PHCT Mod 2-3 Flashcards
1
Q
TYPE OF POISONING
a prompt and marked
disturbance of function or
death within a short timethat are caused by:
1. Taking a strong poison
2. Excessive single dose of a drug
3. Several small doses but frequent
administration of a drug
A
Acute Poisoning
2
Q
poisoning marked by a gradual
deterioration of function of tissues and may or may not result in death
A
Chronic Poisoning
3
Q
TYPE
-less than 24 hours-generally a singledose
-Repeated exposures- usually dietary
A
Acute
4
Q
TYPE
Repeated exposure for a month or less
A
Subacute
5
Q
TYPE
repeated exposure for 1 to 3 months
A
Subchronic exposure
6
Q
TYPE
exposure for greater than three months
A
Chronic exposure
7
Q
Benzene
Acute Exposure =
A
CNS Narcosis
8
Q
Benzene
Chronic Exposure =
A
Bone Marrow Damage and Leukemia
9
Q
Cigarette smoke
Acute exposure =
A
Nervous system stimulation
10
Q
Cigarette smoke
Chronic exposure =
A
Cancer or mouth, pharynx,larynx, lung, esophagus, pancreas, andbladder,emphysema
11
Q
-Major route of entry of poisons in the industrial setting
-Atmospheric pollutants gain entry mainly by _______
A
Inhalation
12
Q
the lowest concentration of a certain odor compound that is perceivable by the human sense of smell.
A
Odor threshold
13
Q
ROUTE
via GIT;
result of ingesting contaminated food or beverages, touching the mouth with contaminated fingers, or swallowing inhaled particles
A
Ingestion
14
Q
ROUTE
Bypasses the protection provided by the intact skin and provides direct access in the bloodstream.
A
Injection
15
Q
occur in hypersensitive individuals or after sensitization in allergic or sensitized persons.
Often requires binding of chemical (hapten)to endogenous protein in order to be recognized by the immune system.
Reaction ranges from skin irritation to fatal anaphylactic shock.
A
Allergic reactions
16
Q
occur in individuals who have genetic polymorphisms that lead to structural changes in biomolecules, making them very sensitive or insensitive to chemical.
A
Idiosyncratic Reactions
17
Q
Most chemicals exert their effects soon after exposure.
A
Immediate Toxicity
18
Q
Others may be delayed for days to years (cancer)
A
Delayed Toxicity
19
Q
Depends on tissue’s ability to regenerate itself at a variety of levels: molecular, cellular and tissue.
ex. Liver vs. CNS
A
Reversible vs.Irreversible Effects
20
Q
Corrosives and irritants act ____
A
locally
21
Q
Little goes _____
A
systematic
22
Q
Chemical Interaction
combined effect is the same as the sum of effects when given alone
A
Additive
23
Q
Chemical Interaction
combined effects are much greater than the sum of effects when given alone
A
Synergistic
24
Q
Chemical Interaction
exposure to a chemical with no toxicity increases the toxicity of another compound.
A
Potentiation
25
Chemical Interaction
co-administration of two chemicals interferes with the toxicity of both or one of them
Antagonism
26
Ex of Antagonism
Antidotal therapies
27
Type of Antagonism
Chemicals counter balance each other by exerting opposite effects on a physiological function
Functional
28
Type of Antagonism
Chemical reaction between two compounds leads to less of the toxic compound.
Chemical (or inactivation)
29
Ex Chemical Antagonism (Inactivation)
Chelators and metals; Antivenins
30
An antitoxin active against the venom of a snake, spider, or other venomous animal or insect
Antivenins
31
Type of Antagonism
Disposition of toxic chemical is changed so that
concentration and/or duration is diminished.
Dispositional
32
Type of Antagonism
Chemicals compete for the same receptor, decreasing effective binding of toxic compound.
Receptor
33
(Antagonism)
Ex of competitive inhibition
Naloxone and morphine
34
(Antagonism)
Ex of antagonist of the estrogen receptor in breast tissue
Tamoxifen and estradiol
35
A state of decreased responsiveness due to prior exposure to the same or structurally similar chemical in an individual.
Tolerance
36
TYPE OF TOLERANCE
A decreased amount of chemical reaches the site where the effect is produced.
Dispositional Tolerance
37
TYPE OF TOLERANCE
Ex of Dispositional (metabolism inhibition)
Carbon tetrachloride CCl4
38
TYPE OF TOLERANCE
Ex of Dispositional
Cd and metallothionein
39
TYPE OF TOLERANCE
Same amount of chemical reaches the site, but target receptor response decreased
Receptor Tolerance
40
Ex of Receptor Tolerance
Nicotine in cigarettes
Morphine and Opioid receptors
41
A change in the susceptibility to a chemical at the population level.
