TOXICOLOGY Flashcards
The light brownish color of smog often apparent in a major metropolitan area on a hot summer
Nitrogen Oxide
Antidote to Carbon monoxide poisoning
Oxygen
Treatment for parathion exposure
Atropine and pralidoxime
A compound that is toxic to bone marrow cells in the early stages of development and that may also be leukemogenic
Benzene
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)
Signs and symptoms of paraquat ingestion
GI irritation with heamtemesis and bloody stools
Chemical warfare agent that causes dyspnea, abdominal cramps, and diarrhea. They also had copious nasal and tracheobronchial secretions
Organophosphates
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
Acute exposure to this alipathic hydrocarbon solvent causes CNS depression; chronic exposure has led to impairment of memory and peripheral neuropathy
Tetrachloroethylene
This compound is apotential environmental environmental hazard that is formed as a contaminating byproduct in the manufacture of herbicides
Dioxin
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
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
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
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
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
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
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
This agent is used in the treatment of wilson’s disease and has been reported to cause SLE and hemolytic anemia
Penicillamine
High doses of this agent can cause histamine release and extreme vasodilation
Deferoxamine
Gingivitas, discolored gums, and loose teeth are common symptoms of chronic exposure to this agent
Inorganic mercury
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
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
Oral iron chelator for treatment of hemochromatosis
Defasirox
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
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)
