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Disease and Defense- Pharm > Poisoning - Toxicology > Flashcards

Poisoning - Toxicology Flashcards

1
Q

What is the most rapid and complete method of stomach emptying?

A

gastric lavage

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2
Q

Name 2 emesis-producing drugs.

A

1) ipecac 2) Apomorphine

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3
Q

What happens in acetaminophen poisoning after 72-96 hours?

A

Peak hepatotoxicity

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3
Q

Acidify urine with ____ or _____ to trap weak bases [pKa 7.5-10.5] like phencyclidine or amphetamine.

A

NH4Cl; ascorbic acid

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4
Q

Death from methanol is almost always preceded by ______ and results from ______.

A

blindness; sudden cessation of respiration

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4
Q

Hepatocellular injury via acetaminophen poisoning occurs via the eventual depletion of cellular glutathione and ______.

A

the binding of NAPQI to critical protein or cellular constituents

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5
Q

How is the volume of distribution used in toxic drug doses?

A

predicts which drugs will be removed by dialysis/exchange transfusion

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6
Q

What is the mechanism of action for ipecac?

A

local irritation and CNS stimulation of chemoreceptor zone (CTZ)

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6
Q

Acidify urine with NH4Cl or ascorbic acid to trap weak bases [pKa 7.5-10.5] like _____ or _____.

A

phencyclidine; amphetamine

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7
Q

What are the symptoms of acetaminophen poisoning in the initial 24 hours?

A

nausea, vomiting, diaphoresis, abdominal pain

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9
Q

The half life may be prolonged in toxic overdoses due to ______.

A

saturation of the elimination mechanisms

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9
Q

_______ results in visual disturbances (“like being in a snowstorm”) occurring soon after onset of acidosis due to effects of formic acid on optic disc and retina.

A

Methanol poisoning

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10
Q

When is N-acetylcysteine given?

A

12-36 after ingestion of acetaminophen poison

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11
Q

Alkalinize urine with NaHCO3 to trap weak acids [pKa 3.0-7.5] like _____ or ______.

A

aspirin; barbiturates

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12
Q

Magnesium citrate or sulfate is contraindicated in ____ or _____.

A

renal disease or nephrotoxic poisons

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13
Q

Name 4 pharmacokinetic/toxicokinetic strategies.

A

1) prevent/decrease absorption of toxin 2) inhibit toxification 3) enhance metabolism/detox 4) increase elimination

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13
Q

What is the mechanism of action for Apomorphine?

A

a dopamine agonist, stimulates CTZ

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14
Q

What are the symptoms of acetaminophen poisoning in after 7-8 hours?

A

severe liver damage and/or death

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15
Q

Hepatocellular injury via acetaminophen poisoning occurs via _____ and the binding of NAPQI to critical protein or cellular constituents.

A

the eventual depletion of cellular glutathione

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15
Q

Alkalinize urine with NaHCO3 to trap _____ [pKa ___-____] like aspirin or barbiturates.

A

weak acids; 3.0-7.5

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17
Q

What is emesis?

A

emptying stomach rapidly

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18
Q

What are the side effects of Apomorphine?

A

respiratory depression

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18
Q

The rate-limiting enzyme in the ethanol metabolism pathway is _____.

A

alcohol dehydrogenase

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19
Q

Why is it important to know clearance mechanisms/excretion in planning a treatment strategy?

A

to know the contribution of each organ to toxin elimination

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19
Q

Ethylene glycol poisoning results in damage to the kidneys due to deposition of _____ leading to acute renal failure in most patients.

A

calcium oxalate crystals

20
Q

_____ and ______ have minimal toxicity until metabolized to formic acid and oxalic acid.

A

Methanol; ethylene glycol

21
Q

Name 3 treatments for EtOH poisoning.

A

1) suppress production of toxic metabolites by inhibiting alcohol dehydrogenase with ethanol or fomepizole 2) hemodialysis and gastric lavage 3) correction of metabolic acidosis with sodium bicarb

22
Q

Alkalinize urine with ____ to trap weak acids [pKa 3.0-7.5] like aspirin or barbiturates.

