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Pharmacology > Toxicology > Flashcards

Toxicology Flashcards

1
Q

What is the definition of toxicology?

A

Branch of pharmacology that encompasses the deleterious effects of chemicals on biologic systems

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2
Q

What are the classifications of toxic chemicals in the environment?

A

Pollutants: air, environmental
Agricultural chemicals: pesticides, herbicides
Solvents

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3
Q

What are the classification of air pollutants?

A 
Carbon monoxide 50%
Sulfur oxides 18%
Hydrocarbons 12%
Particulate matter 10%
Nitrogen oxides 6%
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4
Q

Define carbon monoxide in terms of characteristics and affinity to hemoglobin. At what level does collapse and syncope occur?

A

Colorless, odorless gas
More than 200-fold greater affinity for hemoglobin than O2
When 40% of Hgb has been converted to carboxyhemoglobin

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5
Q

Treatment for CO poisoning

A

Removal of source

100% oxygen

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6
Q

Define sulfur dioxide

A

Colorless, irritating from combustion of fossil fuels

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7
Q

What is formed when sulfur dioxide comes in contact with mucous membranes?

A

Sulfurous acid

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8
Q

What are the effects of sulfur dioxide exposure?

A

Conjunctival irritation and bronchospasm
Delayed pulmonary edema
Aggravate cardiopulmonary disease

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9
Q

Define nitrogen oxides.

A

Brownish, irritant gas from fires and silage on farms

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10
Q

Define ozone.

A

Bluish irritant gas produced in air and water purification devices and in electrica fields

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11
Q

What are some of the aliphatic hydrocarbon solvents?

A

Chloroform
Trichloroethylene
Carbon tetrachloride

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12
Q

What are the adverse effects of aliphatic hydrocarbon exposure?

A

CNS depression
Hepatotoxicity
Nephrotoxicity
Peripheral neuropathy (Tetrachloroethylene, Trichoroethylene)

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13
Q

What are some of the aromatic hydrocarbon solvents?

A

BTX
Benzene
Toluene
Xylene

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14
Q

What are adverse effects of chronic aromatic hydrocarbon exposure?

A

CNS depression - ataxia, coma

Hematologic toxicity and cancers

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15
Q

What are the classifications of pesticides?

A

Acetylcholinesterase inhibitors: carbamates, organophosphates
Botanical agents: rotenone, pyrethrum alkaloids, nicotine
Chlorinated hydrocarbons: DDT and its analogs

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16
Q

What are the clinical manifestations in ACh inhibitor toxicity?

A 
DUMBBELSS
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation
Lacrimation
Salivation
Sweating
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17
Q

What is the treatment for ACh-esterase inhibitor toxicity?

A

Atropine+Pralidoxime

Mechanical ventilation, if necessary

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18
Q

What are the adverse effects of botanical agents?

A

Ropenone: GI distress, conjunctivitis, contact dermatitis
Pyrethrum: CNS excitation, peripheral neurotoxicity, CD
Nicotine: excitation -> paralysis of CNS and neuromuscular transmission

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19
Q

What are some of the commonly used herbicidees and their corresponding adverse effects?

A

Chlorophenoxy acids: muscle hypotonia, coma, inc.risk of NHL

Glyphosate: eye and skin irritation

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20
Q

Clinical manifestations of herbicide toxicity?

A

GI irritation
Hematemesis
Bloody stools
Progressive pulmonary impairment (pulmonary fibrosis)

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21
Q

What are common environmental pollutants?

A

P-D-A
Polychlorinated biphenyls: electrical equipment
Dioxins:by-products of chemical industry, stable and resistant to degradation
Asbestos: used in manufacturing and buildings

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22
Q

Adverse effects of pollutants:

A

Polychlorinated biphenyls: dermatoxocity, inc.liver enzymes and TAG
Dioxin: dermatitis, chloracne, carcinogenic and teratogenic
Asbestos: fibrotic lung disorders, cancers

23
Q

What are some of the heavy metals and chelators?

A 
Heavy metals: M-A-I-L
Mercury
Arsenic
Iron
Lead
Chelators
S-P-E-D-D
Succimer
Penicillamine
EDTA
Dimercaprol
Deferoxamine
24
Q

Clinical manifestation and treatment for acute inorganic lead toxicity

A

Abdominal colic and CNS changes (acute encephalopathy)

Tx: prompt chelation

25
Q

Clinical manifestation and treatment in children with Plumbism

A

Growth retardation, neurocognitive deficits, developmental delay
Tx:
-Chelation with oral succimer (OPD) or EDTA+/- Dimercaprol (severe)
-High dietary calcium

26
Q

Organic lead poisoning is usually due to what?

