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Wolff Pharmacology Review > Toxicology > Flashcards

Toxicology Flashcards

1
Q

refers to very stable man-made compounds used as dielectrics and coolants, banned by Congress in 1979 after recognized to be persistent organic toxins that accumulate in body fat; reason large fish in Lake Hartwell carry warnings

A

PCB

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2
Q

widely used OTC analgesic that is safe at recommended doses but is a frequent cause of poisoning and can easily cause a fatal hepatocellular necrosis at higher levels; early symptoms (GI distress, nausea, irritability) may not occur until > 12 hrs after ingestion

A

acetaminophen

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3
Q

a black powdery substance processed in a manner that it has huge surface area for adsorption of chemicals, can be useful in the treatment of some poisons and also marks the stool during whole bowel irrigation; administration does require a risk-benefit analysis

A

activated charcoal

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4
Q

among symptoms of sympathomimetic toxidrome that is controlled with benzodiazepines

A

agitation

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5
Q

always the first thing to check in a new patient encounter

A

airway

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6
Q

a widely used and abused sedative having withdrawal symptoms of agitation, anxiety, hallucinations, confusion, seizure, mydriasis, tachycardia, hypertension, etc… benzodiazepines can help relieve these symptoms

A

alcohol

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7
Q

toxidrome in which the patient is blind as a bat, mad as a hatter, red as a beat, hot as a hare, dry as a bone, has bowel and bladder that have lost their tone and a heart that runs alone

A

anticholinergic

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8
Q

heavy metal with a garlic taste; toxic in several forms, each of which has some unique characteristics; diminishes ATP formation by a variety of mechanisms and definitely kills (e.g., used in intentional poisonings)

A

arsenic

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9
Q

mineral fibers used for many years because of their fire and chemical resistance and ubiquitous in older structures; use now is highly restricted; causes inflammation and scarring of the lungs and a rare cancer that affects the thin membrane lining the inner surface of the chest wall

A

asbestos

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10
Q

causes a very characteristic toxicity with initial tinnitus, nausea, vomiting and respiratory alkalosis due to direct stimulation of the respiratory center, but eventually gives way to high anion gap metabolic acidosis; give activated charcoal if < 1 hr post ingestion, maintain high urine flow, consider urine alkalization, hemodialysis may be necessary

A

aspirin

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11
Q

standard therapy for bradycardia due to poisoning; also combats bronchoconstriction and bronchorrhea, the other “killer B’s” of the cholinergic toxidrome

A

atropine

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12
Q

sedative-hypnotic drug class that kills readily (e.g., due in part to direct stimulation of GABA-A receptors); there is no antidote so must perform aggressive supportive care with airway protection as necessary… … benzodiazepines can help relieve withdrawal symptoms, switching to a long-half-life agent such as phenobarbital

A

barbiturates

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13
Q

e.g., atropine, are the classic causes of the anticholinergic toxidrome, but a variety of drugs in other classes also inhibit these receptors at higher doses including antihistamines and tricyclic antidepressants

A

belladonna alkaloids

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14
Q

class of drugs of abuse for which there are no proven drugs to use during withdrawal; instead months to years of time are required to wean person off in addition to emotional support

A

benzodiazepines

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15
Q

toxic levels of these drugs cause bradycardia (treated with atropine), hypotension (treated with IV fluids) and myocardial suppression for which glucagon is a textbook therapy but for which IV calcium and high-dose insulin and glucose are also effective

A

beta blockers

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16
Q

lab data that should be obtained immediately for this if the patient is comatose or mentally sluggish since “time is brain” if the value is too low

A

blood glucose

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17
Q

the B in a systematic approach to first aid of a poisoned patient

A

breathing

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18
Q

color of venous blood in cyanide poisoning since cells are unable to utilize oxygen

A

bright red

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19
Q

heavy metal used in some rechargeable batteries; mild exposure causes fever, chills and muscle aches while more significant exposure quickly damages lungs, kidneys and/or liver depending on route; has long half-life in body which cannot regulate its levels, has no specific antidote

