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Toxicology Flashcards

1
Q

What are nerve gases?

A

OP compounds in gaseous form
Eg. Soman, Sarin, Tabun, VX
Produce cholinergic signs and symptoms (DUMBBELS)

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2
Q

What are the nicotinic manifestations of OP poisoning?

A

Muscle fasciculations
Flaccid paralysis
Tachycardia
Transient HTN

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3
Q

What treatment modality has proven mortality benefits in resp failure d/t OP poisoning?

A

Oxygen supplementation– in case of respiratory failure
Urinary alkalinization, hemodialysis– no role

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4
Q

What are two key symptoms of arsenic poisoning related to the kidneys and muscles?

A

PCT Damage with Proteinuria: Damage to the proximal convoluted tubules in the kidneys, leading to protein in the urine.

Muscle Pain: A notable symptom that distinguishes arsenic from other heavy metal poisonings.

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5
Q

What disease does acute arsenic poisoning resemble? What is the asso. odor?

A

Cholera, and it often has a garlicky odor.

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6
Q

List four salient features of chronic arsenic poisoning.

A

Raindrop pigmentation: Seen on the temples, eyelids, and neck.
Aldrich-Mee’s lines: Transverse white striae on the fingernails.
Hyperkeratosis: Thickening of the skin on palms and soles.
Painful paresthesia: Numbness and tingling in hands and feet.
Blackfoot disease

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7
Q

Name two tests used to detect arsenic poisoning.

A

Marsh test
Reinsch test

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8
Q

What are the three treatments for arsenic poisoning?

A

Freshly prepared hydrated ferric oxide
BAL (British Anti-Lewisite)
Penicillamine (if BAL is not available)

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9
Q

Does mercury cause muscle pain?

A

No. While mercury commonly causes PCT damage, it does not cause muscle pain. Arsenic poisoning is unique in this regard.

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10
Q

What is the appearance of the stomach in chronic arsenic poisoning?

A

Red velvety appearance.

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11
Q

Left shift of O2 disso curve occurs with CO poisoning because?

A

When CO binds to Hb, the remaining O2 binding sites have increased affinity to O2

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12
Q

Toxicity from nitrates can be treated with____ to reverse formation of _______

A

Methylene blue
Methhemoglobin

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13
Q

Types of cholinesterases

A

Acetylcholinesterase
Butyrylcholinesterase
Neuropathy target esterase

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14
Q

AchE is located in

A

Aka true/ RBC cholinesterase (also used for diagnosis)
RBC membranes
Nervous tissue
Skeletal muscle

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15
Q

Butyrylcholinesterase located in

A

aka plasma/ pseudocholinesterase
Serum
Liver, Pancreas
Brain, Heart

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16
Q

Neuropathy target esterase located in
Its inhibition leads to?

A

Brain, Kidney
OP induced delayed neuropathy

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17
Q

MOA of:
1. Carbamates
2. Sodium or Potassium chlorates
3. Paraquat

A
  1. Carbamylation of carboxylic esterase
  2. Oxidation of Hb to MethHb
  3. Free radical mediated damage
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18
Q

What are three common names for the Datura plant?

A

Thorn apple
Jimson weed
Devil’s trumpet

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19
Q

What are the active ingredients in Datura that cause toxicity?

A

Anticholinergic alkaloids:
Atropine
Scopolamine
Hyoscyamine

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20
Q

What are the toxic manifestations of Datura?

A

“Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter.”
Dry hot skin
Dilatation of pupils
Diplopia
Dryness of mouth and throat
Dysphagia
Dilatation of cutaneous blood vessels
Dysarthria
Drunken gait
Delirium
Drowsiness
Death d/t resp or cardiac failure

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21
Q

What is the primary treatment for Datura poisoning?

A

Gastric lavage or decontamination with activated charcoal or tannic acid.

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22
Q

What is the physiological antidote used in severe Datura toxicity?

A

Physostigmine (1-2 mg IM/IV every half hour as needed).

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23
Q

Why is gastric decontamination considered important in Datura poisoning?

A

Gastric emptying is often delayed, and the small, plentiful seeds can become trapped among the gastrointestinal folds after ingestion.

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24
Q

What is Datura also known as due to its use in travel-related crimes?

