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120 Cards in this Set

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Name that toxidrome:
symptoms: tinnitis, acidosis
salicylate toxidrome
Name that toxidrome:
symptoms: black body diarrhea
Name that toxidrome:
symptoms: vomitus thick and slimy
Name that toxidrome:
symptoms: immediate pain in buccal cavity and esophagus
Name that toxidrome:
symptoms: pinpoint pupil, repiratory depression/arrest
Name that toxidrome:
symptoms: Dilated pupils & increase in HR
Meperidine (Demerol)
Name that toxidrome:
Source: automatism, what is it?

automatism is forgetting that you already took your dose
Name that toxidrome:
symptoms: low body temp and death due to respiratory depression
What is toxicology?
Primarily a multidisciplinary science that is based on other sciences including:
Pathology (disease/death)
Children under 5 years old are usually poisoned by:
Plants, cosmetics, salicylates, hydrocarbons, detergents and acetaminophen.
name that toxidrome?
treatment: atropine, pralidoxime
name that toxidrome?
signs: deep and rapid breathing, tinnitis
name that toxidrome?
treatment: cranberry juice (100X increase in excretion)
PCP overdose
name that toxidrome?
signs: chloracne, limited systemic effects, death?
name that toxidrome?
source: herbicides, cigarette smoke, smoke from burning trash and debris
main targets of toxicity are ...
small intestines, stomach, liver, CNS, kidney
chelating drug of choice:
mercury (hg) poisioning
primary DOC: BAL
secondary DOC: N-acetylpenicillamine (NAP)
chelating drug of choice:
Methyl mercury
Primary DOC: NAP
secondary: L-cysteine
chelating drug of choice:
primary deferoxamine
chelating drug of choice:
Primary: BAL, EDTA
Secondary: EDTA, succimer
chelating drug of choice:
primary: BAL
secondary: Penicillamine
Chelating drug of choice:
primary: EDTA
Chelating drug of choice:
Primary: NAP
secondary: Penicillamine
Name that toxicon:
symptoms: headache, metallic taste, NVD, cough, dyspnea, chills, fever, muscle depression, memory
Mercury vapors
Name that toxicon:
Symptoms: Nausea, vomiting, hematemesis, renal tubular necrosis, bloody diarrhea, intestinal mucosa necrosis, CV collapse
inorganic mercury
name that toxicon:
effects: neurologic effects, tunnel vision, hearing loss, memory loss, tremors, when blood levels > 20-40 ng/ml
organic mercury
treatment for mercury poisioning
Sodium formaldehyde sulfoxylate
Name that toxicon:
SymptomsL nausea & vomiting
metallic taste
epigastric pain
hepatic & renal failure
RX for copper poisioning
ABC's, dialysis, penicillamine or NAP
what are the two types of Urine tests used to ID drugs?
Immunoassay (EMIT, ELISA)

Thin Layer Chromatography (TLC)
Urine/Blood tests
used to identify toxins
Coma and Stimulant panels
Gastric lavage is ...
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
Name a cathartics.
Mg sulfate
is a nucleophillic reagent that ties up the organophosphates and permits its excretion
Chelator is made in the body

Used for CYANIDE overdose
Give an example of
Accelerating rate of excretion
Compete with reabsorption (Renal Tubules).
I.e. For Sr2+ or Ra2+ radiation give Ca2+; For Br1- poisoning give Cl1- to aid in excretion.
Name that toxicon:

[dry mouth, mydriasis, hyperpyrexia, increase HR, decreased GI motility]
Tricyclic Antidepressants
insulin MOA
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.
Insulin tissue effects: liver
* 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.
Insulin tissue effects: muscle
* Muscle: stimulates glycogen & protein synthesis. Increased GLUT 4 insertion into cell membranes.
insulin tissue effects: adipose tissue
* 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).
Name ultra & short acting insulin

What is it used for?
insulin lispro & insulin aspart

prandial insulin replacement
insulin used iv for emergencies
crystalline zinc insulin
intermediate acting insulins

What type of insulins are they?
-isopane insulin suspension (NPH insulin)
-lente insulin

