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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
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things that increase Li levels
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thiazide and loop diuretics
ACE inhibitors; angiotensin II receptor antagonists NSAIDS (COX-2 inhibitors, indomethacin) clonazepam |
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things that decrease Li levels
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acetazolamide; xanthine preparations
alkalinizing agents such as sodium bicarbonate |
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Target organs of Hg
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kidney and CNS
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Erethism?
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Erethism – irritability, memory loss, anxiety, psychosis, blushing, sweating – “mad as a hatter”
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brown band in eye from Hg deposition
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Mercurialentis –
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Cancer caused by ____-mercury compounds
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methyl
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Reproductive hazard – _____ Hg – fetal Minimata syndrome, others unknown
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organic
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Organic Ethyl Hg source
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Thimerosal (KNOW THIS ONE - vaccines)
Antifungals OTC Topicals |
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Organic Methyl Hg source
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Fish
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Methyl mercury hits the brain while ethyl Hg hits the ___
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kidneys
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50-75% of total body Cd is found in liver and _____
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kidney
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Metallothionein: protein rich in cysteine
traps Cd esp. in ____ |
kidney
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Cd half-life in humans is ____
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20 - 30 years
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Kidney toxicity:
free Cd binds to kidney ____ leads to proximal tubule dysfunction |
glomerulus
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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
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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)
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Arsenic half-life is ____, excretion via kidneys
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10 hr
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Lead can bind with proteins and form protein ______ bodies
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inclusion
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Lead causes damage in the tubules where it inhibits the functions of the ____
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mitochondria
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Chelaters (Greek = claw) bind directly with metal ions to form ______ that remove the metal from competition with the body's cells.
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stable complexes
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Because a chelated metal is ________, it can be excreted readily by the kidney
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water soluble
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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).
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donor
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An agent frequently used in chelation therapy is _____ (also known as BAL or British Anti-Lewisite).
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dimercaprol
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Oral chelating agents used as alternatives to ___ are 2,3-demercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS),
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BAL
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Ethylenediamintetraacetic acid (EDTA) has an affinity for ______ and was one of the first chelators developed.
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lead
know for exam |
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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)
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Dimercaprol - BAL (British Antilewisite) used to treat what?
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As
Hg Au Pb |
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Dimercaprol - BAL (British Antilewisite) cannot be used to treat what?
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Fe
Cd Methyl Hg Se |
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Notable side-effect of BAL
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Nephrotoxicity
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Contraindications to using BAL are
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preexisting kidney disease, pregnancy, hypertension, and current use of medicinal iron.
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Calcium Disodium Edetate – CaNa2 - EDTA
will chelate any metal that has a higher binding affinity than ___ (lead, iron, zinc, manganese, beryllium and copper) |
Ca
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notable side-effect of EDTA
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severe proximal nephron degeneration
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Succimer, Dimercaptosuccinic acid (DMSA) uses
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It produces a lead diuresis comparable to that of CaNa2-EDTA and reverses the biochemical toxicity of lead
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______ is less toxic than BAL and has a higher efficacy.
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DMSA
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