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Pharm Exam 5 > Toxicology > Flashcards

Toxicology Flashcards

1
Q

toxicology referrs to

A

the detection, effects, properties and regulation of toxic substances

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2
Q

Determinants of toxicity?

A

DOSE and DURATION OF EXPOSURE (blood plasma levels)

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3
Q

Father of modern toxicology?

A

paracelsus

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4
Q

Therapeutic index eqn:

A

TI=LD_50/ED_50

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5
Q

Safer drug has what therapeutic index=

A

larger TI number

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6
Q

ALD-Average lethal dose is determined from?

A

estimated from accidental deaths in humans

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7
Q

What is the primary determinant of toxicity?

A

dose

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8
Q

Clinical management of poisoning:

A
  • Support vital - ACB
  • Rule out other differentials- IDENTIFY THE POISON (URINE,BLOOD,GASTRIC CONTENTS)
  • Reduce, remove the drug in, from the body (decrease dose or decrease time of exposure)
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9
Q

Clinical management of poisoning - unconscious patient:

A
  • give general antidotes available (insulin/glucose if diabetic shock or hypoglycemic; naloxone for narcotic OD)
  • use other drugs to treat seizures, cardiac arrhythmias, and severe agitation
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10
Q

toxidromes: what are they? how related to patient?

A

TOXILOGIC FINGERPRINT FOR AN OD OR POISONING
known toxicology standards of known adverse events - so comparison of the drug or chemical response of the patient with the known tox standard

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11
Q

Lab tests that can be performed in less than 2 hours:

A

Urine-immunoassay and TLC

Urine/Blood-HPLC or GCMS

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12
Q

Drug removal via emesis- what to give?

Contraindication

A
  • mechanic - a finger bro
  • apomorphine
  • syrup of Ipecac
  • petroleum hydrocarbon solvent poisoning-chemical pneumonitis
  • caustic acid of alkali agent= rupture
  • seizing or comatose patient
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13
Q

Gastric lavage is?

A

stomach pumping

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14
Q

Activated charcoal

  • how administered
  • how work/
  • what for?
A
  • orally in water
  • very large surface area allows for binding of organic toxicants = no absorption
  • othen induces vomoting too
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15
Q

Cathartics

  • what does it do?
  • exs?
A
  • promotes rapid movement and elimination of poison through GI tract
  • sorbitol, mag citrate, mag sulfate
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16
Q

When to dose activated charcoal?

A

-for max effect within 30 min of poison ingestion

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17
Q

activated charcoal-interactions:-

A

effectiveness of other meds decreases with co-administration

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18
Q

for organophos poisoning and want to use a chelator give? give with what other drug?

A

pralidoxime - give with atropine to block muscarinic effects of PNS

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19
Q

for cyanide poisoning and want o give celator?

MOA?

A

amyl nitrate, sodium nitrate, and sodium thiosulfate with O2
(Hb forms methemoglobin = methemoglobin+CN= nontoxic

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20
Q

farmer poisoning give?

A

pralidoxine + atropine (probably organophos poisoning from fertilizer)

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21
Q

toxic dose of cyanide?

A

2mg/kg = death w/in 10-15 min

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22
Q

Botulinum toxin - give what treatment?

-whats special about botulinum toxin?

A
  • must treat ABCs, lavage, emesis, charcoal, trivalent antitoxin
  • Most potent poison known - rapid absorption = prevent Ach release from nerve terminals = respiratory depression
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23
Q

Heavy metal poisoning - give what?

A
  • Chelators (BAL, EDTA, DMSA, DMPS,Ca-EDTA, deferoxamine)

- form complex with heavy metals = inert and renal excretion

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24
Q

BAL is?

A

british anti-lewisite, dimercaptol - for heavy metal poisoning

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25
Q

Tx for lead poisoning?

A

DMSA, succimer - smells like shit drug - need to put in food or something

26
Q

Dosage for children >=12 yo w/ lead poisoning,arsenic, or mercury poisoning?

