More Plash Cards

Front 1

Name that toxidrome:
symptoms: tinnitis, acidosis

Back 1

salicylate toxidrome

Front 2

Name that toxidrome:
symptoms: black body diarrhea

Back 2

Acids

Front 3

Name that toxidrome:
symptoms: vomitus thick and slimy

Back 3

Base

Front 4

Name that toxidrome:
symptoms: immediate pain in buccal cavity and esophagus

Back 4

acids

Front 5

Name that toxidrome:
symptoms: pinpoint pupil, repiratory depression/arrest

Back 5

Opiates

Front 6

Name that toxidrome:
symptoms: Dilated pupils & increase in HR

Back 6

Meperidine (Demerol)

Front 7

Name that toxidrome:
Source: automatism, what is it?

Back 7

Barbituates

automatism is forgetting that you already took your dose

Front 8

Name that toxidrome:
symptoms: low body temp and death due to respiratory depression

Back 8

Barbituates

Front 9

What is toxicology?

Back 9

Primarily a multidisciplinary science that is based on other sciences including:
Pharmacology
Pathology (disease/death)
Chemistry
Epidemiology

Front 10

Children under 5 years old are usually poisoned by:

Back 10

Plants, cosmetics, salicylates, hydrocarbons, detergents and acetaminophen.

Front 11

name that toxidrome?
treatment: atropine, pralidoxime

Back 11

parathion

Front 12

name that toxidrome?
signs: deep and rapid breathing, tinnitis

Back 12

salicylates

Front 13

name that toxidrome?
treatment: cranberry juice (100X increase in excretion)

Back 13

PCP overdose

Front 14

name that toxidrome?
signs: chloracne, limited systemic effects, death?

Back 14

dioxin

Front 15

name that toxidrome?
source: herbicides, cigarette smoke, smoke from burning trash and debris

Back 15

dioxin

Front 16

main targets of toxicity are ...

Back 16

small intestines, stomach, liver, CNS, kidney

Front 17

chelating drug of choice:
mercury (hg) poisioning

Back 17

primary DOC: BAL
secondary DOC: N-acetylpenicillamine (NAP)

Front 18

chelating drug of choice:
Methyl mercury

Back 18

Primary DOC: NAP
secondary: L-cysteine

Front 19

chelating drug of choice:
Iron

Back 19

primary deferoxamine

Front 20

chelating drug of choice:
Lead

Back 20

Primary: BAL, EDTA
Secondary: EDTA, succimer

Front 21

chelating drug of choice:
arsenic

Back 21

primary: BAL
secondary: Penicillamine

Front 22

Chelating drug of choice:
Cadmium

Back 22

primary: EDTA

Front 23

Chelating drug of choice:
Copper

Back 23

Primary: NAP
secondary: Penicillamine

Front 24

Name that toxicon:
symptoms: headache, metallic taste, NVD, cough, dyspnea, chills, fever, muscle depression, memory

Back 24

Mercury vapors

Front 25

Name that toxicon:
Symptoms: Nausea, vomiting, hematemesis, renal tubular necrosis, bloody diarrhea, intestinal mucosa necrosis, CV collapse

Back 25

inorganic mercury

Front 26

name that toxicon:
effects: neurologic effects, tunnel vision, hearing loss, memory loss, tremors, when blood levels > 20-40 ng/ml

Back 26

organic mercury

Front 27

treatment for mercury poisioning

Back 27

ABC's,
Ipecac,
lavage,
Charcoal
BAL
Antibiotics
Electrolytes
Sodium formaldehyde sulfoxylate

Front 28

Name that toxicon:
SymptomsL nausea & vomiting
metallic taste
epigastric pain
hepatic & renal failure

Back 28

Copper

Front 29

RX for copper poisioning

Back 29

ABC's, dialysis, penicillamine or NAP

Front 30

what are the two types of Urine tests used to ID drugs?

Back 30

Immunoassay (EMIT, ELISA)

Thin Layer Chromatography (TLC)

Front 31

Urine/Blood tests
used to identify toxins

Back 31

HPLC
GCMS
Coma and Stimulant panels

Front 32

Gastric lavage is ...

Back 32

washing of the stomach
insert a tube through the nose or mouth, down into the stomach.
Stomach contents can be removed using suction, immediately followed by irrigation with fluids

Front 33

Name a cathartics.

