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Toxicology Semmelweis > TOX 3 - III. Enhancing of elimination of toxins > Flashcards

TOX 3 - III. Enhancing of elimination of toxins Flashcards

1
Q

ENHANCEMENT OF POISON ELIMINATION? via?

A
  1. via GI
  2. via kidney
  3. EXTRACORPOREAL REMOVAL:

 Dialysis (peritoneal, hemo),

 Hemoperfusion,

Plasmapheresis

  1. NEUTRALIZATION
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2
Q

ENHANCEMENT OF POISON ELIMINATION via GI

A
  1. Multiple-dose activated charcoal („gut dialysis”)
  2. Cholestyramine in digital intoxication (decrease of absorption)
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3
Q

ENHANCEMENT OF POISON ELIMINATION via kidney

A
  1. Forced diuresis (infusion, loop diuretics, mannitol) ??? not very effective and the risk is lung edema, electrolyte disturbance
  2. Alteration of urinary pH

​ excretion of weak acids is HIGH if the urine is more basic (NaHCO3 infusion)

excretion of weak base HIGH if the urine is more acidic (NH4Cl infusion –risk is myoglobin precipitation)

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4
Q

EXTRACORPOREAL REMOVAL

A

Dialysis (peritoneal, hemo)

The molecules diffuse through a membrane into the direction of their concentration gradient .

It can be done only for compounds which are water soluble, have low molecular mass and do not bind very strongly to plasma proteins

Alcohol, Antibiotics, Heavy metals, Salicylates, Benzodiazepines etc.

 Hemoperfusion

Removing the drugs by passing the blood from patient through an adsorbent material and back to the patient.

Molecules which have greater affinity for the materials, will be removed.

Barbiturates, Organophosphates, Digoxin

Plasmapheresis

Removal of cellular components of blood than resuspended on to colloids, albumin, plasma proteins than reinfused

Complication might be thrombocytopenia and/or microembolism

Indicated e.g. in carbamazepine, lithium, methanol, metformin, phenobarbital, salicylate, theophylline, valproic acid intoxication

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5
Q

Extracorporeal removal by Dialysis (peritoneal, hemo)

A

The molecules diffuse through a membrane into the direction of their concentration gradient .

It can be done only for compounds which are water soluble, have low molecular mass and do not bind very strongly to plasma proteins

Alcohol, Antibiotics, Heavy metals, Salicylates, Benzodiazepines etc.

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6
Q

when is dialysis indicated ?

A
  1. Alcohol,
  2. Antibiotics,
  3. Heavy metals,
  4. Salicylates,
  5. Benzodiazepines etc
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7
Q

extracorporeal removal- Hemoperfusion

A

Removing the drugs by passing the blood from patient through an adsorbent material and back to the patient.

Molecules which have greater affinity for the materials, will be removed.

Barbiturates, Organophosphates, Digoxin

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8
Q

when is hemoperfusion indicated?

A
  1. Barbiturates,
  2. Organophosphates,
  3. Digoxin
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9
Q

Plasmapheresis

A

Removal of cellular components of blood than resuspended on to colloids, albumin, plasma proteins than reinfused

Complication might be thrombocytopenia and/or microembolism

Indicated e.g. in carbamazepine, lithium, methanol, metformin, phenobarbital, salicylate, theophylline, valproic acid intoxication

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10
Q

complication of plasmapheresis

A

Complication might be

  1. thrombocytopenia and/or
  2. microembolism
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11
Q

plasmapheresis indicated in

A

Indicated e.g. in

  1. carbamazepine,
  2. lithium,
  3. methanol,
  4. metformin,
  5. phenobarbital,
  6. salicylate,
  7. theophylline,
  8. valproic acid intoxication
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12
Q

Neutralisation

A
  1. alkali-therapy (5% NaHCO3 , 2% Na lactate)
  2. specific antitoxins
  3. neutralization by antibodies
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13
Q

Antidote possible mechanisms

A
  • Binding of the poisons (chelators, toxin-specific antibodies)
  • Inhibition of the distribution (methemoglobin-producers in cyanide intoxication)
  • Inhibition of the formation of toxic metabolites (ethanol, fomepizole in methanol, ethylene glycol intoxication)
  • Promoters of detoxification (acetylcysteine, thiosulfate)
  • Competitive inhibitors (naloxone)
  • Agents promote the regeneration of the target cells (cholinesterase inhibitors, redox dyes)
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14
Q

Heavy metals(Poison) antidote

A

chelating agents

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15
Q

Cholinesterase blockers(Poison) antidote

A
  • Atropine
  • Enzyme reactivators :Toxogonin , PAM
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16
Q

Cyanide (Poison) antidote

A
  • Oxidants producing methemoglobin,
  • Co-EDTA
17
Q

Methemoglobin producers(poison) antidote

A

Methylene blue,

thionin

18
Q

Snake venoms antidote

A

Specific antisera

19
Q

Methanol, ethylene glycol(poison) antidote

A

Ethanol

20
Q

Coumarines antidote

A

vitK

21
Q

Opiates antidote

A

Naloxone

22
Q

Paracetamol antidote

A

Acetylcysteine

23
Q

Cardiac glycosides antidote

A

Digoxin antibodies

24
Q

CO antidote

A

o2

25
Q

Benzodiazepines antidote

A

Flumazenil

Toxicology Semmelweis (20 decks)

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