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32 Cards in this Set

  • Front
  • Back
How does Rosen's classify pesticides?
Organophosphates and Carbamates
Chlorinated Hydrocarbons
Substituted Phenols
Chlorophenoxy compounds
Bipyridyl compoundsPyrethrins and Pyrethroids
How do organophosphates cause toxicity?
Inhibition of acetylcholinesterase causing the buildup of acetylcholine with a cholinergic toxidrome that can weirdly have normo or tachycardia secondary to nicotinic stimulation.
Also causes seizures and respiratory arrest (hyperstimulation -> paralysis)
What is the cholinergic toxidrome?
SLUDGE
Salivation
Lacrimation
Urination
Defication
Gastrointestinal cramps
Emesis
and the killer B's
Bradycardia, Bronchorrhea, Bronchospasm
How do organophosphates affect the nicotinic receptors?
Hyperstimulation causes twitches/fasciculations/reflexes -> muscle fatigue/paralysis -> respiratory insufficiency
What is "aging" in the context of organophosphate poisoning?
Over time OP's cause irreversible conformational change to the acetylcholinesterase enzyme preventing reconstitution of the enzyme by an oxime antidote.
How can decreased cholinesterase activity be diagnosed?
Plasma and erythrocyte cholinesterase levels. Plasma levels drop and recover fast. Erythrocyte levels are indicative of what is happening at the nerve terminal. They recover 1%/d if untreated.
How is organophosphate poisoning treated?
Decontamination, supportive care, and reversal of acetylcholine excess / toxin binding.
LOTS of atropine to treat symptoms
Pralidoxime to regenerate acetylcholinesterase
Should succinylcholine be used for intubation?
No. It is broken down by acetylcholinesterase so it will have a really long half-life
What is the dose of atropine used to treat organophosphate poisoning?
1-2mg IV doubled every 5 minutes until secretions clear
Does atropine work on the nicotinic sites?
No. Therefore it does not reverse the skeletal muscle effects
How does pralidoxime treat organophosphate toxicity?
It restores the cholinesterase activity to muscarinic and nicotinic sites
Dose is 1-2g IV q4-8h over 30-60 minutes and then an infusion
What nerve agents are related to organophosphates? Why are they so toxic?
Sarin & VX
They age very quickly
Contrast carbamates with organophosphates?
They have a shorter duration of action and their beinding to cholinesterase is reversible.
They probably do not require pralidoxime but it is difficult to distinguish from OP poisoning
Why are chlorinated hydrocarbons evil?
These insecticides stick around for pretty much ever and have bad ecological consequences.
They stick around inside us forever because they are super lipophilic.
Where are chlorinated hydrocarbons still used?
On people!
Lindane aka Kwell is a lice and scabies treatment. It's not first-line though and is banned some places.
How do chlorinated hydrocarbons cause toxicity?
They cause neuronal irritability
They are carcinogenic
How does acute chlorinated hydrocarbon toxicity present?
Seizures, tremors, paresthesias, altered mental status, muscle twitching
Hyperthermia, rhabdomyolysis, ATN
Ventricular arrhythmias
How is acute chlorinated hydrocarbon toxicity managed?
Control seizures with benzo's
Acute cardiac monitoring +/- beta blockers
Cooling for hyperthermia
Fluids for rhabdomyolysis
Dialysis and other elimination methods do not work
Name a substituted phenol.
Dinitrophenol
How do substituted phenols cause toxicity?
They uncouple oxidative phosphorylation causing a damaging hyperthermia and some cause methemoglobinemia
How is substituted phenol toxicity treated?
Fluids, cooling, benzo's
What is the most famous chlorophenoxy compound?
Agent Orange
2,4 D and 2,4,5 T are herbicides
How does chlorophenoxy toxicity present?
Dermal/GI irritation, N/V
Muscle fasciculations
May uncouple oxidative phosphorylation -> hyperthermia and rhabdomyolysis -> renal/hepatic failure
How is chlorophenoxy toxicity treated?
Supportive management
Decontamination
Cool
Name a bipyridyl compound.
Paraquat and diquat (the latter is sometimes in Roundup)
They are herbicides that are activated when exposed to sunlight.
How does bipyridyl toxicity cause damage?
They produce super-oxides and cause lipid peroxidations causing ++ GI damage when ingested (esoph perf's)
Paraquat causes the most damage to the lungs -> surfactant loss, pulmonary fibrosis, ARDS and respiratory failure.
Diquat acts more on the kidneys
Are AC, GL, WBI, dialysis effective for bipyridyl toxicity?
GL maybe
AC is if early enough *NOTE*
Dialysis works
What product is glyphosate found in?
Roundup
What is glyphosate?
The isopropyl ammonium salt of a noncholinesterase inhibiting OP herbicide
Humans do not have the enzyme that it works on.
How does glyphosate toxicity present?
Basically only presents with caustic ingestion and GI distress. Drinking a lot could cause liver/heart/kidney effects. Aspirating would cause pulmonary irritation and would be bad.
How is glyphosate toxicity treated?
Supportive
Tube/vent may be required if aspirated. Endoscopy for GI exposure.
How does DEET toxicity present?
Toxicity can occur with high concentrations, repetitive application or GI ingestion.
Can cause contact dermatitis, liver dysfunction and neurologic findings (admit neuro symptoms).
Asymptomatic patients should be observed x 4-6h