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

1
Q

Associate rice water diarrhea with:

A

Arsenic poisoning

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2
Q

Associate cobalt poisoning with:

A

Cardiomyopathy

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3
Q

Associate basophilic stippling and Burton lines with:

A

lead poisoning

also

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4
Q

Associate painful peripheral neuropathy and alopecia with:

A

Thallium poisoning

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5
Q

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

A

Arsenic poisoning

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6
Q

Dimercaprol is also known as:

A

British Anti-Lewisite (BAL)

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7
Q

How is dimercaprol administered?

A

IM

no IV

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8
Q

Use: Dimercaprol

A

Arsenic poisoning
Lead poisoning
Inorganic mercury poisoning

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9
Q

2,3-Dimercaptosuccinic Acid is also known as:

A

DMSA/Succimer

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10
Q

Use: 2,3-Dimercaptosuccinic Acid

A

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

oral and IV available

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11
Q

Side effects: 2,3-Dimercaptosuccinic Acid

A

Nausea, vomiting, flatus, diarrhea;

Mild elevations in AST, ALT

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12
Q

Use: CaNa2EDTA (Edetate Calcium Disodium)

A

Lead poisoning

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13
Q

Side effects: Na2EDTA

A

Hypocalcemia

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14
Q

Side effects: CaNa2EDTA (Edetate Calcium Disodium)

A

Renal toxicity;

Malaise, fever, increases in AST, ALT

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15
Q

Use: Prussian blue

A

Thallium poisoning;

Cesium poisoning

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16
Q

Higher levels of lead are associated with:

A

Encephalopathy

17
Q

How to treat lead poisoning?

A
Remove from source;
WBI;
Succimer:
CaN12EDTA
BAL (dimercaprol)
18
Q

Iron toxicity is significant when:

A

the patient is vomiting

19
Q

How to treat iron poisoning?

A
ABCs;
Xray if vomiting;
CBC, ABG, electrlytes
whole bowel irrigation
chelation therapy w/ deferoxamine
20
Q

Use: Deferoxamine

A

Acute Iron Poisoning

Chronic Iron Overload (from transfusions)

21
Q

Side Effects: Deferoxamine

A

– 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

22
Q

Heavy Metals cause toxicity by binding to:

A

Sulfhydryl groups

23
Q

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

24
Q

Prussian blue is a unique chelator because:

A

it does not get absorbed after oral administration

25
``` What is the toxicity? • Kids: – Colic – Lower levels associated with IQ changes – Think PICA ```
Lead
26
What is the toxicity? Adults: Hypertension Higher levels than in children
Lead
27
What is the toxicity? | Basophilic stippling, Burton's lines
Lead
28
``` What is the toxicity? – Rice-Water Diarrhea – Prolonged QTc – Arsenical dermatitis – “Rain drops on a dusty road” ```
Arsenic
29
What is the toxicity? – Labile Mood; “Mad as a Hatter” – Intention Tremor
Mercury