(Basal insulins)
If you want to mix intermediate acting insulin with regular insulin, use ...
NPH and lente b/c lente can retard the onset of action of regular insulin
Difference between lente and NPH?
lente: can retard the onset of action of regular insulin

lente also has a longer duration of action
long acting insulin

When do you administer it?
ultralente insulin

- administer it in the morning only

basal insulin formation
Ultra long acting insulin
insuilin glargine

-peakless delivery of 20-24 hours
basal insulin
When does glargine achieve steady state?
- 2 hours after administration
-peakless delivery
insulin delivery systems
-subcutaneous injection
-pump ( continuous infusion pump)
-portable pen-sized injection
hazards of insulin use
-antigenic toxic effects
(due to the development of antibodies)
which insulins are basal insulins?

Which are prandial insulins?
Basal: NPH, Lente, Ultralente, glargine

Prandial: regular, lispro, aspart.
acarbose MOA
alpha glucose inhibitors
MOA: inhibits the activity of enzymes required to break carbohydrates down into simple sugars within the intestines
Drugs that increase insulin duration or sensitivity
-Biguanides (metformin)
-Thiazolidinedioness (glitazones) Rosiglitazone, Pioglitazone
sulfonylurea MOA
stimulates the release of insulin from B cells
causes a permanent reduction in thyroid activity
radioactive iodine (131 I)
the antithyroid drug with the most rapid onset of antithyroid action is
a symptom that would be expected to occure in the event of chronic overdose with exogenous T4 is
weight loss
When initiating T4 therapy for an elderly patient with long standing hypothyroidism, it is important to begin with small doses to avoid
overstimulation of the heart
radiocontrast medium that is also useful in thyrotoxicosis
ipodate is a radioactive contrast agent
before surgical removal, a large, highly vascular thyroid gland should be prepared by administration of a short couse of
iodide ion
treatment for anabolic protein synthesis
men who use large doses of anabolic steroids are at increased risk of
cholestatic jaundice and elevation of aspartate transaminase levels in the blood.
which of the second generation sulfonylureas are most potent?
glipizide & glyburide
sulfonylureas that are largely protein bound
tolbutamine and chlorpropamide are extensively bound to serum proteins and drug that compete for protein binding may enhance their hypoglycemic effects
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
C - increased glucose transport into cells
why is glucagon given to a 62 year old man with severe bradycardia and hypotension resulting from ingestion of an overdose of atenolol
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.
succimer uses
lead poisioning (2nd choice)
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
iron !
gingivitis, discolored gums, and loose teeth are common symptoms of chronic exposure to this agent
mercury vapor
this agent has been reported to cause lupus erythematosus and hemolytic anemia
high doses of this agent may cause histamine release and extreme vasodilation
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.
Symptoms: drowsiness, agitation, convulsions, muscle spasms, tremor & rigidity, inability to sit still, miosis,
orthostatic hypotension and hypothermia (poikliothermia), ventricular tachyarrhythmias, coma
Toxicon: Phenothiazines

Treatment: gastric lavage, activated characol
Symptoms: nystagmus (horizontal, vertical), ataxia, slurred speech, lethargy & confusion, coma & seizures,
hypotension. Chronic side effects: gingival hyperplasia, hirsutism (excessive hairiness), rashes, acne.
toxicon: Phenytoin (sodium channel blocker)

treatment: Activated charcol, hemodialysis & hemoperfusion
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.
toxicon: salicylates
salicylate treatment
Treatment: ABCs.
Gastric lavage
activated charcoal
Sodium bicarbonate
Monitor glucose
Symptoms: nausea, sinus tachycardia, tremors, seizures, hypotension, and significant