A

Tetraethyl lead

Tetramethyl lead

27
Q

Acute arsenic poisoning is manifested as? Treatment?

A

Rice-watery stools -> dehydration, shock
Sweet, garlicky odor in breath and stools

Tx: fluid replacement, chelation with dimercaprol

28
Q

Clinical manifestations and presentation of chronic arsenic poisoning
Treatment?

A

CM: GI disturbances, bone marrow depression, hair loss
Presentation: Mee’s lines and skin changes
-Hyperkeratosis
-Raindrop hyperpigmentation
-Milk and roses complexion

Tx: Dimercaprol chelation

29
Q

Noted presentation in arsine gas exposure

Treatment

A 
Massive hemolysis (jaundice, hemoglobinuria)
Tx: exchange transfusion, vigorous hydration, HD

*chelators are of no clinical value

30
Q

What life-threatening condition is caused by acute inorgnic mercury poisoning?
Treatment?

A

Hemorrhagic gastroenteritis -> renal failure

Treatment: ICU, Succimer oral, Dimercaprol IM

31
Q

What are the clinical manifestations of chronic inorganic mercury poisoning?
Treatment?

A

Loosening of gums and teeth
Erethism (neurologic and behavioral changes)

Tx: succimer, unithiol
*dimercaprol: redistributes mercury to the CNS

32
Q

Organic mercury poisoning acquired from consumption of fish or grains containing methylmercury

A 
Minamata disease: M-D-C-B
Mental retardation
Deafness
Cerebral palsy
Blindness
33
Q

Clinical manifestation of iron poisoning

Treatment

A 
Gray-J-P-G-H
Gray cyanosis
GI necrosis
Pneumonitis
Jaundice
Hemosiderosis, hemochromatosis

Deferoxamine

34
Q

What is the MOA of chelators?

A

Forms water-soluble complexes with metals -> excreted in urine

35
Q

What is co-administered with dimercaprol in chronic lead poisoning?

A

EDTA

36
Q

When is succimer given?

A

Lead poisoning with blood concentrations greater than 45ug/dL

37
Q

When do you give penicillamine?

A

Copper poisoning

Wilson disease

38
Q

What are the side effects of penicillamine?

A

P-A-N
Pancytopenia
Autoimmune dysfunction
Nephrotoxicity with proteinuria

39
Q

What are the SE of EDTA?

A

H-E-N
Hypocalcemia
ECG changes
Nephrotoxicity

40
Q

What is the presentation of antimuscarnic poisoning?

A 
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
41
Q

What are the interventions for cholinemimetic/organophosphate poisoning?

A

Support respiration
Atropine + Pralidoxime
Decontaminate

42
Q

What are the manifestations of opioid overdose?

A

PCR
Pupillary contriction
Comatose
Respiratory depression

43
Q

What is the antidote for opioid overdose?

A

Naloxone

44
Q

What are the clinical features of salicylate/ASA poisoning?

A 
CHAFS
Coma
Hyperventilation
Acidosis (HAGMA)
Fever
Seizure
45
Q

What are the interventions for ASA poisoning?

A

Correct acidosis and electrolyte imbalance
Hemodialysis
Alkaline diuresis

46
Q

What are the manifestations of sedative-hypnotic poisoning?

A 
HHHDCN
Hypothermia
Hypotension
Hypoactive BS
Disinhibition
Coma
Nystagmus
47
Q

What are the 3Cs of TCA overdose?

A

Coma
Convulsions
Cardiotoxicity

48
Q

How do you manage TCA overdose?

A 
S-N-T-S
Sodium bicarbonate
Norepinephrine
Temperature control
Seizure control
49
Q

What is the formula for calculated osmolarity?

A

Sum of twice the sodium, 18th of Glucose, and third of BUN

50
Q

What substances causes an increase in stool osmolar gap?

A 
M-E-D-I-E
Methanol
Ethanol
Diuretics
Isopropyl alcohol
Ethylene glycol
51
Q

What is the formula for anion gap?

NV?

A

AG = (Na+K) - (Cl-HCO3)

12 - 16 mEq/L

52
Q

What are the drugs that cause hyperkalemia?

A 
B-D-F-L-P
Beta blockers
Digitalis
Fluoride
Lithium
Potassium-sparing diuretics
53
Q

What are the drugs that cause hypokalemia?

A 
BB-MD
Beta agonist
Barium
Methylxanthines
Diuretics, most

Pharmacology (8 decks)

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