A

Railroad poison

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25
Which parts of the Yellow Oleander plant are poisonous?
All parts of the plant.
26
What are the active poisonous principles in Yellow Oleander?
Thevatin and thevatoxin (cardiac glycosides).
27
List symptoms of Yellow Oleander poisoning.
Burning sensation in the mouth, Tingling of the tongue, Dryness of throat Vomiting, Diarrhea Headache, Dilated pupils Irregular heart action Drowsiness, Coma, Collapse Death
28
What are the two primary metabolites found in the blood in methanol poisoning?
Formic acid and lactic acid.
29
Where is methanol metabolized in the body?
Liver
30
1. What is the first toxic intermediate that methanol is converted into? 2. What is formaldehyde further oxidized into?
1. Formaldehyde 2. Formic acid
31
What are the severe symptoms associated with methanol poisoning due to the accumulation of formic acid?
Confusion Abdominal pain Visual disturbances (blurred vision, blindness) Metabolic acidosis
32
What visual symptom is particularly severe in methanol poisoning?
Blurred vision or blindness due to the toxic effects of formic acid on the optic nerve.
33
What does methanol's disruption of normal oxidative enzyme activity lead to?
Buildup of lactic acid, contributing to acidosis.
34
List three other severe conditions seen in methanol poisoning.
Brain edema Acute renal failure Severe metabolic derangement
35
What are the two primary treatments for methanol poisoning?
Fomepizole or ethanol. They inhibit the metabolic conversion of methanol to its toxic metabolites (formaldehyde and formic acid).
36
What are the three antidotes used to treat cyanide toxicity?
Amyl nitrite Sodium nitrite Sodium thiosulfate
37
What enzyme systems does cyanide inhibit?
Cytochrome oxidase Carbonic anhydrase
38
How does cyanide interfere with cellular respiration?
It inhibits the final step of oxidative phosphorylation, preventing ATP synthesis and its use as an energy source.
39
What does cyanide combine with in the blood to reduce oxygen-carrying capacity?
The ferric iron atom of intracellular cytochrome oxidase.
40
What is the primary aim of cyanide treatment?
Reversing the cyanide-cytochrome combination by providing nitrites to convert hemoglobin to methemoglobin.
41
What non-toxic compound is formed when cyanides combine with methemoglobin?
Cyanmethemoglobin. In presence of sulfate donors such as thiosulfate, cyanide is converted to Thiocynate which is excreted in urine
42
What is the mechanism of action of sodium nitrite in cyanide poisoning?
It forms methemoglobin, which competes with cytochrome oxidase for the cyanide ion, protecting cytochrome oxidase.
43
What is the mechanism of action of sodium thiosulfate in cyanide poisoning?
It converts cyanide to non-toxic thiocyanate, which is excreted in urine.
44
Name two other antidotes that can be used for cyanide poisoning besides the nitrites and thiosulfate.
Hydroxocobalamin (Vitamin B12) Dicobalt EDTA
45
Antidote for nicotine poisoning
Bupropion
46
Amphetamine poisoning atidote
Chlorpromazine
47
Iron, aluminium poisoning antidote
Desferroxamine
48
MCC of death in OP poisoning
Respiratory failure
49
BNS 286 deals with
Negligent conduct wrt poison
50
Death from poison hemlock is d/t
overstimulation of nicotinic receptors
51
Aphrodisiacs examples
Alcohol, Cantharides, Cannabis, Cocaine, Opium, Arsenic
52
DOC for acute arsenic poisoning
BAL > DMSA > DMPS
53
DOC for c/c arsenic poisoning
DMSA (Succimer) > BAL > DMPS
54
Acute arsenic poisoning features
GI changes: colicky abdominal pain, rice water stools Garlicky odor Alopecia Metallic taste Headache, confusion, tremors, coma QTc prolongation and cardiac arrhythmias A/c encephalopathy Acute tubular necrosis
55
Opioid toxicity symptoms
'PINPOINT' Pinpoint pupils Ileus (decreased GI motility) Nausea, vomiting Pain decreased Orthostatic hypotension Increased vesical sphincter tone (urinary retention) Nodding off (sedation, mental status depression) Tchy skin (urticaria d/t histamine release)
56
What are three effects of histamine release in opioid intoxication?
Urticaria, Brinchospasm, a/c lung injury (rare)
57
What is the primary opioid receptor responsible for most of the effects of opioids?
mu
58
Effects of mu receptor
'mu-scared' Miosis Sedation Cough suppression Analgesia Resp depression Euphoria Decreased GI motility
59
Effects of Kappa receptor
'MASHDD' Miosis Analgesia Sedation Hallucination** Decreased GI motility Dysphoria
60
Effects of delta receptor
Antidepressant effect Analgesia

Forensic medicine (6 decks)

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