A

NaHCO3

24
Q

Sodium sulfate is contraindicated in _____ and _____.

A

congestive heart failure; hypertension

25
Q

How are poisons chemically absorbed?

A

activated charcoal

26
Q

What are the symptoms of acetaminophen poisoning after 24-48 hours?

A

hepatic damage: elevated plasma aminotransferases, prothrombin time prolonged

26
Q

Toxic manifestations of _____ are due to enzyme inhibition and alteration of membrane structure (especially in _____ tissues).

A

heavy metals; neuronal

27
Q

What is Hemoperfusion?

A

blood pumped thru a column of absorbent material

29
Q

Methanol poisoning results in visual disturbances (“like being in a snowstorm”) occurring soon after onset of acidosis due to ______.

A

effects of formic acid on optic disc and retina

31
Q

What is a gastric lavage?

A

Washing of stomach contents with saline and removal via nasogastric tube

33
Q

Death from ______ is almost always preceded by blindness and results from sudden cessation of respiration.

A

methanol

34
Q

Predisposing factors for hepatocellular damage are ______ and _______ (both occur with excessive alcohol consumption).

A

increased CYP2E1 activity; decreased hepatic glutathione content

35
Q

When is Polyethylene glycol used?

A

in poisonings with sustained release drugs, metal ions, or drug packets

36
Q

How is heavy metal toxicity treated?

A

chelating agents that complex with free metal ions in body fluids

38
Q

What is given with activated charcoal to soften it?

A

sorbitol 70%

40
Q

The _____ may be prolonged in toxic overdoses due to saturation of the elimination mechanisms.

A

half life

41
Q

How does a toxic dose change absorption/bioavailability?

A

slow dissolving, altered GI emptying, injure GI tract

42
Q

_____ is most effective for toxins with small Vd and low protein binding capacity.

A

Hemodialysis

43
Q

Methanol and ethylene glycol have minimal toxicity until metabolized to _____ and _____.

A

formic acid; oxalic acid

44
Q

Methanol poisoning results in visual disturbances (“___”) occurring soon after onset of acidosis due to effects of formic acid on optic disc and retina.

A

like being in a snowstorm

45
Q

What is the dose of activated charcoal?

A

10:1 of toxin every 4 hours

46
Q

Acidify urine with NH4Cl or ascorbic acid to trap _____ [pKa ___-____] like phencyclidine or amphetamine.

A

weak bases; 7.5-10.5

48
Q

Predisposing factors for hepatocellular damage are increased CYP2E1 activity and decreased hepatic glutathione content (both occur with ____).

A

excessive alcohol consumption

49
Q

What is fomepizole?

A

inhibitor of alcohol dehydrogenase

50
Q

How does activated charcoal work?

A

binds the drug in gut

51
Q

What is ipecac?

A

syrup that produces emesis after 15-30 min

52
Q

Lavage + emesis removes about ____ of most oral poisons.

A

30%

52
Q

Toxic manifestations of heavy metals are due to ____ and _____ (especially in neuronal tissues).

A

enzyme inhibition; alteration of membrane structure

53
Q

Name a pharmacodynamic strategy.

A

antidotes

55
Q

When is Hemoperfusion used?

A

high molecular weight toxins with poor water solubility

56
Q

Hemodialysis is most effective for toxins with _____ and ______.

A

small Vd; low protein binding capacity

57
Q

_____ results in damage to the kidneys due to deposition of calcium oxalate crystals leading to acute renal failure in most patients.

A

Ethylene glycol poisoning

58
Q

The rate-limiting enzyme in the _____ metabolism pathway is alcohol dehydrogenase.

A

ethanol

59
Q

Approximately ____ of acetaminophen goes through a phase II reaction; ____ proceeds through a phase I cytochrome P450 oxidation (CYP2E1).

A

70-80%; 5-10%

60
Q

What does Polyethylene glycol do?

A

whole bowel content elimination

61
Q

When are osmotic cathartics used?

A

if toxin ingestion was more than 1 hour ago, if it’s in enteric coated caplets, or if it’s hydrocarbon

Disease and Defense- Pharm (12 decks)

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