Treatment: activated charcoal & bowel irrigation. Propranolol, Phenobarbital, Hemodialysis
Symptoms: tachycardia, hypotension, confusion or hallucinations, mydriasis, dry mucous membranes
and skin, decreased bowel sounds, urinary retention, seizures, QRS prolongation & arrhythmias.
Toxicon: Tricyclic antidepressants

treatment: activated characoal, sodium bicarbonate, benzodiazepines
Indications: chelator for lead (Pb) & cadmium (Cd)
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
primary drug of choice for methyl mercury & copper poisoning.
N-acetylpenicillamine (NAP)
agent for treatment of copper & arsenic poisoning
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.
Indications: Treatment of prostatic carcinoma & as a postcoital contraceptive.
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
Drug: Ethinyl Estradiol (Estinyl ®)
if used for a long period of time, will decrease HDL levels and lead to
Tamoxifen MOA
Mechanism of Action: two mechanisms - 1) decreases estrogen-induced mitogen production by antagonizing
estrogen receptors; 2) it can directly induces growth factor inhibitors.
Mechanism of Action: has effects on bone, but does not stimulate the endometrium or breast.
Drug: Raloxifene (Evista ®)
Indications: prevention of post-menotpausal osteoporosis
Drug: Raloxifene (Evista ®)
Drug Class: Estrogen partial agonist / antagonist
Drug: Raloxifene (Evista ®)
Drug: Stanozolol (Winstrol ®)
Drug Class: Anabolic Steroid, Synthetic Testosterone Analog
Mechanism of Action: Similar to testosterone
Indications: Hereditary Angioedema. (Abused by atheletes).
Drug: Fluoxymesterone (Halotestin ®)
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).
Intended Use: Prevent jet lag & to induce sleep (reduce insomnia)
Melatonin contraindication
pregnancy or desire to conceive
Melatonin MOA
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
Intended Use: Diet suppressant, bronchodialator, stimulant
Herb: Ma-huang (ephedra)
Herb: Ma-huang (ephedra)
Ephedrine has both direct (alpha and
beta) agonist effects and indirect (amphetamine or tyramine - like) sympathomimetic effects.
Herb: Ma-huang (ephedra) toxicity
an increased risk of stroke, myocardial infarction and sudden death in those using ephedra
Side Effects: higher than normal incidence of myocardial infarction, stroke and sudden death. Hypertension,
Pharmacokinetics: tachyphylaxis develops with repeated dosing.
Herb: Ma-huang (ephedra)
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
St. John's wort
Intended Use: Treatment of cerebrial insufficiency & Alzheimer dementia
Herb: Ginkgo (Ginkgo Biloba)
Herb: Ginkgo (Ginkgo Biloba
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.
Ginkgo has antiplatelet properties & for cerebrial insufficiency & Alzheimer dementia
Intended Use: To improve physical and mental performance, enhancement of immune function
Herb: Ginseng

Mechanism of Action: active principles appear to be a dozen or more triterpenoid saponin glycosides called
ginsenosides or panaxosides.
use cautiously when taking any other psychiatric, estrogenic or hypoglycemic
medication. Should not be used in combination with warfarin
ginseg has antiplatelet properties
Intended Use: Treatment of benign prostatic hyperplasia
Herb: Saw Palmetto

more effective than placebo in reducing nocturnal urinary
frequency, daytime urinary frequency and increasing peak urinary flow
Intended Use: Relief of age-related disorders, weight loss, reduced risk of heart disease, prevention of cancer,
boosting the immune system
Herb: Dehydroepiandrosterone (DHEA)
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
ipodate, B-blockers, and corticosteroids effect on T3 levels
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.
iodide organification
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
Characterized by decreased BMR, CO, fatigue, myxedema, lethargy, etc.
antithyroid drugs adverse effects
agranulocytosis (reversible)
rash (most common)
inhibits thyroid hormone release.
potassium iodide
treat thyroid storm
Propranolol blunts sympathetic stimulation that occurs in hyperthyroidism.

2. Potassium iodide inhibits thyroid hormone release.

3. Large doses of propylthiouracil
BTEX (Benzene, toluene, ethylbenzene and xylene)
gasoline causes
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
leading causes of death in the workplace.
Hydrogen sulfide

MOA: Most likely an inhibitor of cytochrome oxidase. Resulting in increase anaerobic activity, causing a metabolic acidosis.
CNS Depression
Respiratory paralysis and collapse.
dypsnea, pneumonitis, Pneumothorax
inorganic mercury
Acute renal tubular necrosis
inorganic mercury
cadmium antidote
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.