A

DMSA, succimer-10mg/kg PO q8h for 5 days

27
Q

Dosage for children 1-11 yo with lead,arsenic, or mercury poisoning?

A

DMSA, succimer-10mg/kg PO q8h for 5 days

  • give same dose then for q12h for 14 days
  • total of 19 day therapy
  • put in food or juice
28
Q

Trivalent antitoxin for botulism A,B,E

  • where does it come from?
  • how to get?
  • indications?
A
  • equine
  • from CDC via state and local health departments
  • good against botulinum toxins types A B and E -most common types we get

-Another heptavalent antitoxin is available against all types

29
Q

Trivalent antitoxin for botulism A,B,E

-Dosing:

A
  • single 10ml vial per patient - slow IV infusion

- this antitoxin contains WAYYY mORREE antibodies for the toxin than you probably have in your body so itll be enough

30
Q

Cyanide antidote

-administration:

A
  • its an antidote kit
    1) small inhaled dose of amyl nitrite
    2) IV sodium nitrite - oxydize portion of Hb iron from ferrous to ferric state = Hb to methemoglobin
    3) sodium thiosulfate - reacts with cyanmethemoglobin to give thiocyanate (and sulfate) + Hb –> thiocyanate is peed out
31
Q

Treat methanol, ethylene glycol, isopropyl alcohol poisoning?

A
  • Give ehtanol bc it prevents alcohol dehydrogenase from converting bad substances into even more toxic substances that kill you
  • can give FOMEPIZOL - inh alcohol dehydrogenase

-can use hemodialysis as adjunct therapy

32
Q

Methanol in the body is converted into what by what enzyme?

A

-alcohol dehydrogenase - formaldehyde and formic acid

33
Q

Fomepizol is for? MOA?

A

Treat methanol, ethylene glycol, isopropyl alcohol poisoning -

blocks alcohol dehydrogenase

34
Q

Ethylene glycol in the body is converted into what by what enzyme?

What does the breakdown cause?

A
  • alcohol dehydrogenase
  • bunch of crap glycoadehyde… glycoate, glycolic acid, glyxylate

-renal failure

35
Q

Tx for Ethylene glycol poisoning?

A
  • ehtanol - competitive inh of alcohol dehydrogenase
  • fomepizol - block alcohol dehydrogenase
  • hemodialysis in symptomatic patints
36
Q

Carbon monoxide poisoning

  • how poison?
  • tx?
A
  • 210x greater affinity for Hb than O2 - binds strong = carboxyhemoglobin COHb
  • artificial respiration with pure O2 to promote displacement of CO - hyperbaric chamber if symptomatic
37
Q

Symptoms of CO poisoning - 0-10% COHb=

A

NONE

38
Q

Symptoms of CO poisoning - 20-30% COHb=

A

slight headache

exertional dyspnea

39
Q

Symptoms of CO poisoning - 30-40% COHb=

A

throbbing headache
fatigue
dizziness
SOB

40
Q

Symptoms of CO poisoning - 40-60% COHb=

A

-severe headahce
-weakness
-dizziness
-confusion
-dimness of vision
(CHERRY RED APPEARANCE)***

41
Q

Symptoms of CO poisoning - >60% COHb=

A

convulsions
coma
respiratory collapse
DEATH bro

42
Q

Warfarin -

  • what for?
  • adverse symptoms:
A
  • anticoag interferes wtih synthesis coag factors 2, 7,9, 10 c and s (VIT K dependent factors)
  • hemoptysis, excessive bruising, bleeding from nose or gums, blood in urine or stool
43
Q

Overdose of warfarin give?