A

cadmium

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20
Q

administered intravenously to offset a toxic degree of calcium channel blockade

A

calcium

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21
Q

older chelator used for the treatment of lead poisoning, clinician must use the right type as this is a different formulation of a common laboratory reagent; using the wrong formulation can cause a potentially fatal hypocalcemia

A

calcium disodium EDTA

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22
Q

an important component of therapy for people poisoned by drugs such as phencyclidine, LSD, mescaline, psilocybin, and “ecstasy”; may need to add benzodiazepine and additional treatment to counteract symptoms

A

calm reassurance

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23
Q

produced by the incomplete combustion of fuels, displaces oxygen from hemoglobin and turns it a cherry red color; resultant hypoxia causes disorientation, confusion, etc., nausea, muscle weakness, coma, death

A

carbon monoxide

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24
Q

destroy tissues within seconds, so do not induce emesis, do not attempt to neutralize, do not attempt lavage (risk of perforation)… instead, administer IV fluids and other supportive care, and attempt to correct tissue damage with surgery as necessary

A

caustic ingestions

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25
Q

abbr for cardiovascular drug class responsible for a disproportionate amount of deaths due to poisonings

A

CCB

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26
Q

toxidrome in which there is SLUDGE or DUMBBELLS, caused by organophosphate and carbamate insecticides, nerve gases, nicotine, physostigmine, bethanechol and similar agents

A

cholinergic

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27
Q

patients presenting with the sympathomimetic toxidrome due to this tend to be less agitated, paranoid, etc., than those with amphetamine poisoning

A

cocaine

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28
Q

referred to the combination of dextrose (glucose), thiamine and naloxone that used to be administered as standard treatment whenever a comatose patient was encountered

A

coma cocktail

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29
Q

important to measure and maintain using ice-baths, Bair Huggers, etc., as necessary

A

core temperature

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30
Q

has smell of bitter almonds, produced by burning plastic and nitroprusside metabolism, is used in electroplating, etc.; inhibits cytochrome oxidase

A

cyanide

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31
Q

agent that is administered to selectively chelate excess iron from the blood

A

deferoxamine

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32
Q

along with bowel sounds, provides the ability to distinguish the anticholinergic toxidrome from the sympathomimetic toxidrome

A

diaphoresis

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33
Q

standard therapy for treating seizures, but propofol is now also used

A

diazepam

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34
Q

Fab antibody fragments that are a specific antidote for digoxin toxicity

A

digibind

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35
Q

toxic levels cause anorexia, nausea, vomiting, bradycardia, AV block, ectopic beats, halos, among other disturbances due to blockade of Na+ /K+ ATPase

A

digoxin

36
Q

aka BAL (for British anti-lewisite, remedy for lewisite, a toxic gas made from acetylene and arsenic and feared as a potential chemical weapon in WWII); chelator administered for treatment of lead, arsenic and mercury poisoning

A

dimercaprol

37
Q

a frequent cause of the sedative-hypnotic toxidrome; also an antidote for methanol and ethylene glycol poisoning since able to displace these solvents from the enzymes that would rapidly convert them into toxic concentrations of toxic substances

A

ethanol

38
Q

toxic colorless, odorless liquid with a sweet taste, a principal component of antifreeze and brake fluid; ingestion initially causes symptoms of drunkenness but its metabolism to oxalic acid causes precipitates that destroy the kidneys (reason FDA came into existence)

A

ethylene glycol

39
Q

benzodiazepine receptor antagonist, current thinking is to not administer it in cases of benzodiazepine overdose because it can trigger seizures and supportive therapy without it is effective

A

flumazenil

40
Q

a competitive inhibitor of alcohol dehydrogenase useful for treatment of methanol or ethylene glycol ingestion

A

fomepizol

41
Q

principal antidote for most gas exposures, with other treatments added as needed

A

fresh air

42
Q

medical terminology for “pumping the stomach”, not always beneficial

A

gastric lavage

43
Q

administered intravenously to treat beta-blocker and calcium channel blocker poisoning; somehow increases cAMP levels in the heart

A

glucagon

44
Q

toxidrome in which patients experience perceptual distortions, depersonalization, synthesthesia and present with vital signs that include hyperthermia, tachycardia and hypertension

