Toxicology Flashcards
Toxicity of _________ causes
Miosis, salivation, sweats, GI cramps, diarrhea, muscle
twitches → seizures, coma, respiration failure
Ach inhibitors
AChE inhibitor toxicity is intervention & antidotes (Rx)
Respiratory support; atropine + pralidoxime Rx’s
for irreversible AChE inhibitors
________ toxicity causes ↑ HR, ↑ BP, hyperthermia (hot, dry skin), delirium,
hallucinations, mydriasis
Atropine and
muscarinic
blockers
Atropine and
muscarinic
blockers toxicity is Rx via
Control cardiovascular symptoms and
hyperthermia + physostigmine (crosses
blood–brain barrier)
______ toxicity sign/symptoms include: Nausea and vomiting, dyspnea with hyperventilation,
mydriasis, vertigo; cardiovascular signs prominent, ↓ BP,
syncope, ↑ HR, arrhythmias
Carbon
monoxide
(>10%
carboxyHb)
Rx Carbon
monoxide
(>10%
carboxyHb) toxicity with
Hyperbaric O2 and decontamination
humidified 100% O2 okay in mild overdose
_______ toxicity signs/symptoms include: Anxiety/agitation, hyperthermia (warm, sweaty skin),
mydriasis, ↑ HR, ↑ BP, psychosis, seizures
CNS stimulants
Rx CNS stimulant toxicity with
Control cardiovascular symptoms,
hyperthermia, and seizures— +/– BZs or
antipsychotics
______ toxicity signs/symptoms include: Lethargy, sedation, ↓ HR, ↓ BP, hypoventilation, miosis, coma,
respiration failure
Opioid
analgesics
Rx opioid analgesic toxicity with
Ventilatory support; naloxone at frequent
intervals
_________ toxicity signs/symptoms includes: Confusion, lethargy, hyperventilation, hyperthermia,
dehydration, hypokalemia, acidosis, seizures, coma
Salicylates
(ASA)*
Rx Salicylates
(ASA)* with
Correct acidosis and electrolytes: urinary
alkalinization, possible hemodialysis
______, ____ toxicity signs/ symptoms include: Disinhibition (initial), lethargy, ataxia, nystagmus, stupor,
coma, hypothermia, respiratory failure
Sedativehypnotics
and
ethanol
Rx Sedativehypnotics
and
ethanol with
Ventilatory support: flumazenil if BZs
implicated
toxicity of _________ signs and symptoms include: Agitation, confusion, hallucination, muscle rigidity,
hyperthermia, ↑ HR, ↑ BP, seizures
SSRIs
Rx SSRIs with
Control hyperthermia and seizures: possible
use of cyproheptadine, antipsychotics, and
BZs
toxicity _______ signs/symptoms include: Mydriasis, hyperthermia (hot, dry skin), 3 Cs (convulsions,
coma, and cardiotoxicity) → arrhythmias
Tricyclic
antidepressants
Rx Tricyclic
antidepressants toxicity with
Control seizures and hyperthermia, correct
acidosis and possible arrhythmias
the drugs with * indicates *More details in antiinflammatory section
Heavy metal poisoning is NEXT
Signs and symptoms of __________ poisoning include: Acute: gastroenteritis, hypotension, metabolic
acidosis, garlic breath, “rice water” stools,
torsades, seizures
Chronic: pallor, skin pigmentation (raindrop
pattern), alopecia, stocking glove neuropathy,
myelosuppression
Arsenic (wood preservatives,
pesticides, ant poisons)
Rx toxicity of Arsenic (wood preservatives,
pesticides, ant poisons) with
Activated charcoal, dimercaprol (EDT)
Penicillamine or succimer
Signs and symptoms of __________ poisoning include:
Acute (mainly children): severe GI distress →
necrotizing gastroenteritis with hematemesis and
bloody diarrhea, dyspnea, shock, coma
Iron (medicinal for anemias
and prenatal supplements)
Rx toxicity of Iron (medicinal for anemias
and prenatal supplements) with
Gastric aspiration + carbonate
lavage, deferoxamine IV
Signs and symptoms of __________ poisoning include: Acute: nausea and vomiting, GI distress and pain,
malaise, tremor, tinnitus, paresthesias,
encephalopathy (red or black feces)
Chronic: multisystem effects: anemia (↓ heme
synthesis), neuropathy (wrist drop), nephropathy
(proteinuria, failure), hepatitis, mental retardation
(from pica), ↓ fertility and ↑ stillbirths
Lead (tap water, leaded paint
chips, herbal remedies, gas
sniffing, glazed kitchenware,
etc.)
