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Block 7; Week 3-Michelle > Toxicology-Buxton > Flashcards

Toxicology-Buxton Flashcards

1
Q

What are the 2 relationships to think about with toxicology?

A

Conc’n-Effect

Dose-Response

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2
Q

What are some ways to describe a dose-response relationship?

A

local v. systemic
reversible v. irreversible
immediate v. delayed
graded v. quantal

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3
Q

Which do you use to describe an individual & which do you use to describe a population?
Graded, Quantal

A

Graded: individual
Quantal: Population

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4
Q

What is ED50?

A
  • Median Effective Dose 50; the dose at which 50 percent of the population or sample manifests a given effect; used with quantal d/r curves
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5
Q

What is TD50?

A

Median Toxic Dose 50 - dose at which 50 percent of the population manifests a given toxic effect

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6
Q

What is LD50?

A

Median Toxic Dose 50 - dose which kills 50 percent of the subjects (animal studies)

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7
Q

What is the therapeutic index?

A

LD50/ED50

OR TD50/ED50

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8
Q

What is the margin of safety for drugs?

A

LD1/ED99

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9
Q

What is the margin of safety for toxins?

A

NOAEL/Exposure

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10
Q

Which does Buxton like more–NOAEL or MABEL?

A

MABEL: minimal anticipated biological effect level

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11
Q

What makes a good drug: a lower or higher therapeutic index?

A

higher the TI–better the drug

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12
Q

T/F Drugs acting on same receptor or enzyme have the same therapeutic index.

A

True.

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13
Q

What happens if your Vitamin A is too low?

A

blindness
dry skin
increased infections

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14
Q

What happens if your Vitamin A is too high?

A

anorexia
anemia
nose bleeds
muscle & joint pain

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15
Q

Describe the group to which Vitamin A belongs.

A

unsaturated nutritional hydrocarbons

  • *includes retinol, retinal, retinoic acid, beta-carotene
  • *regulates gene transcription at RXR receptors
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16
Q

What is the adequate adult intake of Vitamin A?

A

3 mg/day

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17
Q

Give the time frames for acute, subacute, sub chronic, chronic exposures to a toxin.

A

Acute: 3 mo

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18
Q

What is the purpose of metabolism?

A 
decrease lipid solubility
decrease amt at target
increase ionization
increase excretion rate
**all help make chemical agents more water soluble & easier to excrete
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19
Q

What is paraoxon?

A

parasympathomimetic acetylcholinesterase inhibitor

organophosphate active metabolite of insecticide parathion

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20
Q

What terrible thing happened with Project Coast?

A

South Africa
during apartheid
tried to use paraoxone to sterilize black people

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21
Q

What are the key organs for biotransformation? What are the 2 biotransformation pathways?

A

Liver, Lung, Kidney, Intestine
Phase 1: make the toxicant more water soluble
Phase 2:link w/ a soluble endogeneous agent (conjugation)

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22
Q

What is N-acetyl transferase?

A

enzyme responsible for acetylating & detoxifying many chemicals including aryl amines
some people are slow acetylators & others are fast–>individual susceptibility!

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23
Q

Who are the slow acetylators? Fast?

A

Slow: Me, Scandinavians, Jews, North African Caucasians
Fast: Inuit, Japanese

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24
Q

What’s the problem with being a slow acetylator?

A

you have a higher rate of bladder cancer formation etc. if you are exposed to N-aryl amine & are a slow acetylator

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25
Q

What is thiopurine S-methyltransferase (TPMT)?

A

enzyme responsible for S-methylation of anti-cancer drugs used in chemo
(like azathiopurine & 6-mercaptopurine)

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26
Q

What is the individual susceptibility significance of being a person with high TPMT levels?

A

respond poorly to chemo b/c they conjugate drugs before they can act

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27
Q

What’s the problem with CO in the air or in smokers?

A

it forms carboxyhemoglobin which doesn’t carry O2

effects: headache, confusion, vision changes, tachypnea, tachycardia, coma, respiratory failure, death

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28
Q

What is SO2?

A

colorless product of fossil fuel combustion

exposure shouldn’t exceed 2 ppm in air pollution

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29
Q

What is bad about SO2?