Back 33

Mg sulfate

Front 34

Pralidoxime

Back 34

is a nucleophillic reagent that ties up the organophosphates and permits its excretion

Front 35

methemoglobin

Back 35

Chelator is made in the body

Used for CYANIDE overdose

Front 36

Give an example of
Accelerating rate of excretion

Back 36

Compete with reabsorption (Renal Tubules).
I.e. For Sr2+ or Ra2+ radiation give Ca2+; For Br1- poisoning give Cl1- to aid in excretion.

Front 37

Name that toxicon:

[dry mouth, mydriasis, hyperpyrexia, increase HR, decreased GI motility]

Back 37

Tricyclic Antidepressants

Front 38

insulin MOA

Back 38

Mechanism of Action: Binds to insulin receptors in cell membranes consisting of alpha subunits on the outside surface and cytoplasmic beta subunits having tyrosine kinase activity. Binding of insulin to two receptors (forming a dimer) brings the beta subunits into close proximity, resulting in phosphorylation of tyrosine residues (autophosphorylation) on the beta subunits, and chronicly elevated tyrosine kinase activity. This ultimately results in the activation of other intracellular kinases including ras and MAPK. The network of phosphorylations within the cell results in multiple effects including a translocation of glucose transporters (GLUT 1-5 subtypes) to the cell membrane, with a resultant increase in glucose uptake, glycogen synthase activity & increased glycogen formation, increased protein synthesis, lipolysis, and lipogenesis.

Front 39

Insulin tissue effects: liver

Back 39

* Liver: increased storage of glucose as glycogen. This involves insertion of GLUT 2 into liver cell membranes & increased synthesis of enzymes involved in glucose metabolism. Insulin also decreases the breakdown of proteins.

Front 40

Insulin tissue effects: muscle

Back 40

* Muscle: stimulates glycogen & protein synthesis. Increased GLUT 4 insertion into cell membranes.

Front 41

insulin tissue effects: adipose tissue

Back 41

* Adipose tissue: facilitates triglyceride storage by activating plasma lipoprotein lipase. Increased glucose transport into cells via GLUT 4, reduced breakdown of lipid (reduced intracellular lipolysis).

Front 42

Name ultra & short acting insulin

What is it used for?

Back 42

insulin lispro & insulin aspart

prandial insulin replacement

Front 43

insulin used iv for emergencies

Back 43

crystalline zinc insulin

Front 44

intermediate acting insulins

What type of insulins are they?

Back 44

-isopane insulin suspension (NPH insulin)
-lente insulin

(Basal insulins)

Front 45

If you want to mix intermediate acting insulin with regular insulin, use ...

Back 45

NPH and lente b/c lente can retard the onset of action of regular insulin

Front 46

Difference between lente and NPH?

Back 46

lente: can retard the onset of action of regular insulin

lente also has a longer duration of action

Front 47

long acting insulin

When do you administer it?

Back 47

ultralente insulin

- administer it in the morning only

basal insulin formation

Front 48

Ultra long acting insulin

Back 48

insuilin glargine

-peakless delivery of 20-24 hours
basal insulin

Front 49

When does glargine achieve steady state?

Back 49

- 2 hours after administration
-peakless delivery

Front 50

insulin delivery systems

Back 50

-inhaled
-subcutaneous injection
-pump ( continuous infusion pump)
-portable pen-sized injection

Front 51

hazards of insulin use

Back 51

-hypoglycemia
-antigenic toxic effects
(due to the development of antibodies)

Front 52

which insulins are basal insulins?

Which are prandial insulins?

Back 52

Basal: NPH, Lente, Ultralente, glargine

Prandial: regular, lispro, aspart.

