TOXICOLOGY Flashcards by Jonathan Paul Ladera

The light brownish color of smog often apparent in a major metropolitan area on a hot summer

Nitrogen Oxide

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Antidote to Carbon monoxide poisoning

Oxygen

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Treatment for parathion exposure

Atropine and pralidoxime

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A compound that is toxic to bone marrow cells in the early stages of development and that may also be leukemogenic

Benzene

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A compound or group of compounds that damages the skin and whose use in manufacturing has largely been eliminated because of extensive persistence in the environment and bioaccumualtion

Polychlorinated biphenyls (PCBs)

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Signs and symptoms of paraquat ingestion

GI irritation with heamtemesis and bloody stools

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Chemical warfare agent that causes dyspnea, abdominal cramps, and diarrhea. They also had copious nasal and tracheobronchial secretions

Organophosphates

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Asthma is often exacerbated in patients wxposed to this reducing agent. When concentrations in the air are as low as 1-2 ppm

Sulfur dioxide

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Acute exposure to this alipathic hydrocarbon solvent causes CNS depression; chronic exposure has led to impairment of memory and peripheral neuropathy

Tetrachloroethylene

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This compound is apotential environmental environmental hazard that is formed as a contaminating byproduct in the manufacture of herbicides

Dioxin

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A small child is brought to a hospital department suffering drom severe GI distress and abdominal colic. If this patient has severe acute lead poisoning with signs and symptoms of encephalopathy. treatment should be instituted immediately with

EDTA

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A young woman empliyed as a dental laboratory technician complains of conjunctivitis, skin irritation and hair loss. On examination she has perforation of the nasal septum and a “milk and roses” complexion. These signs and symptoms are most likely due to

Chronic inorganic arsenic poisoning

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A patient complains of chronic headache, fatigue, loss of appetite and constipation. He has slight weakness of the extensor muscles in the upper limbs. Based on the laboratory data. The most reasonable Diagnosis is

HgB <13
Urine coproporphyrin >80mcg/100 mg
- Urinary aminolevulinic acid >2 mg/100 mg

Inorganic lead

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A young engineer involved in the smelting process of cobalt and gold presented with severe GI discomfort, rice water stools, and sweet garlicky breath. Acute arsenic poisoning was diagnosed. What drug should be included in the management?

Dimercaptol

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A 24 year old man was employed in the supply department of a company that manufactures semiconductors. After an accident at the plant, he presented with nausea and vomiting, headache, hypotension, and shivering. Laboratory showed hemoglibinuria and a plasma free hemoglobin level >1.4 g/dL This young man was probably exposed to

Arsine

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A 2 year old boy ingested an unknown table. His symptoms included marked GI distress, vomiting,(with hematemesis) and epigastric pain. MEtabolic acidosis and leukocytosus were also present. This patient probably ingested

Iron

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This toxic compound can be produced in seawater by the action of bacteria and algae, It also synthesized chemically for commercial use as a fungicide.

Methylmercury

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This agent is used in the treatment of wilson’s disease and has been reported to cause SLE and hemolytic anemia

Penicillamine

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High doses of this agent can cause histamine release and extreme vasodilation

Deferoxamine

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Gingivitas, discolored gums, and loose teeth are common symptoms of chronic exposure to this agent

Inorganic mercury

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EDTA

Chelator of many divalent and trivalent metals

USed in lead poisoning. Posioning by zince, manganese and certain heavy radionucleide

Parenteral

Administered as calcium disodium salt to avoid calcium depletion. Nephrotoxicity, ECG changes

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Deferoxamine

Chelates excess iron

Used in acute iron poisoning. Inherited or acquired henochromatosis

Preferred rout of administraion: IM or SQ
Rapid IV adminsitration may cause hypotension. neutoroxicity and icnreased susceptibility to certain infections have occured with long term use

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Oral iron chelator for treatment of hemochromatosis

Defasirox

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Dimercaprol

Bidentate chelator forms 2 bonds with metal ions

Arsenic and inorganic mercury poisoning. COmbined with EDTA for lead poisoning.

Parenteral

Transient hypertension, tachycardia, headache, nausea, vomiting, paresthesias, fever, thrpmbocytopenia, and increased prothrombin time with long term use

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Water soluble cogener of demercaprol used for oral treatment of lead poisoning

Succimer

Water soluble cogener of dimercaprol used IV for initial treatment of severe mercury or arsenic poisoning and used orally for lead poisoning

Unithiol

Penicillamine

Bidentate Chelator Copper poisoning and Wilson's disease Oral Nephrotoxicity, pancytopenia, autoimmune dysfunction, including SLE and hemolytic anemia

A 2 year olf girl presented with lethargy, increased respiratory rate and an elvated temperature that appeared to result from drug poisoning. Laboratory testing revealed the following serum concentrations: glucose 36 mg/DL; Na: 148 K 5 Cl 111 HCO3 12, BUN 21, osmolality 300 Anion gap? Osmolal Gap? what is the drug?

+30 -5 Aspirin

an 18 month old boy presented in semiconcsious state with profound hypotension and bradycardia after ingesting a number of his grandmother's metoprolol tablets. In this case, the most appropriate antidote is

Glucagon

\_\_\_\_\_\_ can be used in metormin overdose with lactic acidosis

Hemodialysis

A 24 year old female was rushed to the ER after she was found in herroom hypotensive with seizure. In the ER, the ECG confirmed Ventricular arrhythmias. An overdose of what drug is most likley?