Rx toxicity of: Lead (tap water, leaded paint chips, herbal remedies, gas sniffing, glazed kitchenware, etc.) with
Decontamination—gastric lavage \+ dimercaprol (severe) or EDTA or succimer (penicillamine if unable to use dimercaprol or succimer) Children: succimer PO
Signs and symptoms of __________ poisoning include:
Acute: vapor inhalation: chest pain, dyspnea,
pneumonitis
Acute: inorganic salt ingestion: hemorrhagic
gastroenteritis, acute tubular necrosis, shock
Chronic: organic Hg—CNS effects, ataxia,
paresthesias, auditory and visual loss, loosening of
teeth
Mercury (elemental in instruments); salts used in amalgams, batteries, dyes, electroplating, fireworks, photography
Rx toxicity of: Mercury (elemental in instruments); salts used in amalgams, batteries, dyes, electroplating, fireworks, photography with
Succimer PO or dimercaprol (IM) Activated charcoal for oral ingestion, then support with succimer PO or dimercaprol (not IV) → causes redistribution of Hg to the CNS →↑neurotoxicity
NEXT
ANTIDOTES
what _____ is used for Rx AChE inhibitors—physostigmine, neostigmine, and pyridostigmine; organophosphates,
including insecticides, such as malathion and parathion poisoning
Atropine + pralidoxime (for
irreversible AChE inhibitors)
what ____ is used for Rx of Iron and iron salts poisoning
Deferoxamine
what____ is used for Rx of Digoxin immune F(ab) poisoning
Digoxin
what ____ is used for Rx of Arsenic, gold, mercury, lead; oral succimer for milder lead and mercury toxicity
Dimercaprol (BAL)
what ___ is used for Rx of Backup in lead poisoning, then for rarer toxicities (Cd, Cr, Co, Mn, Zn)
EDTA
what ___ is used for Rx of Theophylline, beta agonists poisoning
Esmolol
what _____ is used for Rx of Methanol or ethylene glycol poisoning
Ethanol, fomepizole
what ____ used for RX of Benzodiazepines, zolpidem, zaleplon poisoning
Flumazenil
what ____ is used for Rx of Opioid analgesics poisoning
Naloxone
what ___ is used for Rx of Carbon monoxide poisoning
Oxygen
what ____ is used for Rx of Copper (e.g., Wilson’s disease), iron, lead, mercury poisoning
Penicillamine
what ____ is used for Rx of Anticholinergics: atropine, antihistamine, antiparkinsonian—not tricyclics poisoning
Physostigmine
what _____ is used for Rx of Heparins poisoning
Protamine
what ___ is used for Rx of Warfarin and coumarin poisoning anticoagulants
Acute: Fresh plasma
Chronic: Vitamin K
what ____ is used for Rx of Nonspecific: all oral poisonings except Fe, CN, Li, solvents, mineral acids, or corrosives poisonings
Activated charcoal
NEXT
NATURAL MEDICINALS
“______” medicinals are available without prescription and are considered to be nutritional
supplements rather than drugs
Natural
_______products are marketed without FDA review of
safety and efficacy, and there are no requirements governing the purity or the chemical identities of
constituents.
Herbal (botanic)
______ is Clinically used for ↓ Cold symptoms by ↑ ILs and TNF
Echinacea
Side effects of Echinacea include
GI distress, dizziness, headache
Side effects of Echinacea are?
GI distress, dizziness, headache
______ is Clinically used for Hyperlipidemias, cancer
(evidence is weak) works via Inhibits HMG-CoA
reductase and ACE
Garlic
Side effect of garlic are?
Allergies, hypotension, antiplatelet actions; use
caution when used with anticoagulants
\_\_\_\_\_\_ is Clinically used for Intermittent claudication; Alzheimer disease (evidence is weak) works via Antioxidant, free radical scavenger, ↑ NO
Gingko
side effects of Gingko are?
Anxiety, GI distress, insomnia, antiplatelet
actions; use caution when used
with anticoagulants
\_\_\_\_\_\_ is Clinically used for Possible ↑ in mental and physical performance (evidence is weak) via Unknown mechanism
Ginseng
side effects of Ginseng are?
Insomnia, nervousness, hypertension, mastalgia,
vaginal bleeding
______ is Clinically used for Symptomatic treatment of
BPH; works via 5α-reductase inhibitor
and androgen receptor
antagonist
Saw palmetto
side effects of Saw palmetto are?
GI pain, decreased libido, headache, hypertension
____________ is Androgen precursor advocated for treatment of AIDS (↑CD4 in
women), Alzheimer disease and “aging,” diabetes,
hypercholesterolemia, and SLE (↓in symptoms and “flare-ups”
in women)
Dehydroepiandrosterone
DHEA
side effects of Dehydroepiandrosterone
(DHEA) are?
Women: androgenization and concern regarding CV disease and breast cancer Men: feminization in young and concern in elderly regarding BPH and cancer
_______ is a Serotonin metabolite used for “jet-lag” and sleep disorders
Melatonin
side effects of Melatonin
Drowsiness, sedation, headache
Contraindicated in pregnancy,
in women trying to conceive
↓LH), and in nursing mothers
(↓prolactin
Chronic poisoning with ______ will result in a multitude of effects including inhibition of heme
synthesis and accumulation of δ-aminolevulinate in the plasma
lead
Arsenic poisoning is associated
with _______ breath and changes in ________ pigmentation
Garlic; skin
________ causes auditory and visual
loss and loosening of the teeth, while inhaled mercury vapor can cause interstitial pneumonitis
and neurological effects.
Organic mercury
_______ chelates iron and is the antidote in iron
poisoning
Deferoxamine
______ is useful for a variety of metals including lead, arsenic, and mercury.
Dimercaprol
______ is a back-up in lead poisoning.
EDTA
_______ is useful in copper poisoning, and succimer is
preferred for lead poisoning in kids.
Penicillamine
snake poisoning leads to coagulation & CNS @ Nn receptor Rx with____?
giver fresh plasma to stop bleeding
Rx phenytoin (class IB anti-arrhythmic) toxicity (cadriotoxicity)
Sodium bicarbonate
Amphetamines toxicity Rx___?
to Rx symptoms give: Beta-blockers
to excrete out in urine give: ascorbic acid
NSAID toxicity Rx with___?
sodium bicarbonate
mushroom posioning aka muscarnic posioning Rx with__?
atropine