A

forms acid (H2SO4) on moist membranes
irritates the eyes, mucous membranes, skin
toxic for the lung
causes bronchiolar constriction & bronchospasm at greater exposure levels

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30
Q

What is NO2 in air pollution?

A

brownish gas associated with fire
product of fermentation
given off in large amounts in grain silos
can’t exceed 3 ppm without really bad effects

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31
Q

What are the bad side effects of having NO2 in the air?

A

deep lung irritant: irritating to eyes & nose
significant toxicity in lung-pulmonary edema
can cause pulmonary lesions, pulmonary edema, death

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32
Q

What is O3?

A

ozone is a bluish gas that is a product of electrical equipment & generators of ozone used in water purification
can’t exceed .5 ppm without bad effects

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33
Q

What’s the issue with having O3 in your body?

A

deep lung irritant–pulmonary edema
airway inflammation
hyper-responsiveness

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34
Q

What’s the deal with the toxicity of organophosphate & carbamate insecticides?

A

they are cholinesterase inhibitors
organophosphates bind irreversibly
carbamates are reversible inhibitors
**rapidly absorbed from skin, GI, resp tract

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35
Q

Who is at risk for organophosphate toxicity?

A

workers who are constantly exposed to organophosphates

infants with underdeveloped cholinesterase activity–at greater risk

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36
Q

What are the symptoms of organophosphate & carbamate & how do you make the diagnosis?

A

Symptoms: DUMBELS: diarrhea, urination, miosis, bronchorrhea, bradycardia, excitation with muscle fasciculation, anxiety, seizures, lacrimation
can die from resp depression
diagnosis: low plasma or red blood cell cholinesterase level

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37
Q

What is parathione?

A

organophosphate insecticide

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38
Q

What’s the toxicity of parathione?

A

delayed toxicity
once ingested it is converted into paraoxone
paraoxone is an inhibitor of cholinesterase

39
Q

What do you do when you treat insecticide poisoning?

A

atropine (reverse muscarinic effects)
pralidoxime (2-pam)–reverses the effects organophosphates (reversal of the phosphorylation of acetylcholinesterase enzyme)

40
Q

T/F Ibuprofen is the Leading cause of toxic drug ingestions in the United States. These can lead to hepatic toxicity and death when ingested in quantities of 150 mg/kg or more.
Currently found in over 600 Rx and OTC products.

A

FALSE

acetaminophen

41
Q

How can acetaminophen lead to liver damage?

A

when it is metabolized…its toxic intermediate can deplete hepatic gluathione
liver damage in infants or adults

42
Q

What is the treatment for acetaminophen poisoning?

A

Oral activated charcoal 60–100 g mixed in aqueous slurry (if given within 2–3 h of acute ingestion)
**Oral N-acetylcysteine (NAC), Mucomyst. 140 mg/kg loading dose, followed by 70 mg/kg Q 4 h for 72 hr.
Acetadote® (i.v. N-acetylcysteine), administered intravenously within 8 to 10 hours after ingestion of a potentially hepatotoxic quantity of acetaminophen, is indicated to prevent or lessen hepatic injury (21 hr infusion).
Alternate oral treatment end point: may stop NAC if no evident liver injury at 36 h after ingestion
Fulminant liver failure may require emergency liver transplantation

43
Q

In general what is the approach for treating poisoning? Note: most toxins don’t have specific antidotes-like acetaminophen

A 
Treat the patient not the poison
emesis (ipecac)
*not for strong acids or bases, petrol or stimulants
Gastric lavage
activated charcoal
urinary excretion (thru alkalination)
dialysis
44
Q

Once again, what is the antidote for organophosphate poisoning?

A

quaternary ammonium oxime (2-pam)

**reconstitution of cholinesterase activity

45
Q

what is the antidote for formaldehyde poisoning?

A

ammonia

**Forms hexamethylenetetramine

46
Q

What is the antidote for mercury poisoning?

A

formaldehyde sulfoxylate

47
Q

What is the antidote to convert ferrous ion to ferrous carbonate?

A

sodium bicarb

48
Q

What are some common heavy metal poisonings?

A

Lead
Arsenic
Mercury
Iron

49
Q

What is the MOA that makes lead poisonous?

