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Toxicology Flashcards

1
Q

what is occupational toxicology?

A

deals with the chemicals found at the work place. The

workplace must follow threshold limit values (TLV)

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2
Q

define Hazard

A

is the ability of a chemical agent to cause injury in a given situation or setting; the conditions of use and exposure are primary considerations.

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3
Q

define Risk

A

The expected frequency of the occurrence of an

undesirable effect arising from exposure to a chemical or physical agent.

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4
Q

define Bioaccumulation

A

If the intake of a long-lasting contaminant by an
organism exceeds the latter’s ability to metabolize or excrete the
substance, the chemical accumulates within the tissues of the
organism.

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5
Q

define biomagnification

A

although the concentration of a contaminant may
be virtually undetectable in water, it may be magnified hundreds or thousands of times as the contaminant passes up the food chain.

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6
Q

name acute toxic effect toxins?

A

cyanide
coniin
fuge
ethanol

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7
Q

name subchronic toxic effect toxins?

A

eye/methanol phalloidin (3 days)

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8
Q

name chronic toxic effect toxins?

A

vinyl chloride: hepatic angiosarcoma

Ethanol: cirrhosis

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9
Q

name reversible toxic effect toxins?

A

N-hexane: regeneration of peripheral axons

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10
Q

name irreversible toxic effect toxins?

A

Aminoglycosides - no regeneration of central axons

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11
Q

what are predictable toxic effects?

A

dose/effect relationship

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12
Q

what are non-predictable toxic effects?

A

immunological
genetic background
idiosyncrasy (behavior) (G6PD)

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13
Q

pathway of exposure?

A
  1. exposure pathway: reaching individual
  2. toxicokinetic: reaching target site within body
  3. toxic effect: depends on dose and time
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14
Q

what influences dose at target site?

A

individuals may react different, like bodyweigt

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15
Q

Routes of exposure?

why is it important?

A

dermal
inhalation
oral inngestion
injection

related to tissue specific toxic response, they may be local or systemic

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16
Q

why is the timeframe of exposure important?

A

duration and frequency contribute to dose, acute vs chronic

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17
Q

what is the key concept in toxicology?

A

DOSE!!

All things are poisonous, only the dose makes it non-poisonous. all chemicals, synthetic or natural may be toxic.

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18
Q

What is the dose-response relationship?

A

A key concept in toxicology is the quantitative relationship between the concentration of a xenobiotic and the magnitude of the biological effect in produces

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19
Q

4 important processes that control the amount of a chemical that reaches the target site

A 
ATME 
absorption 
tissue distribution 
metabolism 
excretion
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20
Q

beneficial and toxic dose of aspirin?

A

beneficial: 300-1000 mg
toxic: 1000 - 30 000mg

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21
Q

beneficial and toxic dose of vitamin A?

A

beneficial: 5000 U/day
toxic: 50 000 U/day

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22
Q

beneficial and toxic dose of oxygen?

A

beneficial: 20% (air)
toxic: 50-80% (air)

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23
Q

dose dependent functions of aspirin?

A

<300mg: blocks platelet agg.
300-2400mg/day: antipyretic and analgetic effect
2400-4000mg/day: anti-inflammatory effects

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24
Q

when is plasma salicylate concentration toxic?

A

50-80 mild - hyperventilation
80-110 moderate - fever, dehydration, met. acidosis
110-160 severe - vasomotor collapse, coma, hypoprothrombinemia
160 and above is lethal - renal and respiratory failure