A selective process (evolution) by which sensitive individuals do not survive and only those with a genetic trait that accommodates the chemical survive.
Resistance
42
Evidences contributed by circumstances
Circumstantial
43
Deduced from various occurrences and facts.
Moral Evidence
44
Examples:
motives for poisoning
purchasing the poison
keeping the materials used
Circumstantial / Moral Evidence
45
Includes symptoms observed during poisoning.
Symptomatic Evidence
46
alcoholic coma may stimulate _____
diabetic coma
47
arsenic poisoning is like ______
Cholera
48
Examples:
- arsenic poisoning
- alcoholic coma
SymptomaticEvidence
49
Evidence obtained by chemical analysis of the suspected substance, or the vomitus or secretion of the body.
This alone is not reliable because the poison may be decomposed or changed or it may have been placed anywhere after death.
Chemical Evidence
50
Evidence fromexaminationof tissuesandorgans after death.
Post-mortem Evidence
51
Obtained by administering the suspected substance to some living animal and noting the effects or symptoms.
This is not a very conclusive procedure since tolerance may not be the same as in man.
Experimental Evidence
52
Denotes the alteredpharmacodynamicsof a drug when givenintoxicdosage,since normal receptors andeffector’smechanisms may bealtered.
Toxicodynamics
53
applied to the pharmacokineticsof toxic doses of chemicals, since the toxic effect sof an agent may alter normal mechanisms for absorption, metabolism or excretion of a foreign material
Toxicokinetics
54
log dose that can produce 50% mortality in a population
--Dose that is required to kill half the members of a tested population after a specified test duration
LD50 or Median Lethal Dose
55
is defined as the into which a substance is distributed.
Volume of Distribution(Vd)
56
A ______ implies that the drug is not readily accessible to measures aimed at purifying the blood such as hemodialysis
large VD
57
Drugs with large volumes of distribution (6)
1. Antidepressants
2. Antimalarials
3. Narcotics
4. Propranolol
5. Antipsychotics
6. Verapamil
58
Drugs with relatively small volume of distribution (6)
1. Salicylate
2. Phenobarbital
3. Lithium
4. Valproic Acid
5. Warfarin
6. Phenytoin
59
a measure of the volume of plasmathatiscleared of drug per unit time.
Clearance
60
is the sum clearances of excretion by the kidneys and metabolism by the liver
Total clearance
61
2 Types of Clearance
First-order kinetics
Zero-order kinetics
62
in planning detoxification strategy, it is important to know the contribution of each organ to total clearance.
For example, if a drug is by liver metabolism and by renal excretion, even a dramatic increase in urinary concentration of the poison will have little effect on overall elimination
Clearance
63
Most _______ poisoning are due to intentional suicidal overdose by an adolescent or adult
Acute
64
Childhood deaths due to _______ ingestion of a drug or toxic household product
accidental
65
Careful management of _______ (4)
will result in an improved survival of patients who reach hospital alive.
respiratory failure
hypotension
seizures
thermoregulatory disturbances
66
How does a poisoned patient die?
(1) ________ of the central nervous system
Depression
67
Types of Cardiovascular toxicity
Hypotension
Peripheral Vascular Collapse
Lethal arrythmia
68
How does a poisoned patient die?
(2) ________ toxicity
Cardiovascular
69
How does a poisoned patient die?
(3) ________ frequently lose their airway protective reflexes and their respiratory drive.
Comatose patients
70
How does a poisoned patient die?
(4) _______________
Hypothermia or hyperthermia
71
Signs and Symptoms of Hypoxia (4)
Hypotension
Tachycardia
Severe Lactic Acidosis
Signs and Ischemia on the ECG
72
How does a poisoned patient die?
(5) _______________It occurs in spite of adequate ventilation and oxygen administration when poisoning is due to certain toxic compounds.
Cellular hypoxia
73
How does a poisoned patient die?
(6) _______ may result in death.
Seizures, muscular hyperactivity, andrigidity
74
Drugs that can often cause seizures (7)
1. Antidepressants
2. Theophylline
3. Isoniazid (INH)
4. Diphenhydramine
5. Antipsychotics
6. Cocaine
7. Amphetamines
75
How does a poisoned patient die
(7) _____ decrease BV
Hypovolemia
76
How does a poisoned patient die
(8) ________ may occur after poisoning, and is sometimes delayed in onset.