A

interferes protein function where carboxyl, phosphate, sulfhydryl binding occurs
where calcium, zinc, iron binding are important

50
Q

What is the result of lead poisoning?

A

widespread dysfunction possible
binds to erythrocytes & can be deposited in bone
children: mental retardation, peripheral neuropathy, nephrotoxcity, anemia

51
Q

What is the treatment for lead poisoning?

A

metal chelators

calcium, EDTA, dimercaprol

52
Q

What are some chelators that are in use to treat heavy metal toxicity?

A 
Chelators in use are:
Dimercaprol (British antilewisite)
Succimer (dimercaptosuccinic acid)
EDTA (general)
Penicillamine (copper poisoning)
Deferoxamine (iron poisoning)
53
Q

Why can methanol be toxic? Why are people usu exposed?

A

exposed when it is used as an ethanol sub
30-200 mL is toxic
methanol–>formaldehyde via alcohol dehydrogenase
formaldehyde–>formic acid via aldehyde dehydrogenase
formate=acidosis & blindness

54
Q

What is the metabolism of methanol like compared to ethanol? What is the toxicity timeline for methanol?

A

1/10 the metabolism of ethanol

toxicity 6-30 hrs after ingestion

55
Q

What is the treatment for methanol poisoning?

A

Supportive measures, airway etc.
Correct acidosis with bicarbonate
Administer fomepizole to block the alcohol dehydrogenase (also used in ethylene glycol poisoning)
Administer folic acid to enhance breakdown of formic acid

56
Q

The Ginger Jake drink during prohibition caused Jake leg. What toxin was in it? What is this Jake paralysis now called?

A

Toxin was TOCP (an organophosphate)
neurotoxin–axonal damage to spinal cord neurons
delayed paralysis by 1-3 weeks
called organophosphate induced delayed neuropathy (OPIDN)

57
Q

Where is dioxin found? this is the Times Beach toxin.

A

concentrated inf at & thymus

58
Q

what are the symptoms of dioxin exposure?

A

Acute exposure causes eye, skin and mucous membrane irritation, nausea, vomiting and muscle pain
Polyneuropathies, sensory impairment and lower extremity weakness and motor problems present after a period of weeks

59
Q

What is the treatment for dioxin?

A

There is no antidote

Administration of olestra can promote elimination decreasing the T1/2 of dioxins from 7 to 1-2 years

60
Q

What is risk?

A

known impacts & known probabilities

61
Q

What is uncertaintY?

A

known impacts & unknown probabilities

62
Q

What is ignorance?

A

unknown impacts & unknown probabilities

63
Q

What are some important human carcinogens to keep in mind?

A 
aflatoxins
alcoholic beverage consumption
analgesic mixtures containing phenacetin
cyclosporin A
environmental tobacco smoke
estrogens (steroidal)
64
Q

What are some drugs that can cause bradycardia?

A 
PACED
propranolol, poppies
anticholinesterases
clonidine, CCBs
Ethanol 
Digoxin
65
Q

What are some drugs that can cause tachycardia?

A 
FAST
freebase
anticholinergics/antihistamines
amphetamines
sympathomimetics
solvents
theophylline
66
Q

What are some drugs that can cause hypothermia?

A 
COOLS
carbon monoxide
opiates
oral hypoglycemics
liquor
sedatives/hypnotics
67
Q

What are some drugs that can cause hyperthermia?

A 
NASA
NMS, nicotine
antihistamines
salicylates
sympathomimetics
anticholinergics
antihistamines
68
Q

What are some drugs that can cause hypotension?

A 
CRASH
clonidine, CCBs
reserpine
antihypertensives
antidepressants
aminophylline
sedative/hypnotics
heroin (opiates)
69
Q

What are some drugs that can cause hypertension?

A 
CTSCAN
Cocaine
thyroid supplements
sympathomimetics
caffeine
antichoinergics
amphetamines
nicotine
70
Q

What are some drugs that can cause hypoventilation?

A 
SLOW
Sedative/hypnotics
liquor
opiates
weed (marijuana)
71
Q

What are some drugs that can cause hyperventilation?

A 
PANT
PCP
Pneumonitis
Noncardiogenic pulmonary edema
toxic metabolic acidosis
72
Q

What are some drugs that can alter mental status?