Front 53

acarbose MOA

Back 53

alpha glucose inhibitors
MOA: inhibits the activity of enzymes required to break carbohydrates down into simple sugars within the intestines

Front 54

Drugs that increase insulin duration or sensitivity

Back 54

-Biguanides (metformin)
-Thiazolidinedioness (glitazones) Rosiglitazone, Pioglitazone

Front 55

sulfonylurea MOA

Back 55

stimulates the release of insulin from B cells

Front 56

causes a permanent reduction in thyroid activity

Back 56

radioactive iodine (131 I)

Front 57

the antithyroid drug with the most rapid onset of antithyroid action is

Back 57

ipodate

Front 58

a symptom that would be expected to occure in the event of chronic overdose with exogenous T4 is

Back 58

weight loss

Front 59

When initiating T4 therapy for an elderly patient with long standing hypothyroidism, it is important to begin with small doses to avoid

Back 59

overstimulation of the heart

Front 60

radiocontrast medium that is also useful in thyrotoxicosis

Back 60

ipodate is a radioactive contrast agent

Front 61

before surgical removal, a large, highly vascular thyroid gland should be prepared by administration of a short couse of

Back 61

iodide ion

Front 62

treatment for anabolic protein synthesis

Back 62

stanozolol

Front 63

men who use large doses of anabolic steroids are at increased risk of

Back 63

cholestatic jaundice and elevation of aspartate transaminase levels in the blood.

Front 64

which of the second generation sulfonylureas are most potent?

Back 64

glipizide & glyburide

Front 65

sulfonylureas that are largely protein bound

Back 65

tolbutamine and chlorpropamide are extensively bound to serum proteins and drug that compete for protein binding may enhance their hypoglycemic effects

Front 66

an important effect of insulin is
(a) increased conversion of amino acids into glucose
(b) increased gluconeogensis
(c) incresed glucose transport into cells
(d) inhibition of lipoprotein lipase
(e) stimulaiton of glycoenolysis

Back 66

C - increased glucose transport into cells

Front 67

why is glucagon given to a 62 year old man with severe bradycardia and hypotension resulting from ingestion of an overdose of atenolol

Back 67

glucagon acts through cardiac glucagon receptors to stimulate the rate and force of contaction of the heart. Makes glucagon useful in the treatment of B-blocker induced cardiac depression.

Front 68

succimer uses

Back 68

lead poisioning (2nd choice)
arsenic
mercury

Front 69

a 2 year old child was brought to the emergency room 1 hour after ingestion of tablets he had managed to obtain from a bottle on top of the refrigerator. His symptoms included marked gastrointestinal distress, vomiting (with hematemesis), and epigastric pain. metabolic acidosis and leukocytosis were also present. This patient is most likely to have ingested tablets of

Back 69

iron !

Front 70

gingivitis, discolored gums, and loose teeth are common symptoms of chronic exposure to this agent

Back 70

mercury vapor

Front 71

this agent has been reported to cause lupus erythematosus and hemolytic anemia

Back 71

penicillamine

Front 72

high doses of this agent may cause histamine release and extreme vasodilation

Back 72

iron

Front 73

the most likely drug to be needed in an overdose due to this substance is an anticonvulsant, but B-blockers are appropriate when cardiac arrhythmias are present.

Back 73

theophylline

Front 74

Symptoms: drowsiness, agitation, convulsions, muscle spasms, tremor & rigidity, inability to sit still, miosis,
orthostatic hypotension and hypothermia (poikliothermia), ventricular tachyarrhythmias, coma

Back 74

Toxicon: Phenothiazines

Treatment: gastric lavage, activated characol

Front 75

Symptoms: nystagmus (horizontal, vertical), ataxia, slurred speech, lethargy & confusion, coma & seizures,
hypotension. Chronic side effects: gingival hyperplasia, hirsutism (excessive hairiness), rashes, acne.

Back 75

toxicon: Phenytoin (sodium channel blocker)

treatment: Activated charcol, hemodialysis & hemoperfusion

Front 76

Symptoms: Acid-base disturbances vary with the severity of toxicity. Initially, hyperventilation a respiratory
alkalosis develops secondary to direct stimulation of the respiratory centers. This may be the only consequence
of mild salicylism. A severe metabolic (ketolactic) acidosis with compensatory respiratory alkalosis may
develop with severe salicylate intoxication. Potassium moves from the intracellular space to the extracellular
space. Excretion of hydrogen ions produces acidic urine. A paradoxical aciduria (hydrogen ion excretion) occurs
with the depletion of sodium bicarbonate and potassium. Ototoxicity, tinnitus, tachycardia, CNS depression,
seizures, nausea & vomiting, GI hemorrhage, prolonged bleeding time, dehydration.

