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PB+T > Toxicology > Flashcards

Toxicology Flashcards

0
Q

Drug testing process

A

Earliest analysis is toxic effects followed by IND application
Clinical trials
- Phase 1: Healthy volunteers; safety concerns and dosages
- Phase II: diseased PTs., toxic effects
- Phase III: large number of PTs., effectiveness, rare side effects
- Phase IV: post marketing research, verification
- ANDA: generic release
- Phase IV: research

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1
Q

Orphan drugs

A

Drugs for diseases that have that effect Less than 200,000 people

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2
Q

Dosage adjustment equation

A

Body Surface Area(M^3)/1.73 x adult dose

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3
Q

Category A,D and X

A

A - no known risks to fetus
D - risk to fetus, therapeutic effect may justify use
X - significant risk to fetus: Do not use in pregnant pt

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4
Q

Schedules

A
  • I: High potential for abuse/dependency no therapeutic value: heroine, PCP et al
  • II: High potential for abuse/dependency; Written prescription only, No refills
  • III: Moderate potential for abuse; Written or oral prescription, 5/6mo refills
  • IV: Limited potential for abuse; Written or oral prescription, 5/6mo refills
  • V: Limited potential for abuse; Prescription or OTC
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5
Q

Recall classes

A
  • I: serious health effects or death: contaminated Abx
  • II: temporary or medically reversible adverse health consequences:
  • III: Not likely to cause any health effects: quantity packaging error
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6
Q

Dialysis of toxins

A

Primarily a function of volume of distribution

- High Vd indicates low chance of success and visa versa

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7
Q

ABC’s of poison treatment

A

Airway, breathing, circulation, dextrose
- Alcohol: thiamine (avoids Warneke’s encephalopathy)
- Opioid: Naxalone (narcan)
- Benzodiazepine antagonist (flumazenil)
Assess exposure especially if anyone else may have been affected

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8
Q

Poison treatment physical exam

A

Vitals, eyes, mouth, CNS, abdomen, skin

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9
Q

Decontamination

A
  • Activated charcoal: superior to emesis and gastric lavage
  • Emesis and gastric lavage: especially if < 1 hour postexposure
  • Cathartics: laxatives or whole bowel irrigation
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10
Q

Acetaminophen toxicity

A

P450 converts acetaminophen to NAPQI which is then typically converted to an excreta bowl conjugate via glutathione

  • In an acetaminophen glutathione gets overloaded, and the toxic NAPQI builds up and causes hepatotoxicity
  • N-acetylcystine, a glutathione precursor is administered to handle the toxic metabolite overload
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11
Q

Cyanide poisoning

A

Two treatment options:

  • nitrates -> methemoglobin + methylene blue -> hemoglobin
  • hydroxycolobamin -> cyanocolobamin (soluble excretory product)
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12
Q

Nicotine poisoning

A

Nicotinic receptors are preganglionic autonomics; Sympathetic and parasympathetic activation. Stimulation followed by inactivation

  • insecticide is highly toxic -> coma, resp arrest, HTN, arrythmias,
  • Trt: symptomatic; usually if pt survives 4 hours recovery is good
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13
Q

Halogenated aliphatic hydrocarbons

A

Carbon tetrachloride, chloroform

  • chloriform is a CNS depressant
  • carbon tet is hepatotoxic
  • trt: support/symptomatic
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14
Q

Heavy metal toxicity: Arsenic

A

Toxin and toxicant (natural and man made)
- MOA: Interferes with oxidative phosphorylation, cell signaling and gene expression
- clinical effects: often seen in manufacturing processes and water supplies/aquatic sources
~ pancytopenia
~ Gastroenteritis
~ Cardiovascular: shock/arrhythmias
~ CNS: encephalopathy, peripheral neuropathy

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15
Q

Heavy metal toxicity: lead

A

Organic and inorganic forms
Inorganic: deposits in bone (X-ray diagnosis)
- MOA: interferes with essential cations
- Clinical affects: CNS and peripheral neuropathy, HTN, repro toxicity
- can be excreted in breast milk
Organic:
- MOA: hepatic dealkylation (fast) trialkylmetabolites (slow)
- clinical findings: encephalopathy

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16
Q

Heavy metal toxicity: elemental mercury

A
  • MOA: enzyme inhibition, membrane alteration
  • clinical findings: tremor, behavioral changes, gingivostomatitis, acrodynia; high dose pneumonitis
  • Higher tissue distribution then the other mercury types
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17
Q

Heavy-metal toxicity: inorganic Mercury

A
  • MOA: inhibits enzymes; alters membranes

- clinical findings: Acute tubular necrosis, GI

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18
Q

Heavy metal toxicity: organic mercury

A
  • MOA: alters enzymes, microtubules and neuronal structure

- clinical findings: CNS and birth defects

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19
Q

Heavy metal chelators

A 
Dimercaperol
Succimer
Penicillamine
Calcium EDTA
Ferroxamine
Unithiol
Dferoxamine
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20
Q

Dimercaperol

A

Arsenic and inorganic/elemental mercury

  • in cases of severe lead poisoning, add it to calcium EDTA
  • not H2O soluble (admin with 10% peanut oil)
  • succimer and unithiol superior agents
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21
Q

Succimer

A

Use in children with blood [lead] > 45 ng/dl and adults

  • arsenic and mercury poisoning
  • water soluble
  • prodrug: binds cystines to form mixed disulfides
  • comparable to parenteral EDTA, and is used more commonly now
  • does not affect other Ca, Zn, Mn
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22
Q

Calcium EDTA

A
  • primarily lead
  • zinc, manganese, certain heavy radionuclides
  • 1 hour 1/2 life
  • nephrotoxicity if not careful (hydration, low adequate dose)
23
Q