A

hallucinogenic

45
Q

a treatment option if the poison stays primarily distributed in body water and is not extensively protein bound

A

hemodialysis

46
Q

aspiration of these is bad, either because their volatility displaces air being inhaled or because they are nonvolatile and create a barrier to gas exchange

A

hydrocarbons

47
Q

gas noted for its “rotten eggs” smell

A

hydrogen sulfide

48
Q

antidote for cyanide poisoning, it reacts with cyanide to produce a common form of vitamin B12

A

hydroxycobalamin

49
Q

treatment that can decrease the half-life of carbon monoxide in the body from ~320 minutes to ~ 25 minutes

A

hyperbaric oxygen

50
Q

when encountered in a poisoned patient, initially treated with a sedative such as benzodiazepines; may need to supplement with agents such as labetalol or nitroprusside

A

hypertension

51
Q

generally, when to obtain IV access, pulse oximeter data, apply a cardiac monitor and provide high flow oxygen for a poisoned patient

A

immediately

52
Q

administered in high doses along with glucose during calcium channel blocker or beta-blocker poisoning; clear proof of benefits, thought to be due to beneficial effects on cardiac metabolism

A

insulin

53
Q

poisoning was typically seen in young children who ingested pregnant mom’s pills, symptoms begin with abdominal pain, vomiting and bloody diarrhea, and can spiral downward from there

A

iron

54
Q

principal remedy rapidly administered in relatively large amounts to a poisoned patient presenting with hypotension

A

isotonic saline

55
Q

blood glucose, CBC, BMP, ECG, blood gases, and serum levels of common poisons acetaminophen and aspirin are among the forms of this that should be obtained quickly for a poisoned patient

A

lab data

56
Q

toxin commonly found in old paint, moonshine, improperly glazed pottery, batteries and as a component of solder; toxic effects thought to be due to its inhibition of sulfhydryl dependent enzymes and perhaps its competition with calcium in calcium-dependent cell processes

A

lead

57
Q

a component of parenteral nutrition that can be utilized o create a lipophilic sink for drugs in the plasma in an attempt to keep them from reaching toxic levels elsewhere in the body

A

lipid emulsion

58
Q

administered in 2 g boluses IV as treatment for torsades de pointes, giving additional boluses as necessary

A

magnesium sulfate

59
Q

risperidone and quetiapine are among the newer agents that can cause this toxidrome in which there is hyperthermia, tachycardia, muscle rigidity, etc., symptoms that mandate aggressive supportive care and will typically resolve in 1-2 weeks if the offending agents are immediately discontinued

A

malignant neuroleptic

60
Q

the simplest alcohol, used in canned fuels, paint removers, etc.; initial ingestion causes symptoms of drunkenness, but its conversion to formaldehyde and/or formic acid leads to permanent blindness (e.g., ~10 ml) or death (~>= 30 ml)

A

methanol

61
Q

fish are the principal source of this organic heavy metal; it causes peripheral neuropathy, vision and hearing loss, mental retardation, etc.; its binding to sulfhydryl groups incapacitates key enzymes in the body

A

methylmercury

62
Q

prototype for this class of analgesics that is the principal cause of drug-induced death (e.g., due to respiratory depression)

A

morphine

63
Q

possibility to consider along with health care worker safety when encountering a poisoned patient

A

multiple casualties

64
Q

antidote for acetaminophen poisoning, replenishes the glutathione stores so that acetaminophen metabolism proceeds without generating toxic intermediates

A

Nacetylcysteine

65
Q

administered to reverse respiratory depression of opioid toxicity

A

naloxone

66
Q

when to induce vomiting with syrup of ipecac

A

never

67
Q

poorly soluble reddish-orange gas that is heavier than air, inhalation does little damage to mucosal surfaces and upper respiratory tract but it then dissolves in water in alveoli to form an acid that damages the endo- and epithelial structures… encountered in grain storage silos and welding operations

