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35 Cards in this Set

  • Front
  • Back
treatment of manic episodes of bipolar disorder
maintenance treatment in bipolar disorder
may normalize manic episode within 1-3 wks
Lithium
things that increase Li levels
thiazide and loop diuretics
ACE inhibitors; angiotensin II receptor antagonists
NSAIDS (COX-2 inhibitors, indomethacin)
clonazepam
things that decrease Li levels
acetazolamide; xanthine preparations
alkalinizing agents such as sodium bicarbonate
Target organs of Hg
kidney and CNS
Erethism?
Erethism – irritability, memory loss, anxiety, psychosis, blushing, sweating – “mad as a hatter”
brown band in eye from Hg deposition
Mercurialentis –
Cancer caused by ____-mercury compounds
methyl
Reproductive hazard – _____ Hg – fetal Minimata syndrome, others unknown
organic
Organic Ethyl Hg source
Thimerosal (KNOW THIS ONE - vaccines)
Antifungals OTC Topicals
Organic Methyl Hg source
Fish
Methyl mercury hits the brain while ethyl Hg hits the ___
kidneys
50-75% of total body Cd is found in liver and _____
kidney
Metallothionein: protein rich in cysteine
traps Cd esp. in ____
kidney
Cd half-life in humans is ____
20 - 30 years
Kidney toxicity:
free Cd binds to kidney ____

leads to proximal tubule dysfunction
glomerulus
Chronic Cd toxicity
Kidney - major target organ and storage site (1/3 of stores)
Proximal renal tubule damage
Proteinuria, reduction in GFR and increase in ______-microglobulin
ß2
What Cd disease?
From 1939 to 1954, some two hundred people near Fuchu, Japan suffered from a condition termed ______
The itai-itai disease (Japan, literally: ouch-ouch-disease)
Arsenic half-life is ____, excretion via kidneys
10 hr
Lead can bind with proteins and form protein ______ bodies
inclusion
Lead causes damage in the tubules where it inhibits the functions of the ____
mitochondria
Chelaters (Greek = claw) bind directly with metal ions to form ______ that remove the metal from competition with the body's cells.
stable complexes
Because a chelated metal is ________, it can be excreted readily by the kidney
water soluble
By definition, Chelation is the formation of a metal ion complex in which the metal ion is associated with a charged or uncharged electron ______, referred to as ligand group(s).
donor
An agent frequently used in chelation therapy is _____ (also known as BAL or British Anti-Lewisite).
dimercaprol
Oral chelating agents used as alternatives to ___ are 2,3-demercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS),
BAL
Ethylenediamintetraacetic acid (EDTA) has an affinity for ______ and was one of the first chelators developed.
lead

know for exam
Which Chelating agent?:

Not useful to chelate cadmium because it can partially dissociate in urine and enhance renal damage. Also true for iron and selenium.
Dimercaprol - BAL (British Antilewisite)
Dimercaprol - BAL (British Antilewisite) used to treat what?
As
Hg
Au
Pb
Dimercaprol - BAL (British Antilewisite) cannot be used to treat what?
Fe
Cd
Methyl Hg
Se
Notable side-effect of BAL
Nephrotoxicity
Contraindications to using BAL are
preexisting kidney disease, pregnancy, hypertension, and current use of medicinal iron.
Calcium Disodium Edetate – CaNa2 - EDTA

will chelate any metal that has a higher binding affinity than ___ (lead, iron, zinc, manganese, beryllium and copper)
Ca
notable side-effect of EDTA
severe proximal nephron degeneration
Succimer, Dimercaptosuccinic acid (DMSA) uses
It produces a lead diuresis comparable to that of CaNa2-EDTA and reverses the biochemical toxicity of lead
______ is less toxic than BAL and has a higher efficacy.
DMSA