Back 76

toxicon: salicylates

Front 77

salicylate treatment

Back 77

Treatment: ABCs.
Gastric lavage
activated charcoal
Hemodialysis
Sodium bicarbonate
Monitor glucose

Front 78

Symptoms: nausea, sinus tachycardia, tremors, seizures, hypotension, and significant
dysrhythmias.

Back 78

Toxicon:Theophylline

Treatment: activated charcoal & bowel irrigation. Propranolol, Phenobarbital, Hemodialysis

Front 79

Symptoms: tachycardia, hypotension, confusion or hallucinations, mydriasis, dry mucous membranes
and skin, decreased bowel sounds, urinary retention, seizures, QRS prolongation & arrhythmias.

Back 79

Toxicon: Tricyclic antidepressants

treatment: activated characoal, sodium bicarbonate, benzodiazepines

Front 80

Indications: chelator for lead (Pb) & cadmium (Cd)

Back 80

Drug: EDTA (ethylene diamine tetra acetic acid)

Mechanism of Action: used as a disodium calcium salt. Forms a soluble heavy metal chelate in the blood
which is excreted through the urine

Front 81

primary drug of choice for methyl mercury & copper poisoning.

Back 81

N-acetylpenicillamine (NAP)

Front 82

secondary
agent for treatment of copper & arsenic poisoning

Back 82

Penicillamine

Front 83

Mechanism of Action: Forms a chelate by binding sulfhydryl groups with arsenic, mercury, lead, and gold,
thus increasing both urinary and fecal excretion of the metals.

Back 83

BAL

Front 84

Indications: Treatment of prostatic carcinoma & as a postcoital contraceptive.

Back 84

DES

Front 85

Pharmacokinetics: As a "morning after pill" - take within 72 hrs of unprotected coitus to prevent blatocyst
implantation w/ a dose regimen of 2.5 mg twice daily for 5 day

Back 85

Drug: Ethinyl Estradiol (Estinyl ®)

Front 86

if used for a long period of time, will decrease HDL levels and lead to
atherosclerosis.

Back 86

progestins

Front 87

Tamoxifen MOA

Back 87

Mechanism of Action: two mechanisms - 1) decreases estrogen-induced mitogen production by antagonizing
estrogen receptors; 2) it can directly induces growth factor inhibitors.

Front 88

Mechanism of Action: has effects on bone, but does not stimulate the endometrium or breast.

Back 88

Drug: Raloxifene (Evista ®)

Front 89

Indications: prevention of post-menotpausal osteoporosis

Back 89

Drug: Raloxifene (Evista ®)

Front 90

Drug Class: Estrogen partial agonist / antagonist

Back 90

Drug: Raloxifene (Evista ®)

Front 91

Drug: Stanozolol (Winstrol ®)

Back 91

Drug Class: Anabolic Steroid, Synthetic Testosterone Analog
Mechanism of Action: Similar to testosterone
Indications: Hereditary Angioedema. (Abused by atheletes).

Front 92

Drug: Fluoxymesterone (Halotestin ®)

Back 92

palliation of androgen responsive recurrent mammary cancer in postmenopausal women
• replacement therapy in conditions associated with symptoms of deficiency or absence of endogenous
testosterone in men (e.g. hypogonadism or delayed puberty).

Front 93

Intended Use: Prevent jet lag & to induce sleep (reduce insomnia)

Back 93

Melatonin

Front 94

Melatonin contraindication

Back 94

pregnancy or desire to conceive

Front 95

Melatonin MOA

Back 95

Mechanism of Action: A serotonin derivative that is released by the pineal gland & is believed to be inolved in
regulating sleep-wake cycles. Melatonin release coincides with darkness & is suppressed by daylig

Front 96

Intended Use: Diet suppressant, bronchodialator, stimulant

Back 96

Herb: Ma-huang (ephedra)

Front 97

Herb: Ma-huang (ephedra)

Back 97

Ephedrine has both direct (alpha and
beta) agonist effects and indirect (amphetamine or tyramine - like) sympathomimetic effects.

Front 98

Herb: Ma-huang (ephedra) toxicity

Back 98

an increased risk of stroke, myocardial infarction and sudden death in those using ephedra

Front 99

Side Effects: higher than normal incidence of myocardial infarction, stroke and sudden death. Hypertension,
insomnia.
Pharmacokinetics: tachyphylaxis develops with repeated dosing.

