a chemical in an environment (generally air or water) which produces death in 50% of an exposed population of test animals in a specified time frame

67
Q

GIVE THE 4 CHEMICAL INTERACTIONS WITH EXAMPLES

A
  • Additive 1+1=2
  • Synergistic 1 +1>2
  • Potentiation 1+0>1
  • Antagonism 1+1<2
68
Q

toxic chemicals affecting the same organ/system

A

Additive 1+1=2

69
Q

toxic chemicals enhance each other’s effects

A

Synergistic 1 +1>2

70
Q

non-toxic chemical increases the toxic effect of a toxic chemical

A

Potentiation 1+0>1

71
Q

chemicals hinder the toxic effect(s) of one another or both (le, antidote

A

Antagonism 1+1<2

72
Q

EFFECTS OF TOXINS ON REPRODUCTION

A
  1. Teratogenic
     physical defects in embryo/fetus
     mother is exposed but not necessarily affected
  2. Mutagenesis
     “mutate genes: permanent DNA changes
     inheritable changes (future generations)
     exposure to mother or father
     usually also carcinogens
73
Q

INFLUENCING FACTORS (7) CDRIIEC

A

 Concentration
 Duration and frequency of exposure
 Route of entry
 Interspecies variation
 Intraspecies variation
 Environmental factors
 Chemical combinations

74
Q

INTRASPECIES VARIATION

A
  • Age and maturity
  • Gender and hormonal status
  • Genetic makeup
  • State of health
74
Q

3 WAYS OF PREVENTING ABSORPTION OF TOXICANTS

A

 Gastric lavage
 Induced Vomiting
 Activated charcoal

75
Q

Recommended for up to 2 hrs in TCA & up to 4hrs in Salicylate OD

A

Gastric lavage

76
Q

Ipecac - Not routinely recommended and risk of aspiration

A

Induced Vomiting

77
Q

Repetitive doses useful to enhance the elimination of certain drugs used in actiavted charcoal

A

theophylline, phenobarbital. carbamazepine, aspirin, sustained-release products (TPCAS)

78
Q

Activated charcoal are not effective for.

A

cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol poisoning, lithium

79
Q

3 ways on ELIMINATION OF POISONS

A
  1. Renal elimination
  2. Forced alkaline diuresis
  3. Hemodialysis or hemoperfusion
80
Q
  • Renal elimination
A

 Medication to stimulate urination or defecation may be given to try to flush the excess drug out of the body faster.

81
Q
  • Forced alkaline diuresis
A

 Infusion of large amount of NS+NAHCO3
 Used to eliminate acidic drug that mainly excreted by the kidney eg salicylates

82
Q

Hemodialysis or hemoperfusion

A
  • Reserved for severe poisoning
83
Q

Antidote for OPIATES

84
Q

MOA OF NALOXONE

A

Pure opioid antagonist competes and displaces narcotics at opioid receptor sites

85
Q

S/E OF OPIATES

A

BP changes; arrythmias; seizures; withdrawal

86
Q

Antidote for BENZODIAZEPINE

A

flumazenil

87
Q

PHARMACOLOGY –TCAs

A

 Presynaptic neurotransmitter reuptake
 Cardiac fast sodium channels
 Histamine (H1) receptors
 CNS GABA-A receptors

88
Q

TCAD OVERDOSE CLINICAL FEATURES

A

 Arrhythmias (abnormal rhythm of heart rate)- widening of PR, QRS, and QT intervals; heart block; VF/VT
 Hypotension (low BP)
 Anticholinergic toxicity – hyperthermia (fever), flushing, dilated pupils, intestinal ileus, urinary retention, sinus tachycardia
 Confusion, delirium, hallucinations
 Seizures

89
Q

TCAD OVERDOSE -TREATMENT

A

 ABC-many require intubation
- Airway: palakaihin yung airway ng patient via incubation
- Breathing
- improve Circulation
 Consider gastric lavage if taken < 2hrs
 Activated charcoal
- The charcoal absorbs the toxins/ toxicity
 Treatment of hypotension with isotonic saline
 Sodium bicarbonate for cardiovascular toxicity
 Alpha adrenergic vasopressors (norepinephrine) for hypotension refractory to aggressive fluid resuscitation and bicarbonate infusion
 Benzodiazepines for seizures

90
Q

Sodium bicarbonate is an high alert drug: T/F

91
Q

SPECIAL CAUTIONS IN TCAD OVERDOSE

A

 Class IA and IC antiarrhythmic agents are contraindicated.
 Magnesium may be useful
 Flumazenil must not be given

92
Q

DRUGS UNDER SALICYLATE OVERDOSE

A

 Aspirin (acetylsalicylic acid)
 Methyl salicylate (Oil of Wintergreen)

93
Q

Fatal intoxication can occur IN TCAD overdose after the ingestion of ______ by adults and as little as _____ by children

