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Pharm Exam 2 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

______ -disrupt biologic function and potentially kill an organism.

A

Poison

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2
Q

_____- a poison of biologic origin that does not have the ability to replicate. More loose definition such as “environmental toxin” has been used to describe toxic substances of nonbiologic origin

A

Toxin

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3
Q

_____ -toxin that is injected into the victim by some means (e.g., bee sting, snake bite)

A

Venom

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4
Q

_____ -any harmful substance and is generally
interchangeable with poison

A

Toxicant

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5
Q

______ -pharmacodynamics (interaction with
molecular targets and mechanisms of effects) as applied to interactions and mechanisms that generate toxic effects

A

Toxicodynamics

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6
Q

_____ -pharmacokinetics (absorption, distribution, biotransformation, and elimination) as applied to toxic substances

A

Toxicokinetics

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7
Q

Overdoses & Poisonings cause ___% all hospital admissions and ___% all ICU admissions

A

1; 10

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8
Q

Majority of overdoses are _______

A

Pediatric
Ø Usually accidental, peak age 2 years (why?)
Ø Accounts for ~10% pediatric admits

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9
Q

____% of heroin users started with prescription opioids

A

80

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10
Q

Mechanisms of toxicity

A

Physical
Chemical
Pharmacologic
Biochemical

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11
Q

“reacts chemically with the tissues or body
fluids such as blood to produce harmful effects (e.g., strong acids or bases cause burns)” is an example of what mechanism of toxicity?

A

Chemical

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12
Q

“interacts with endogenous
pharmacologic pathways, resulting in inhibition or overstimulation (e.g., botulinum toxin inhibits release of acetylcholine to cause paralysis)” is an example of what mechanism of toxicity?

A

Pharmacologic

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13
Q

“Reacts biochemically with cellular
constituents to produce cellular damage (e.g., venom of many snakes contains phospholipases that destroy cell membranes)” is an example of what type of mechanism of toxicity?

A

Biochemical

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14
Q

asbestos fibers in the lung are an example of what mechanism of toxicity?

A

Physical

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15
Q

______ - alters the genetic material of the
cell, resulting in disruption of function

A

Genomic (genotoxic)
mechanism of toxicity

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16
Q

______ alters DNA structure or function
sufficiently to cause mutations (benzene) or initiate and promote the development of cancers

A

Mutagenic (carcinogenic)

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17
Q

penicillin-induced hemolytic
anemia is an example of what mechanism of toxicity

A

Immunologic

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18
Q

phenytoin is associated with development of
cleft lip is an example of what mechanism of toxicity?

A

Teratogenic

19
Q

Blood-borne toxicants are also distributed extensively to the _____

A

Lungs

20
Q

toxicants that affect the ____ may
influence multiple systems and result in widespread systemic toxicity

A

Brain

21
Q

____ receives a large proportion of systemic blood flow

A

Liver

22
Q

primary elimination pathway of water soluble metabolites

A

Kidney

23
Q

an estimate is essential; dose,
concentration and the amount of toxicant; acute versus chronic

A

Degree of exposure

24
Q

T/F dermal exposure is generally associated with reduced rates and extent of absorption compared with oral ingestion or inhalation

A

T

25
Q

Time since exposure is helpful in estimating the following

A

Ø Degree of absorption
Ø Usefulness of blood sampling
Ø Value of management therapies

26
Q

Serum Overdose Panel

A

Alcohol, acetaminophen, barbiturate, salicylate,
& tricyclic antidepressants

27
Q

Types of diagnostic studies in Toxicology management

A

Serum Overdose Panel
Urine Toxicology Screen

28
Q

ACTIVATED CHARCOAL for decontamination strategy

A

Ø Adsorbs molecules to particle surface
Ø Reduces GI absorption of many toxic agents
Ø Enhances total body clearance of some agents
Ø given orally or via orogastric tube as a slurry
Ø Adults: 50-100gm (1-2g/kg), Children: 10-25g (1- 2g/kg)

29
Q

GASTRIC LAVAGE decontamination strategy

A

ØUseful < 2hrs after ingestion
ØLonger with agents that are strongly
Øanticholinergic
ØMay be done in an awake or in
unconscious patient after intubation
ØWarm tap water (~5 min or until clear)

30
Q

_____ contains multiple alkaloids (notably
emetine)-causes emesis by direct action on the gastric mucosa & by stimulating the
chemoreceptor trigger zone

A

Ipecac syrup

31
Q

Contraindications/considerations to decontamination by emesis

A

Has not been proven to improve outcomes in overdoses

32
Q

Most treatments for toxicity are _____

A

Supportive care

33
Q

Antidote mechanisms and examples

A
  • Receptor competition: naloxone for opiate
  • Complex formation: dimercaprol /edetate calcium disodium for heavy metal
  • Metabolic conversion: Fomepazole and ethanol for methanol or ethylene glycol poisoning
  • Prevention of toxic metabolite formation: N-acetylcysteine for acetaminophen poisoning
  • By changing the physio-chemical nature of toxicant: sodium thiosulfate for cyanide poisoning
  • Promotes return to normal function by repairing a defect or enhancing a function that corrects the effects of poison: vitamin K for warfarin overdose
34
Q

Acetominophen overdosing

A

Ø Overdose leads to toxic metabolic pathway
Ø Acute toxic dose: >140mg/kg in pediatric and >6g in adults
Ø Chronic toxic dose: >4g/day in adults
Ø Hepatic and renal damage
Ø Treatment with prevention of absorption = activated
charcoal
Ø N-acetylcysteine (NAC)

35
Q

How does NAC work?

A

N-acetylcysteine (NAC). A primary treatment strategy for acetaminophen toxicity is replenishment of cellular glutathione via the administration of NAC, a precursor of
glutathione (manipulation of biotransformation)

36
Q

Salicylates

A

Ø Available in many over the counter preparations
Ø Normal daily dose is 40-60mg/kg; toxic dose 150-500mg/kg
Ø toxicity manifests as progressive metabolic, neural, cardiovascular, and renal dysfunction
Ø Treatment with prevention of absorption = activated charcoal, emesis not recommended

37
Q

emesis not recommended for what type of overdose

A

Opioid

38
Q

Oxalate-calcium crystals precipitate in the renal tubules and cause nephrotoxicity for what substances

A

Ethylene Glycol
Ø toxic metabolites ; high mortality and morbidity if not treated
Ø ethylene glycol converted to glycoxylic acid and then oxalate

39
Q

_____ is converted to formaldehyde and then formic acid

A

Methanol
§ causes metabolic acidosis, multi-organ failure and death
§ damage to the retina and optic nerve and blindness

40
Q

induction of cardiac arrhythmias can occur with what type of overdose

A

Cardiac Glycosides- digoxin

41
Q

Organophosphates-characteristics

A

Ø binds and inhibits acetylcholine esterase- acetylcholine is a key transmitter at muscarinic, nicotinic and CNS synapses

42
Q

Organophosphates effect on muscarinic and nicotinic receptors

A

Ø effect on muscarinic receptors- increased salivation and bronchial secretions bronchoconstriction, bradycardia
Ø effect on nicotinic receptors- muscle tremors, weakness and paralysis

43
Q

Calcium Channel and β-Blockers toxicity is a direct extension of ____

A

Ø Used for hypertension, heart failure, arythmias and headaches
Ø Toxicity is a direct extension of the pharmacologic activity of these agents; use in controlling pressure, arrhythmias and heart
failure

Pharm Exam 2 (9 decks)

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