A
  • receptor competitor therapy
  • injection of vitamin K (phytonadione)
  • if severe bleeding give pro-thrombin complex or fresh frozen plasma to replace coag factors
44
Q

Opiates -

  • name classes
  • what tx? benefit to each?
A
  • heroin, morphine, meperidine…
  • receptor competitor theory
    1) Naloxone: act at mu, kappa, and delta recptors = block reverse effects- duration of action = 45min
  • used to save acute OD life
    2) Naltrexone:
  • act at same receptors
  • longer duration (24-72 hrs)
  • used for withdrawal symptoms in rehab
45
Q

Methemoglobinemia

  • issue with this state?
  • how caused?
  • tx & MOA?
A
  • cant transport O2 (Ferric=ok, ferrous= not good)
  • caused by exposure to various chemicals (nitrites sulfa, drugs, and many others
  • Methylene blue- direct chemical reduction of methemoglobin back to hemoglobin
46
Q

Sympatheticomimetic toxidrome

  • what drugs?
  • what do you see?
A
  • cocaine, amphets, PCP
  • mydriasis (DIALYSIS)
  • HTN
  • tremor
  • hyperthermia
  • CNS= hallucination agitation, paranoia
47
Q

Sedative/hypnotic toxidrome

  • what drugs
  • what do you see?
A
  • ETOH, barbs, benzos
  • coma
  • Decrease respiration
  • miosis or mydriasis
  • hypotension
48
Q

Opioid Toxidrome

  • what drugs?
  • what do you see?
A
  • opiates, morphine, codine, propoxyphene, oxycodone, hydrocodone
  • CNS - coma or dec consciousness
  • respiratory depression
  • MIOSIS (PINPOINT)
  • opiad triad (hypothermia, hypotension, histamine release)
49
Q

Anticholinergic toxidrome

  • what drugs?
  • what do you see?
A
  • anticholinergics and antidepressants
  • agitation
  • mydriasis
  • FEVER, DRY SKIN, FLUSHING, URINARY RETENTION (HOT,DRY, MAD, RED, BLIND)
50
Q

Cholergic toxidrome

  • what drugs?
  • what do you see?
A
  • organophosphatese/carbamates and insectisides, nicotine
  • miosis (PINPOINT)
  • DUMBBELLS (EVERYTHING WET)
51
Q

tricyclic antidepressant toxidrome

  • what drugs?
  • what do you see?
A
  • TCAs (amytriptyline, imipramine, desipramine)
  • coma, agitation
  • mydriasis
  • dysrhthmias
  • convulsions, hypotension (alpha block)
52
Q

Salicylate toxidrome

  • what drugs?
  • what do you see?
A
  • aspirin
  • inc or normal RR
  • diaphoresis aka sweaty
  • tinnitis
  • agitation
  • alkalosis (early)
  • acidosis (late)
  • hyperpyrexia
53
Q

Acid poisoning characteristics

A
  • immediate pain in buccal cavity and esophagus
  • less often swallowed than bases
  • no esophageal perforation
54
Q

Base poisoning characteristics

A
  • primary cause of chemical burns
  • rapidly penetrating liquefactive necrosis
  • primary effects on esophagus and only 20% on stomach
  • esophageal damage including perforation
55
Q

Meperidine OD characteristics:

A
  • mydriasis due to antimuscarinic

- INC IN HR

56
Q

Opiates OD chacteristics:

A
  • bilateral miosis

- HR and RR depression/arrest

57
Q

Benzos OD characteristics:

TX?

A

-rarely fatal unless taken with ETOH or other CNS depressants

give flumazenil!!

58
Q

Acetaminophen OD characteristics

-TX?

A
  • after depletion of glutathione (important for phase 2 metabolism)= hepatic necrosis and death due to hepatic failure
  • give n-acetylcysteine!
59
Q

Cocaine OD characteristics

-tx?

A
  • cardiac dysrhythmias –>cardiac arrest

- give lidocaine for dysrhythmias but noantidote

60
Q

dioxin

-signs of exposure?

A

cloaracne - small yellow comedones on face

Pharm Exam 5 (10 decks)

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