Ferroxamine

A

Iron and aluminum

24
Q

Unithiol

A
  • increases excretion of mercury, arsenic and lead

- associated with sever allergic rxns, Stevens-Johnson syndrome

25
Q

Penicillamine

A
  • D is less toxic than L isomer
  • readily absorbed in the gut
  • copper chelators: Wilson’s disease
26
Q

Deferoxamine

A
  • Iron chelator
  • in combo with dialysis useful for treatment of aluminum toxicity in renal failure
  • IM/IV
  • can cause hypotension and increased susceptibility to yersinia enterocolitica
27
Q

Chlorinated hydrocarbons (4) ABCD

A
  • insecticides: DDT, Benzine Hexachlorides, cyclodienes, toxaphens
28
Q

DDT

A
  • Poor dermal absorption
  • prevents inactivation of Na channels -> depol of neurons
  • inhibits Ca transport -> increases neuronal excitability
  • symptomatic treatment
29
Q

bipyridyl herbicide: paraquat

A

Oral toxicity

  • free radical production
  • initially GI irritation hematemesis, bloody stools
  • accumulation in lungs-> edema, alviolitis, progressive fibrosis
  • treat with activated charcoal, gastric lavage and symptomatic care; PROMPT IS KEY
30
Q

Chlorophenoxy herbicides

A
  • increased risk of Hodgkin’s lymphoma
  • 2,4 D: large doses req for coma/hypotonia. Symptoms last weeks
    -2,4,5D: coma more muscular effects
  • TCDD: by product of combustion of organic + chlorine
    ~ MOA: Aryl Hydrocarbon receptor
    ~ forest fires, bleaching, waste incineration
    ~ agent orange
    ~ Chloracne
    ~ human tumor promoter
31
Q

Organophosphates

A
  • MOA: AChE inhibition-> hypercholinergic effect: DUMBELS

- trt: atropine and pralidoxamine (AChE agonist)

32
Q

Carbamate insecticides

A
  • less toxic, effects more transient

- pralidoxamine is not indicated

33
Q

Venomous vs. non venomous snakes

A
  • triangular head
  • pits AND nostrils
  • elliptical pupil
  • undecided scales on underside of tail
34
Q

Jimsom weed

A
  • all parts toxic
  • contains atropine, scopolamine, hyocyanamine
  • anticholinergic effect: mydriasis, flushed dry skin, agitation, tachycardia, hyperthermia, hallucinations
35
Q

Death cap mushroom

A
  • amanitin: inhibits RNA Pol II -> hepatocellular necrosis

- death may occur 4-9 days after infection

36
Q

Alcohol toxicity treatment

A

Administration of thiamin helps avoid Wernecke’s encephalopathy

37
Q

Opioid overdose treatment

A

Naxalone (Narcan)

38
Q

SO2

A
  • combustion of fossil fuels: colorless irritant
  • clinical: bronchospasm, pulmonary edema
  • trt: support
39
Q

NO2

A
  • waste fires and silage on farms: brown irritant
  • clinical: bronchial irritation, pulmonary edema
  • trt: support
40
Q

CO

A
  • causes tissue hypoxia; HA followed by confusion, deteriorating visual acuity, coma, seizures, death
  • Trt: pure O2; hyperbaric oxygen therapy may help
41
Q

Aromatic hydrocarbons

A

Benzene, toluene, xylene

  • CNS depression, ataxia, coma
  • industrial, chemistry settings
  • trt: support
42
Q

Rotenone

A

Plant insecticide

  • irritant: dermatitis, GI irritation
  • trt: symptomatic
43
Q

Pyrethrum

A
  • plant alkaloid insecticide
  • most commonly irritation: contact dermatitis, CNS excitation -> seizures
  • trt: generally support, anticonvulsant
44
Q

Glyphosate

A

Irritant

Trt: Support

45
Q

PCB (polychlorinated biphenyls)

A
  • bioaccumulate in food chain, electrical equipment manufacturing
  • dermatotoxic, screws with liver enzymes
46
Q

TDCC

A

by-product of combustion of organic + chlorine
~ MOA: Aryl Hydrocarbon receptor
~ forest fires, bleaching, waste incineration
~ agent orange
~ Chloracne

47
Q

Membrane depressant cardiotoxic drugs OD

A
  • tricyclic antidepressants, quinidine

- trt: bicarbonate, sodium

48
Q

Fluoride OD

A
  • calcium channel blockers

- give calcium

49
Q

Short acting beta-blockers OD

A
  • theophylline, caffeine, metaproterenol

- esmolol

50
Q

Methanol, ethaleneglycol OD

A

Ethanol, fomepizol easier to use

51
Q

Benzo OD

A

Flumazenil

- Cind: seizures, benzo dependance

52
Q

Delirium caused by anticholinergic agents

A

Phyostigmine

53
Q

B-blocker OD

A

Glucagon

54
Q

Fomepezil

A

Methanol/ethylene glycol antidote

55
Q

Previously healthy patient presents to the emergency room after burning refuse. He is suffering from headaches, nausea, dizziness and is cyanotic and upon admission begins to seize. His breath has a distinct odor of bitter almonds.

A

Diagnosis: cyanide poisoning
- cytochrome C oxidase inhibition
Trt: hydroxycolobamin or nitrates/sodium thiosulfate followed by methylene blue.

56
Q

45-year-old man previously healthy reports to the ED with Bright cherry red skin on his extremities, nausea/vomiting dizziness, confusion. The wife reports that he was working out in his shop and had a small kerosene heater burning when she found him.

A

Diagnosis: CO poisoning (looks just like cyanide poisoning: clues in history)
Trt: 100% O2 and hyperbaric therapy

PB+T (20 decks)

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