A 
AEIOU TIPS
Alcohol
Endocrine/Epilepsy
intoxication
oxygen
uremia
trauma/tumor
infection
psychological
shock/strokes
73
Q

What are some drugs that can cause seizures?

A 
OTIS CAMPBELL
Organophosphates
Tricyclics
INH/Insulin
Sympathomimetics
Camphor/Cocaine
Amphetamines
Methylxanthines
PCP
Benzo withdrawal
Ethanol
Lead/Lithium
LIdocaine LIndane
74
Q

What are some things that can cause miosis?

A 
COPS
Cholinergics
Clonidine
Opiates
Organophosphates
Pontine bleed
Phenothiazines
Sedatives/hypnotics
75
Q

What are some things that can cause mydriasis?

A 
AAAS
Antihistamines
Antidepressants
Anticholinergics (Atropine)
Sympathomimetics (Cocaine)
76
Q

What are some things that can cause diaphoresis?

A 
SOAP
sympathomimetics
organophosphates
ASA
PCP
77
Q

What are some drugs that can cause red skin?

A

CO
Boric Acid
Anticholinergics

78
Q

What are some things that can cause blue skin?

A

cyanosis

MetHB

79
Q

What are some substances that can cause blistering?

A

barbituates
CO
sedative hypnotics
snake/spider bites

80
Q 
What creates the smell in the following?
Bitter Almonds
Mothballs
Garlic
Peanuts
Carrots
Rotten Eggs
Wintergreen
Gasoline
Fruity
Pears
A 
Bitter almonds:		Cyanide
Mothballs:			Camphor
Garlic: 				Organophosphates, Arsenic
Peanuts: 				Rodenticide
Carrots: 				Water hemlock
Rotten eggs: 			Sulfur dioxide, HS
Wintergreen: 			Methyl salicylates
Gasoline: 			Hydrocarbons
Fruity: 				DKA, Isopropanol
Pears:				Chloral hydrate
81
Q 
Most commonly reported poison?
Least commonly reported?
Associated with the most deaths?
Associated with the least deaths?
Number one poisonous killer?
A 
The most commonly reported poison?
		Analgesics!
The least commonly reported? 
		Alcohol!
Which is associated with the most deaths?
		Analgesics!
Which is associated with the least deaths?
		Hydrocarbons!
The number one poisonous killer? 
		Carbon monoxide!
82
Q

When would you need an EKG after a poisoning?

A 
to look for conduction delays & ischemia
sympathomimetics 
Beta blockers
TCAs
digoxin
CCBs
CO
83
Q

When would you need a comprehensive metabolic panel after a poisoning?

A

To calculate anion gap and osmolality

84
Q

Why might you need a chest X-ray after a poisoning? Which agents are we talking?

A 
Pulmonary Edema
MOPS
Meprobamate
Methadone
Opiates
Phenobarbital
Propoxyphene
Salicylates
85
Q

What is diaphoresis?

A

perspiring profusely

86
Q

When would you need a KUB (kidney ureter, bladder X-ray) after a poisoning?

A 
COINS
Chloral hydrate
cocaine packets
opiate packets
iron (heavy metals)
neuroleptics
sustained release/enteric coated tabs
87
Q

When is flumazenil used?

A

used for people who are overdosed on benzos

88
Q

What is the coma cocktail?

A

dextrose
narcan
thiamine

89
Q

When is gastric lavage contraindicated?

A

after ingestion of corrosives

90
Q

Use multiple doses of charcoal as treatment after ingesting which drugs?

A 
antimalarials
aminophylline
ASA
barbiturates
Beta blockers
carbamazepine
dapsone
dilantin
91
Q

When do you not need multiple doses, but rather a single dose, of charcoal to treat?

A 
CHARCOAL
Caustics/Corrosives
Heavy Metals
Alcohols
Rapid Onset Cyanide
Chlorine/Iodine
Other insolubles 
aliphatic 
laxatives
92
Q

When are cathartics used?

A

given with charcoal to enhance the elimination of the poison

93
Q

When do you use hemodialysis to treat a poisoning?

A 
ISTUMBLE
Isopropranolol
salicylates
theophylline
uremia
methanol
barbiturates
lithium
ethylene glycol

Block 7; Week 3-Michelle (6 decks)

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