Other organ system damage
77
attacks lung tissue, resulting in pulmonary fibrosis, beginning several days after ingestion.
Paraquat
78
due to poisoning by acetaminophen or certain mushrooms results in hepatic encephalopathy and death 48–72 hours or longer after ingestion.
Massive hepatic necrosis
79
Intoxication with alcohol and other ______ drugs is a frequent contributing factor to motor vehicle accidents
Sedative-Hypnotic
80
Patients under the influence of hallucinogens such as________ may die in fights or fall from high places.
pencyclidine (PCP) or LSD
81
"ABCDs" of PoisoningTreatment
Airway
Breathing
Circulation
Dextrose
82
Obstruction of airway is caused by:
flaccid tongue, pulmonary aspiration of gastric contents, or respiratory arrest.
83
The airway should be cleared of _____ or any other obstruction
vomitus
84
An _________ tube maybe inserted if needed.
oral airway or endotracheal tube
85
For many patients, simple positioning in the ____________ position is sufficient to move the flaccid tongue out of the airway.
lateral decubitus
86
A soft, flexible tube is passed through the nose and into the trachea using a “blind” technique.
Nasotracheal intubation.
87
The tube is passed through the mouth into the trachea under direct vision.
Orotracheal intubation.
88
Advantages of Nasotracheal intubation
May be performed in a conscious patient without requiring _______
neuromuscular paralysis
89
Advantages of Nasotracheal intubation
Once placed, it is better tolerated than ________
orotracheal tube
90
are major cause of morbidity and death in patients with poisoning or drug overdose.
Complications:
-ventilatory failure
-hypoxia
-bronchospasm
Breathing difficulties
91
Breathing should be assessed by observation and ________ and, if in doubt,by measuring ________.
oximetry; arterial blood gases.
92
Patients with respiratory insufficiency should be
intubated and mechanically ventilated
93
Correct hypoxia. Administer ______ as indicated based on arterial PO2
Intubation and assisted ventilation may be required.
supplemental oxygen
94
BREATHING
If carbon monoxide poisoning is suspected, give _____
100% oxygen
95
BREATHING
2. Treat Pneumonia
Obtain frequent sputum samples and initiate appropriate ________ when there is little evidence of infection.
antibiotic therapy
96
There is no basis for ____________ of aspiration- or chemical-induced pneumonia.
prophylactic antibiotic treatment
97
May result from the following:
Direct irritant injury from inhaled gasesorpulmonary aspiration of petroleum distillates or stomach contents. Pharmacologic effects of toxins
Hypersensitivity or allergic reactions
Bronchospasm
98
BREATHING
Administer bronchodilators such as :
Aerosolized ß2 stimulant
99
If Aerosolized ß2 stimulant IS not effective, and particularly for betablocker-induced wheezing, give ______
aminophylline
Dose: 6mg/kg IV over 30 minutes.
100
For patients with bronchospasm and bronchorrhea caused by organophosphate or other anticholinesterase poisoning, give _____
atropine
101
An ________ should be placed and blood drawn for serum glucose and other routine determinations.
intravenous line
102
At this point, every patient with altered mental status should receive a challenge with ______
, unless rapid bedside blood sugar test demonstrates that the patient is not hypoglycemic
concentrated dextrose
103
Dextrose Dose Adult
25g (50mLof 50% dextrose solution) intravenously,
104
Dextrose Dose Children
0.5g/kg (2mL/kg of 25%dextrose).
105
_______ may appear to be intoxicated
Hypoglycemic patients
106
Alcoholic or malnourished patients should also receive ____________________ at this time to prevent Wernicke's syndrome.
100mg of thiamine IM or in the IV infusion solution
107
________ will reverse respiratory and CNS depression due to all varieties of opioid drugs
Naloxone
108
The opioid antagonist naloxone maybe given in a dose of _______
0.4–2mg intravenously
109
_______ may be of value in patients with suspected benzodiazepine overdose
Flumazenil
110
_____ should not be used if there is a historyof tricyclicantidepressant overdose or a seizure disorder, asitcaninduce convulsions in such patients.
Flumazenil
111
_____ should not be used if there is a historyof tricyclicantidepressant overdose or a seizure disorder, asitcaninduce convulsions in such patients.
Flumazenil
112
Examples:
- arsenic poisoning
- alcoholic coma
SymptomaticEvidence
113
Examples:
- arsenic poisoning
- alcoholic coma
SymptomaticEvidence
114
Hydromorphone
SymptomaticEvidence