Amitriptyline (TCA)

A patient is brought to the ER having an overdose (unknown quantitiy) of a sustained release of theophylline by oral administration 2h previously. He has marked GI distress with vomiting, is agitated and exhibits hyperreflexia and hypotension. * Measure: 80 mg/L * Vd 35L * T1/2 Amount of ingested? what can be used to reduce tachycardia

2.8 Esmolol

A contraindication to the use of gastric lavage for the removal of drugs from stomach of a victim of poisoning

Ingestion of corrosive

Can cause hypertension and tachycardia

Amphetamines, cocaine, antimuscarinic drugs

Hypotension with bradycardia

CCB and sedative hypnotics

Hypotension with tachycardia

TCA, phenothiazines, theophylline

Hyperthermia

antimuscarinic, salycylates or sympathomimetics

Hypothermia

ethanol and CNS depressants

Increased RR

carbon monoxide, salicylates

[Toxic syndrome] Delirium, hallucinations, seizures, coma, tachycardia, hypertension, hypethermia, mydriasis, decreased bowel sounds, urinary retention

Antimuscarinic * Control hyperthemia * physostigmine may be helpful, but not for TCA overdose

[Toxic syndrome] Anxiety, agitation,s eizures, coma, bradycardia or tachycardia, pinpoint pupils, salivation, sweating, hyperactive bowel, muscle fasciculations, then paralysis

Cholimomimetic drugs (Carbamate or organophosphate cholinesterase inhibitots) * Support resipiration * Treat with atropine and pralidoxime * Decontaminate

[Toxic syndrome] Lethargy, sedation, coma, bradycardia, hypotension, hypoventilation, pinpoint pupils, cool skin, decreased bowel sounds, flaccid muscles

Opiods (heroin, morphine, methadone) * Provide airway and respiratory support * Give naloxone as required

[Toxic syndrome] Confusion, lethargy, coma, seizures, hyperventilation, hyperthermia, dehydration, hypokalemia, anion gap, metabolic acidosis

Salicylates * Correct acidois and fluid and electrolytes imbalance * alkaline diuresis or hemodialysis to aid elimination

[Toxic syndrome] Disinhibition initially, later lethargy, stupor, coma, nystagmus is common, decreased muscle tone, hypothermia, small pupils, hypotension, and decreased bowel sounds in severe overdose

Sedative hypnotics (barbiturates, BZ, ethanol) * Provide airway and respiratory support * Avoid fluid overload * Consider flumazenil for benzodiazepine overdose

[Toxic syndrome] Agitation, anxietym seizures,. Hypertension, tachycardia, arrhythmias, mydriasis, certical and horizontal nystagmus with PCP. SKin warm and sweaty, hypethermia, icnreased muscle tone, possible rhabdomyolysis

Stimulants (amphetamines, cocaine, PCP, bath salts) * Control seizures with BZ (lorazepam), hypertension and hyperthermia

[Toxic syndrome] Mild: shivering, hyperreflexia, and diarrhea. Sevre: muscle rigidity, fever seizures, and cardiovascular instability

SSRIs * Stop offending drug, supportive management, and antidote with cyproheptadine

[Toxic syndrome] Antimuscarinic effects. The 3Cs of coma, convulsion and cardiac toxicity (widened QRS, arrhythmias, hypotension)

TCA * Control seizures. * Correctr acidosis and cardiotoxicity with ventilation, sodium bicarbonate, and norepinephrine (for hypotension). COntrol hyperthermia

Mild anorexia, nausea, vomiting, delayed jaundice, and renal failure

Acetaminophen

Dysphagia, dysarthria, ptsosi, ophthalmoplegia, muscle weakness; incubation period 12-36h

Botulism

Coma, metabolic acidosis, retinal hemorrhages

Carbon monoxide

Bitter almond odor, seizures, coma, abnormal ECG

Cyanide

Renal failure, crystals in urine, icnreased anion and osmolar gap, initial CNS excitationl eye exam normal

Ethylene glycol

Bloody diarrhea, coma, radioopaque material in gut, high leukocyte count, hyperglycemia

Iron

Abdominal pain, hypertension, seizures, muscle weakness, metallic taste, anorexia, encephalopathy, delayed motor neuropathy, changes in renal and reproductive function

Lead

Hallucinations, dilated pupils, hypertension

LSD

Acute renal failure, tremor, salivation, gingivitis, colitis, erethism (fits of cryingm irrational behavior), nephrotic syndrome

Mercury

Rapid respiration, visual symptoms, osmolar gap, severe metabolic acidosis

Methanol

Severe nausea and vomiting 8h after ingestion; delayed hepatic and renal failure

Amanita phalloides

Coma wirh eyes open, horizontal and vertical nystagmus

PCP

[Antidote] acetaminophen

Acetylcysteine Best given within 8-10 h of overdose

[Antidote] cholinesterase inhibitors, rapid onset mushroom poisoning with muscarinic effects

Atropine

[Antidote] Membrane depressant cardiotoxic drugs

Bicarbonate, sodium

[Antidote] fluoride, CCB

Calcium

[Antidote] iron salts

Deferoxamine

[Antidote] digoxin and related cardiac glycosides

Digoxin antibodies

[Antidote] caffeine, theophylline, sympathomimetics

Esmolol

[Antidote] Benzodiazepies, zolpidem

flumazenil | (can cause seizures)

[Antidote] methanol, ethylene glycol

Fomepizole

[Antidote] Beta-blcokers

Glucagon

[Antidote] hypoglycemics

glucose

[Antidote] cyanide

Hydroxycobalamin

[Antidote] opiod analgesics

Naloxone

[Antidote] Carbon monoxide

Oxygen

[Antidote] muscarinic receptor blcokers when effect needed in CNS

Physostigmine | (not for TCA)

[Antidote] Organophosphate cholinesterase inhibitors

Pralidoxime (most effective if used within 24 hours of exposure)