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PHARM 3 > toxicology > Flashcards

toxicology Flashcards

1
Q

what should not be given as an antidote to TCA OD

A

physostigmine

**can cause heart block or asystole

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2
Q

most toxic beta blocker

A

propanolol

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3
Q

high levels of beta blockers can block what channels

A

sodium

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4
Q

beta blocker OD sxs

A

lipophilic – cross CNS = seizures and coma

bradycardia
hypotension

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5
Q

pindolol OD sxs

A

hypertension

tachycardia

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6
Q

IV glucagon for beta blocker OD tx does what

A

inc cAMP

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7
Q

TCA toxicity: CA reuptake inhibition

A

tachycardic

hypertensive

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8
Q

TCA anticholinergic effects

A

sedation

coma

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9
Q

TCA alpha blockade effects

A

hypotension

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10
Q

TCA on cardiac myocytes

A

quinidine like blockade of cardiac fast sodium channels

QRS widening

slowed conduction and depressed cardiac contractility

inhibits VG K+ channels = QT prolongation

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11
Q

TCA toxicity management

A

sodium bicarb for quinidine like toxicity

NE - for hypotension

never give physostigmine

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12
Q

hyperthermia
myoclonic jerking
muscle rigidity

A

serotonin syndrome

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13
Q

tx serotonin syndrome

A

cyproheptadine

5HT2 antagonist

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14
Q

nalmefene

A

opioid OD tx

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15
Q

naloxone

A

opioid OD tx

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16
Q

theophyline acute intoxication

A

vomiting/hematemesis
coarse tremor, anxiety
tachycardia
metabolic acidosis: hypokalemia, low PO4, high Ca2+, high glucose

SEVERE - seizures (most common in acute), hypotension, arrhythmias

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17
Q

theophylline chronic intoxication

A

**dysrhythmias (more common with chronic)

minimal GI sxs, less likely to have seizures

18
Q

theophylline OD tx

A

propranolol, esmolol

benzo/barb for seizures

19
Q

sulfonylurea/meglitinides OD tx

A

IV dextrose

octreotide

20
Q

hyperthermia
lead pipe rigidity
metabolic acidosis
confusion

A

neuroleptic malignant syndrome

21
Q

neuroleptic malignant syndrome tx

A

physical cooling tx

benzo for agitation

dantroline, bromocriptine, amantadine - unknown effectiveness

22
Q

formic acid

A

toxicity of methanol poisoning

causes acidosis, retinal damage, and blindness

methanol directly –> CNS depression

23
Q

fomepizole

A

compeitiive inhib of alcohol dehdyrogenase = dec production of formic acid

24
Q

ethanol use in methanol toxicity

A

competitive inhibitor of alcohol dehdyrogenase = dec production of formic acid

25
Q

ethylene glycol toxicity

A

metabolized to aldehdyes and oxalate:

acidosis
renal damage
GI sxs
Ca2+ oxalate crystals

26
Q

ethylene glycol toxicity tx

A

fomepizole
ethanol

if acidotic: sodium bicarb

same as methanol poisoning

27
Q

pralidoxime

A

splits phosphate enzyme bond as the pesticide has phosphorylated AchE

postively charged - doesn’t cross BBB, no reversal of CNS effects

28
Q

carbamates

A

inhibit AchE by carbamoylation of active site

29
Q

carbamate OD tx

A

atropine

30
Q

warfarin OD tx

A

vitamin K - doesn’t restore for 6 or more hours

initally give fresh frozen plasma or whole blood

31
Q

Cyanide toxicity

A

binds Fe3+ strongly - prevents from serving as electron acceptor

32
Q

CN OD tx: antidote kit

A

provide pool of ferric iron to compete with CN

cyanide antidote kit:

  • amyl nitrite pearls: inhale
  • sodium nitrite: IV
  • sodium thiosulfate (donate sulfur to form thiocyanate via rhodanese)

forms methemoglobin –> cyanmethemoglobin and cyochrome oxidase is restored

give methylene blue

33
Q

CN OD tx: cyanokit

A

hydroxocobalamin (B12 precursor)
–> reacts with CN to form cyancobalamin

**no methemoglobin produced

34
Q

lead OD tx

A

seizures - diazepam
cerebral edema - mannitol, dexamethasone

chelation

35
Q

arsenic poisoning

A

pyruvate dehydrogenase complex sensitive to trivalent arsenicals

pentavalent: uncouple oxidative phosphorylation

hemolysis via depletion of glutathione

36
Q

arsenic OD tx

A

ACUTE - chelate: dimercaprol (w/in 24 hours), unithiol

CHRONIC - succimer or unithiol (after 24 hours)

supportive: IV hydration, osmotic diuresis with mannitol - maintain urine output

37
Q

acute mercury poisoning tx

A

unithiol
IM dimercaprol
oral succimer

38
Q

chronic mercury poisoning tx

A

unithiol and succimer

dimercaprol may redistribute mercury to CNS - NOT USED

39
Q

vomiting
GI bleedings
lethargy
gray cyanosis

A

iron toxicity

40
Q

iron chelator

A

deferoxamine

PHARM 3 (21 decks)

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