Back 99

Herb: Ma-huang (ephedra)

Front 100

herbal med: similar efficacy as some prescribed
antidepressants for mild to moderate depression. However, clinical trials indicate that it is not effective
against major or severe depressio

Back 100

St. John's wort

Front 101

Intended Use: Treatment of cerebrial insufficiency & Alzheimer dementia

Back 101

Herb: Ginkgo (Ginkgo Biloba)

Front 102

Herb: Ginkgo (Ginkgo Biloba

Back 102

Mechanism of Action: has antioxidant and free-radical scavenging properties that may reduce ischemic injury
and oxidative stress. Ginkgo has been shown to increase blood flow and reduce blood viscosity (antiplatelet
effect). Enhancment of nitric oxide may be involved.

Front 103

Ginkgo

Back 103

Ginkgo has antiplatelet properties & for cerebrial insufficiency & Alzheimer dementia

Front 104

Intended Use: To improve physical and mental performance, enhancement of immune function

Back 104

Herb: Ginseng

Mechanism of Action: active principles appear to be a dozen or more triterpenoid saponin glycosides called
ginsenosides or panaxosides.

Front 105

use cautiously when taking any other psychiatric, estrogenic or hypoglycemic
medication. Should not be used in combination with warfarin

Back 105

ginseg has antiplatelet properties

Front 106

Intended Use: Treatment of benign prostatic hyperplasia

Back 106

Herb: Saw Palmetto

more effective than placebo in reducing nocturnal urinary
frequency, daytime urinary frequency and increasing peak urinary flow

Front 107

Intended Use: Relief of age-related disorders, weight loss, reduced risk of heart disease, prevention of cancer,
boosting the immune system

Back 107

Herb: Dehydroepiandrosterone (DHEA)

Front 108

DHEA MOA & SE

Back 108

Mechanism of Action: a precursor hormone (to as many as 50 different hormones) that is secreted by the
adrenal cortex & CNS. It is converted to androstenedione, testosterone & androsterone. In peripheral tissues
aromatase converts DHEA to estradiol. In the plasma, DHEA is converted to DHEA sulfate (DHEAS)

Side Effects: Adrongenic side effects are common

Front 109

ipodate, B-blockers, and corticosteroids effect on T3 levels

Back 109

Drugs such as ipodate, B-blockers, and corticosteroids, and severe illness or starvation inhibit the 5’-deiodinase necessary for the conversion of T4 to T3, resulting in low T3 and high rT3 levels in the serum.

Front 110

iodide organification

Back 110

Iodide is then oxidized by thyroidal peroxidase to iodine, in which form it rapidly iodinates tyrosine residues within the thyroglobulin molecule to form monoiodotyrosine (MIT) and diiodotyrosine (DIT)-IODIDE ORGANIFICATION

Front 111

Characterized by decreased BMR, CO, fatigue, myxedema, lethargy, etc.

Back 111

hypothyroidism

Front 112

antithyroid drugs adverse effects

Back 112

agranulocytosis (reversible)
rash (most common)
edema.

Front 113

inhibits thyroid hormone release.

Back 113

potassium iodide

Front 114

treat thyroid storm

Back 114

Propranolol blunts sympathetic stimulation that occurs in hyperthyroidism.

2. Potassium iodide inhibits thyroid hormone release.

3. Large doses of propylthiouracil

Front 115

BTEX (Benzene, toluene, ethylbenzene and xylene)
gasoline causes

Back 115

CNS depressants, nausea, vomiting, mucous membrane irritation, pulmonary irritation, skin irritation and convulsions (high dose).

Treatment: Discontinue exposure, ABC’s, no emesis, anticonvulsants as needed

Front 116

leading causes of death in the workplace.

Back 116

Hydrogen sulfide

MOA: Most likely an inhibitor of cytochrome oxidase. Resulting in increase anaerobic activity, causing a metabolic acidosis.

Front 117

CNS Depression
Coma
Respiratory paralysis and collapse.

Back 117

H2S

Front 118

dypsnea, pneumonitis, Pneumothorax

Back 118

inorganic mercury

Front 119

Acute renal tubular necrosis

Back 119

inorganic mercury

Front 120

cadmium antidote

Back 120

No specific antidote for cadmium poisoning
BAL is contraindicated due to evidence that large concentration of cadmium in the kidney will lead to greater damage.