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MLSCI 263 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

general approach to the poisoned patient

A
  • stabilization
  • history
  • examination (lab testing)
  • diagnosis
  • decontamination/enhanced elimination
  • poison-specific treatment (Antidote)
  • disposition
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2
Q

Toxidromes

A

group of signs and symptoms that are characteristically associated with a drug or class of drugs

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3
Q

preventing absorption or enhancing elimination of drugs

A
  • none are universally applied

- techniques depend on state of patient and drug in question

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4
Q

mechanism of activated charcoal

A

toxins bind to charcoal and prevent absorption

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5
Q

whole bowel irrigation

A

cleanse whole bowel using PEG

- used esp if someone is a drug mule

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6
Q

how do we enhance renal elimination when enhancing elimination

A

make urine more acidic or basic depending on drug you are trying to eliminate
- if drug is ionized it will not cross cell membranes
> acidic drug for ex = ionized in a basic medium
> enhance elimination of acidic drug = try to make urine more basic bc if urine is basic, acidic drug will be ionized and it will not cross cell membrane and will not be reabsorbed

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7
Q

T or F. every drug has an antidote

A

F!

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8
Q

different mechanisms of actions for different antidotes

A
  • antidotes that interfere with metabolism
    > ex: Fomepizole interferes with the metabolism of methanol and ethylene glycol bc it inhibits alcohol dehydrogenase
  • interact with receptors
    > preventing opioids from binding (ex: naloxone bonds instead of opioids = no effect)
  • shunting a particular pathway (different direction that what would normally cause intoxication)
  • antagonist of receptor
  • sop up all of the drugs
  • chelating agents = bind to substance to help excrete it out of body
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9
Q

disposition

A

when we would consider transferring the patent to a higher-level facility

  • if unable to stabilize
  • patient deteriorates
  • cant provide ongoing support
  • timely diagnostic testing not available
  • toxin-specific therapy is unavailable
  • suicidal ingestions = Psych consult needed
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10
Q

which clinical toxicology testing is STAT

A

quantitative ( except trace elementS)

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11
Q

immunoassays for initial testing

A
  • antigen-antibody rxns
  • both instrument-based and non (POCT)
  • detects broad class of drugs (not specific drug in a class though); can distinguish drugs between classes, just not within a class
  • cross-reactivity dependent n reagent chem and devices used
  • limited in scope
  • prone to FNs and FPs
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12
Q

Define cutting agents

A

help with “bulking up” supply or dose of drug

- interferes with qualitative testing

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13
Q

This can cause a false positive with fentanyl immunoassays

A

trazodone

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14
Q

Cross-reactivity can be poor for these class of drugs

A

benzodiazepines

  • some are more detectable than others
  • oxaprozin = FP
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15
Q

confirmatory or definitive testing

A
  • uses GC/MS or LC/MS/MS
  • confirms immunoassay or initial testing for drugs with no immunoassay
  • more resource driven
  • provides high specificity
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16
Q

the action of the body on the drug

A

pharmacokinetics

17
Q

Two reasons for therapeutic failure

A
  • not taking medication (patient feeling ok so stop taking it OR side effects of meds is too much)
18
Q

pharmacodynamics

A

the action of the drug on the body

- how does the drug interact with receptor systems to cause effects

19
Q

indications for TDM (7)

A
  • for drugs with a defined plasma therapeutic range
  • when the toxic effects of drugs resemble the symptoms of the condition being treated
  • for drugs with a defined plasma therapeutic range, but with great inpatient variability in elimination
  • for drugs whose clinical effects are difficult to determine (not done for BP medications for example because can just measure blood pressure)
  • complicating factors such as GI, CV, hepatic, or renal disease
  • verification of patient compliance
  • narrow therapeutic index
20
Q

narrow therapeutic index

A

very narrow range for when a drug is effective vs when it is toxic

21
Q

define steady-state

A

drug intake = drug elimination
MAKE SURE WHEN DOING TDM = do it at this plateau
- takes five half-lives to get to steady-state
- TDM too early = drug level is low; might say sub-therapeutic when not really…

22
Q

half-life

A

the time required to decrease drug concentration by 50%

23
Q

T or F. Different drugs have different half-lives

A

T!

24
Q

time to achieve steady-state is influenced by

A

half life

25
Q

steady-state concentration determined by

A

dose and frequency of dose

26
Q

MEC

A
  • minimum effective concentration

- the lowest drug concentration above which drug is active i most patients (or will produce an effect)

27
Q

MTC

A
  • minimum toxic concentration

- lowest concentration above which most patients are likely to experience adverse or toxic effects

28
Q

therapeutic range

A

relationship between the desired clinical effect of a drug and the plasma drug concentration (MEC to MTC range)

29
Q

therapeutic index

A

ratio between the plasma concentrations yielding toxicity and desired effects of the drug (MTC/MEC)

30
Q

the highest drug concentration reached after a dosage

A

peak concentration

31
Q

trough concentration

A

the lowest drug concentration reached, usually before the next dose is given

32
Q

inter-patient variability = will afect pharmacokinetics

A
  • age
  • sex
  • pregnancy
  • drug interactions
  • disease (ex: renal, heart disease, etc.)
  • pharmacogenetics
  • malnutrition (will affect GI absorption)
  • patient compliance
33
Q

major goals of TDM labs

A
  • serve as a testing resource to health care professionals and the public
  • provide excellent analytical service
  • ensure analysis is done on appropriate specimens at appropriate time
  • provide interpretation of results
  • conduct research

MLSCI 263 (31 decks)

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