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25
which organs can do biotransformation?
liver (primary site of metabolism) kidney lung GI
26
toxins causing fatty liver?
triglyceride accumulation hydrazine, tetracycline CCI4 - necrosis ethanol repeated exposure
27
toxins causing cytotoxic damage to liver
cocaine, allyl alcohol - periportal necrosis CCI4, paracetamol - centrilobular necrosis TNT - massiv liver necrosis Phalloidin - ischemia and swelling of sinusoid cells furosemide - biliary excretion saturated at high dose
28
General management of poisoned patient
ALL patient should be managed as it they have potentially life-threatening intoxication even if they seem fine. initial approach is the same irrespective of toxin 1. emergency care 2. decontamination 3. antidotes 4. Enhancing elimination of toxins
29
diagnostic approach to intoxication
1. clinical signs 2. ECG 3. Lab test analysis
30
what is to be done during the emergency stage of treatment?
1. Initial assessment and stabilization 2. recognition of poisoning 3. identification of agents involved 4. assessment of severity
31
the critical care ABCDEF
``` A: airway protection B: oxygenation/ventilation C: treat arrhythmias D: hemodynamic support E: treatment of seizures F: correction of temperature, abnormalities ```
32
Decontamination of GI?
NOT in unconscious patients, poisoned with corrosive agents (acid/bases), petroleum distillate or convulsant. 1. induce emesis (syrup ipecac or rarely apomorphine) 2. gastric lavage (protect the airway) 3. whole bowel irrigation with gastric tube 4. catharsis (not if paralytic ileus)
33
How long to do eye decontamination?
at least 20 minutes
34
how to do skin decontamination?
1. remove clothing and seal them in double bags | 2. wash the kin area that was in contact with clothes with soap and water
35
how can you enhance elimination of poison?
GI: multiple doses activated charcoal or cholestyramine in digital intoxication Kidney: forced diuretic but high risk of lung edema
36
extra corporal removal of toxins?
1. Dialysis (peritoneal, hemolysis) only for water-soluble molecules wit low molecular mass and don't bind plasmaproteins strongly (alcohol, antibiotics, HM, salicylates, benzos) 2. Hemoperfusion - removing drugs by passing the blood through an adsorbent material and back to the patient 3. Plasmapheresis
37
mechanism of specific antidotes?
1. Binding the poison 2. Inhibit distribution 3. Inhibit formation of toxic metabolites 4. Promotes detoxification 5. Competitive inhibitors 6. Agents promoting regeneration of target cells
38
specific antidote: heavy metals (HM)?
chelating agents
39
specific antidote: cholinesterase blockers?
Atropin | Enzyme reactivators - Toxogonin and PAM
40
specific antidote: Cyanide?
Oxidants producing met-hemoglobin | Co-EDTA
41
specific antidote: Methemoglobin
Methylene blue | Thionin
42
specific antidote: snake venom
specific antisera
43
specific antidote: methanol, ethylene glycerol
ethanol
44
specific antidote: coumarines
vitamin K
45
specific antidote: opiates
Naloxone
46
specific antidote: paracetamol
acetylcystein
47
specific antidote: cardiac glycosides
digoxin antibodies
48
specific antidote: CO
O2
49
specific antidote: benzodiazepines
flumazenil
50
chelators?
Dimercaprol - gold, bismuth, arsenic, encephalopathy Succimer - lead, arsenic and mercury poisoning Penicillamine - copper intoxication EDTA calcium disodium - lead poisoning Deferoxamine - iron poisoning
51
what do you give in severe lead intoxication?
Dimercaprol with NaCaEDTA
52
What to give in encephalopathy induced by inorganic lead or bismuth
Dimercaprol
53
what is given in lead poisoning but not in encephalopathy?
Succimer or DMPS
54
recommended max dose of arsenic? | when is it dangerous?
child: 14 ug adult: 14 ug healt threat at 50 ug
55
arsenic pharmacodynamics
inhibit enzymes via sulfhydryl binging inhibiting oxidative phosphorylation
56
distribution of arsenic`
soft tissues mostly liver and kidney
57
what is the acute lethal dose of arsenic?
70-200mg or 1mg/kg/day
58
acute effects of arsenic?
1. gastroenteritis 2. hypovolemic shock 3. CNS symptoms
59
weeks and months after arsenic poisoning?
weeks: peripheral neuropathy months: transverse white striate on the nails
60
chronic effects of arsenic poisoning?
1. weakness 2. peripheral neuropathy 3. anemia 4. liver and kidney damage 5. skin changes 6. hyperkeratosis 7. hyperpigmentation 8. cachexia
61
treatment in arsenic poisoning?
1. supportive care 2. dimercaprol 3. calcium sodium edetate
62
lead distribution?
binds to erythrocytes inorganic: soft tissue, redistribution in bones organic: liver and CNS
63
lead half-life?
tissue 12 months | bones 20 years
64
acute effect of lead poisoning?
very rarely but encephalopathy may occur acutely with hemolytic anemia and spasmic ileus
