Pharmacology - Metal Toxicity & Chelation Therapy I & II - Jeanna Marraffa

Question 1

Associate rice water diarrhea with:

Answer 1

Arsenic poisoning

Question 2

Associate cobalt poisoning with:

Answer 2

Cardiomyopathy

Question 3

Associate basophilic stippling and Burton lines with:

Answer 3

lead poisoning

also

Question 4

Associate painful peripheral neuropathy and alopecia with:

Answer 4

Thallium poisoning

Question 5

Rash of “rain drops in a dusty road” with:

Answer 5

Arsenic poisoning

Question 6

Dimercaprol is also known as:

Answer 6

British Anti-Lewisite (BAL)

Question 7

How is dimercaprol administered?

Answer 7

IM

no IV

Question 8

Use: Dimercaprol

Answer 8

Arsenic poisoning
Lead poisoning
Inorganic mercury poisoning

Question 9

2,3-Dimercaptosuccinic Acid is also known as:

Answer 9

DMSA/Succimer

Question 10

Use: 2,3-Dimercaptosuccinic Acid

Answer 10

Chelation of Cadmium, Lead and Mercury (and Arsenic and Cadmium)

oral and IV available

Question 11

Side effects: 2,3-Dimercaptosuccinic Acid

Answer 11

Nausea, vomiting, flatus, diarrhea;

Mild elevations in AST, ALT

Question 12

Use: CaNa2EDTA (Edetate Calcium Disodium)

Answer 12

Lead poisoning

Question 13

Side effects: Na2EDTA

Answer 13

Hypocalcemia

Question 14

Side effects: CaNa2EDTA (Edetate Calcium Disodium)

Answer 14

Renal toxicity;

Malaise, fever, increases in AST, ALT

Question 15

Use: Prussian blue

Answer 15

Thallium poisoning;

Cesium poisoning

Question 16

Higher levels of lead are associated with:

Answer 16

Encephalopathy

Question 17

How to treat lead poisoning?

Answer 17

Remove from source;
WBI;
Succimer:
CaN12EDTA
BAL (dimercaprol)

Question 18

Iron toxicity is significant when:

Answer 18

the patient is vomiting

Question 19

How to treat iron poisoning?

Answer 19

ABCs;
Xray if vomiting;
CBC, ABG, electrlytes
whole bowel irrigation
chelation therapy w/ deferoxamine

Question 20

Use: Deferoxamine

Answer 20

Acute Iron Poisoning

Chronic Iron Overload (from transfusions)

Question 21

Side Effects: Deferoxamine

Answer 21

– Rate-related hypotension
– Anaphylactoid reactions – Yersinia enterocolitis
• DFO-Iron Chelate facilitates growth of unusual organisms
– Acute Lung Injury
• Occurs in patients that are treated for > 24 hours

Question 22

Heavy Metals cause toxicity by binding to:

Answer 22

Sulfhydryl groups

Question 23

T/F: Medication errors with severe toxicity have occurred when Na2EDTA is given instead of CaNa2EDTA

Answer 23

True

Question 24

Prussian blue is a unique chelator because:

Answer 24

it does not get absorbed after oral administration

Question 25

What is the toxicity?
•  Kids: 
–  Colic
–  Lower levels associated with IQ changes 
–  Think PICA

Answer 25

Lead

Question 26

What is the toxicity?
Adults:
Hypertension
Higher levels than in children

Answer 26

Lead

Question 27

What is the toxicity?

Basophilic stippling, Burton’s lines

Answer 27

Lead

Question 28

What is the toxicity?
–  Rice-Water Diarrhea
–  Prolonged QTc
–  Arsenical dermatitis
–  “Rain drops on a dusty road”

Answer 28

Arsenic

Question 29

What is the toxicity?
– Labile Mood; “Mad as a Hatter”
– Intention Tremor

Answer 29

Mercury