A

nitrogen dioxide

68
Q

withdrawal syndrome characterized by agitation, anxiety, mydriasis, tachycardia, hypertension, abdominal cramping and diarrhea, salivation, yawning, and the skin appearance of having gone “cold turkey”; symptoms can be minimized by substituting agents with long half-lives and the slowly weaning off

A

opiate

69
Q

toxidrome in which CNS depression and bradypnea are prominent; poisoned patient typically also has miosis, hypothermia, bradycardia, hypotension, hyperreflexia, decreased bowel sounds, scratch marks due to itchy skin, and needle marks

A

opioid

70
Q

class of cholinesterase inhibitors used in insecticides (e.g., malathion) and as nerve gases in chemical weapons (e.g., sarin)

A

organophosphate

71
Q

regulates permissible exposure levels for lead and can mandate paid time off when employees are exposed to higher levels that require time for elimination

A

OSHA

72
Q

pungent pale blue gas that is a powerful oxidant and damages the tissue with which it comes in contact; is NOT approved as a safe and effective means of purifying room air

A

ozone

73
Q

cholinesterase inhibitor used clinically that crosses the blood brain barrier and serves as an antidote for anticholinergic poisoning

A

physostigmine

74
Q

antidote for organophosphate cholinesterase inhibitors provided the binding has not aged (i.e., become irreversible) but not for the carbamate cholinesterase inhibitors used as insecticides (e.g., aldicarb); has utility in the local ED as well as a battlefield hospital where nerve gases were deployed

A

pralidoxime

75
Q

nomogram used to determine if plasma acetaminophen levels are sufficient to cause hepatic injury

A

Rumack-Matthew

76
Q

toxidrome characterized by CNS depression, stupor, coma, hypothermia, bradycardia, hypotension, bradypnea like opioids, but has additional symptoms such as slurred speech, double vision and ataxia

A

sedative hypnotic

77
Q

refers to the confusion, agitation, hyperthermia, hypertension, tachycardia, tremors, rigidity, etc., when drugs such as fluoxetine or venlafaxine are present at toxic levels, and obviously must be discontinued ASAP

A

serotonin syndrome

78
Q

principal remedy when toxins cause a potentially deadly “membrane stabilizing effect” (= wide QRS complex) in the heart due to the blockade of fast Na+ channels; also can be administered to alkalize the urine to facilitate excretion of weak acid toxins; keep plasma pH < 7.55

A

sodium bicarbonate

79
Q

aka DMSA, a chelator approved for use in children with lead poisoning, now also used in adults with lead poisoning and in the treatment of mercury and arsenic poisoning

A

succimer

80
Q

colorless nonflammable gas with a strong odor (“just-struck match”) produced by fossil fuel combustion and used as a preservative for fruits and vegetables; forms acid on contact with mucous membranes and is highly irritating, need to flush exposed areas for 10-15 min to minimize damage

A

sulfur dioxide

81
Q

toxidrome in which patient is often hyperalert, agitated, and paranoid with vital sign assessment revealing mydriasis, hyperthermia, tachycardia, hypertension, tachypnea, hyperpnea, diaphoresis and hyperreflexia

A

sympathomimetic

82
Q

abbr. for class of drugs used by depressed people, overdosage causes a refractory hypotension that is the main cause of death and is seen in conjunction with other anticholinergic, antihistamine and alpha-antagonist toxicities; treatment is a challenge but utilizes symptomatic remedies described by other puzzle clues

A

TCA

83
Q

routinely administered in ED to prevent Wernicke encephalopthy suspected of be alcoholic

A

thiamine

84
Q

added to symptomatic therapy of hypotension when blood pressure remains low after administering isotonic saline (e.g., NE drip)

A

vasopressor

85
Q

refers to the measurements of HR, BP, RR, body temperature and assessment of pupil size, muscle tone, bowel sounds, skin appearance, alertness, etc., that are crucial for proper treatment of a poisoned patient

A

vital signs

86
Q

may be beneficial in poisoned patient, reason to use a product such as GoLYTELY

A

whole bowel irrigation

87
Q

smell that indicates a sick child may have been overdosed with methyl salicylate

A

wintergreen

Wolff Pharmacology Review (12 decks)

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