65
chronic effect of lead poisoning?
Blood: inhibit heme synthesis and basophil stripping GI: loss og appetite, lead colic, gingival lines Nervous system Bones: growth retardation in children
66
therapy of acute lead poisoning?
FIRST give dimercaprol and 4h later give CaNaEDTA IV
67
therapy of chronic lead poisoning?
CaNaEDTA IV for 5 days then succimer
68
which drug can remove lead from bones?
NaCaEDTA
69
major effect and therapy of organic lead poisoning?
Major effect: CNS (delirium, convulsion, brain edema) | Therapy: chelators has no effect
70
CO poisoning route?
inhalation
71
normal CO levels in humans?
COHb is normally at 1% and 5-10% in smokers
72
Mechanism of CO poisoning?
binds Hb 250 higher affinity then O2 and decreases the O2 carrying capacity by forming carboxyhemoglobin
73
what happens to the Hb O2 dissociation cure in CO poisoning?
shifts to LEFT
74
% of CO giving the different symptoms?
15% may produce symptoms 40% lead collapse 60% death
75
treatment of CO poisoning?
1. remove source 2. maitane ventilation 3. administer O2 4. hyperbaric O2 treatment
76
forms of mercury entering body?
Elementary mercury - respiratory mercury salts - GI organic Hg (methyl Hg) - GI, skin, respiratory
77
acute effects of mercury poisoning?
elementary: pulmonary edema salts: corrosive hemorrhagic gastroenteritis --> Hypovolemic shock, ANT, oliguric kidney failure, anuria
78
treatment of acute mercury poisoning?
dithiol chelators
79
major effect of chronic mercury poisoning?
``` neuropsychiatric disturbance memory loss fatigue insomnia depression/anger loosing teeth kidney damage acrodynia in children ```
80
Formaldehyde poisoning effect?
protein precipitation - necrotic effect
81
therapy for formaldehyde poisoning
milk, water, gastric lavage, hemodialysis
82
what NOT give in formaldehyde poisoning?
Don't give sulfonamides - causes precipitation in kidney tubules
83
Halogenated aliphatic hydrocarbon therapy if monohalogenated methanes?
alkali therapy in case og acidosis
84
what is the lethal dose of halogenated aliphatic hydrocarbon CCL4?
20-30ml
85
examples of aromatic hydrocarbons?
``` Benzen Toluene Xylene Phenol Nitrobenzen Aniline Dinitrophenol Dinitroortocresol ```
86
phenol intoxication treatment?
gastric lavage purgation with cooking oil activated charcoal
87
nitrobenzen and aniline intoxication therapy?
reduce methemoglobinemia drink milk oil
88
what can provoke urinary bladder papilloma or cancer?
benzidine, naphthylamine, minophenydile
89
lethal dose of dinitroortocresol?
1g
90
Dinitrophenol and dinitroortocresol intoxication therapy?
cold bath O2 inhalation 0.9% NaCl Glucose infusion
91
lethal dose methaldehyde?
adults: 4g children: 0.1-0.5g for children
92
enzyme converting methanol to formaldehyde?
ethanol (alcohol) dehydrogenase
93
enzyme converting formaldehyde to formic acid?
aldehyde dehydrogenase
94
symptoms of methanol intoxication?
has a latency period (8-30h), if ingested with ethanol it gives ethanol intoxication sumptomes met. acidosis abdominal pain blindness
95
methanol and glycoles therapy?
1. ethanol 10g/hr IV or orally 20-30cl drink every 3-4h | 2. Fomepizole IV
96
what is the mechanism of divalent glycols? | Name two
Diethylene glycol | Ethylene glycol
96
what is the mechanism of divalent glycols? | Name two
Diethylene glycol Ethylene glycol Alcohole dehydrogenase converts them to glycol aldehyde then to oxalic acid which causes tubular necrosis
97
Inocybe mushroom poisoning therapy? | onset time?
atropin 1-2mg every 30 min | RAPID onset
98
Amanita muscaria and pantherina mushroom poisoning therapy? | Onset time?
RAPID onset | treat symptoms but DO NOT give atropin
99
Amanita phalloides, vorisa, vera mushroom poisoning therapy and onset time?
Delayed onset 1. protect liver and kidney 2. high dose G-penicillin 3. Silibinin 4. N-acetylcystein
100
acid intoxication therapy?
1. NO emesis and NO gastric lavage 2. dilute the acid in stomach (not milk) 3. oral local anesthetics 4. morphine, atropine, glucocorticoids 5. drop infusion 5% NaHCO3 or Na lactate
101
oxalic acid intoxication treatment?
CaCl2 Ca gluconate IV fluids + treat acidosis
102
what happens to iron in MH intoxication?
Ferro-Ferri (2+ to 3+)
103
lethal dose MH?
60-80%
104
what is verdoglobin?
irreversibly changes of Hb where the porphyrin ring oxidizes and split
105
what may be seen in RBC in MH intoxication?
Heinz bodies
106
what are the bacteria causing food poisoning?
Salmonella Proteus vulgaris E.coli B. cereus
107
food poisoning treatment?
gastriv lavage activated charcoal replacement of volume and electrolytes
108
lethal dose botulotoxin?
0.001-0.002 mg/kg
109
botulism therapy?
Antitoxin ABE purge with casteroil + neostigmine transfusion

Pharmacology (3 decks)

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