A

10 to 30 g by adults and as little as 3 g by children

94
Q

SALICYLATE OVERDOSE

A

 Inhibition of cyclooxygenase
 Stimulation of the chemoreceptor trigger zone
 Activation of the respiratory center of the medulla
 Uncoupled oxidative phosphorylation in the mitochondria

95
Q

CLINICAL FEATURES in salicylate

A

o Early symptoms of aspirin toxicity include tinnitus, fever, vertigo, nausea, hyperventilation, vomiting, diarrhea

96
Q

a condition that causes ringing or other noises in your ears

97
Q

a condition where your blood has too little carbon dioxide due to rapid breathing

A
  • Respiratory alkalosis
98
Q

a condition in which acids build up in your body fluids

A
  • Metabolic acidosis
99
Q

measurement that tells you the acid levels in the blood

100
Q

SALICYLATE OVERDOSE – TREATMENT

A

> administration of sodium bicarbonate
IV fluids +/- vasopressors
Avoid intubation if at all possible
Supplemental glucose
Hemodialysis

101
Q

What is N-ACETYLCYSTEINE

A

Antidote for paracetamol overdose

102
Q

MOA of N-ACETYLCYSTEINE

A

a glutathione precursor & limits the formation and accumulation of NAPQI

103
Q

Powerful anti-inflammatory and antioxidant effects

A

N-ACETYLCYSTEINE

104
Q

measurement dose of N-ACETYLCYSTEINE

A
  • 150mg/Kg over 15 min
  • 50mg/Kg over next 4 hrs
  • 100mg/kg over next 16 hrs. up to 36hrs
105
Q

S/E OF N-ACETYLCYSTEINE

A

nausea, flushing, urticaria, bronchospasm, angioedema, fever, chills, hypotension, hemolysis and rarely, cardiovascular collapse

106
Q

How many of acetaminophen is metabolized in the liver to sulfate and glucuronide conjugates that are then excreted in the urine ?

107
Q

____ of the remaining acetaminophen is excreted unchanged in the urine and ____ is metabolized via the hepatic ____ mixed function oxidase pathway to N-acetyl-p- benzoquinoneimine (NAPQI), which is hepatotoxic.

A
  1. 1/2
  2. 1/2
  3. Cytochrome P450 (CYP2E1, CYP1A2, CYP3A4)
108
Q

Drug that is widely available and potential toxicity underestimated

A

PARACETAMOL

109
Q

DOSE MEASUREMENT OF NONTOXIC OF PARACCETAMOL

A

less than 150 mg/kg in child or 7.5 to 10 g for adult

110
Q

DOSE MEASUREMENT OF TOXICICITY OF PARACCETAMOL

A

greater than 250 mg/kg or those greater than 12 g over a 24-hour period

111
Q

PARACETAMOL OVERDOSE TREATMENT

A

 Activated charcoal within four hours of ingestion
 At the end of NAC infusion
 Inhibits absorption of oral methionine

112
Q

Mechanisms of Target Organ Toxicity and Agents Involved in Poisoning

A

Nervous system
1. central nervous system
2.peripheral nervous system

113
Q

Central nervous system is made up of

A

brain and spinal cord

114
Q

Peripheral nervous system of made up of

A

neurons (chemical agents that cause the release of chemical messenger)

115
Q

Efferent division of PNS

A
  • SOMATIC: Isa lang ang target organ, 1 neuron set up only
  • AUTONOMIC: complicated, may 2 or more target organ, 2 neuron set up only. Nandito na yung synaptic cleft
116
Q

Any adverse change in the structure or function of Nervous System during development or at maturity following exposure to a chemical, physical and biological agent

A

Neurotoxicity

117
Q

Certain toxicants are specific for neurons, or sometimes a particular group of neurons, resulting in their injury or death

A

Neuropathies

118
Q

Primary site of toxicity is the axon

A

Axonopathies

119
Q

Myelin provides electrical insulation of neuronal processes, and its absence leads to a slowing of and/or aberrant conduction of impulse between adjacent processes, SO called ephaptic transmission

A

Myelopathies

120
Q

Example of neuropathies

A

ANTICANCER AGENTS: vinca alkaloids, taxane derivatives, thalidomide
ANTIMICROBIALS: chloroquine, colistin, dapsone
CARDIOVASCULAR AGENTS: amiodarone, digoxin, statins
IMMUNOSUPPRESSANTS: interferons, leflunomide, penicillamine
MISCELLANEOUS AGENTS: cimetidine, phenytoin, lithium

121
Q

Example of Axonopathies

A

Pyridinethion, compounds, Acrylamide, Gamma diketones.

122
Q

Example of Myelopathies

A

Myelin, lead, hexachlorophene

123
Q

Meaning of NAPQI?

A

N-acetyl-p-benzoquinone-imine

TOXICOLOGY (5 decks)

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