Pharm Exam 3: Toxicology

Front 1

most common category of exposure according to the AAPCC

Back 1

analgesics

Front 2

seizure, hypoglycemia, bradycardia, low blood pressure from grandma's house =

Back 2

beta blockers (i.e. propanol)

Front 3

topical benzocaine results in ...

Back 3

methemoglobinemia

Front 4

CV drug overdose from grandpa, hyperkalcemia =

Back 4

digitoxin

Front 5

brown recluse spider bites produces

Back 5

dermonecrotic skin lesion

Front 6

what affects cytochrome system?

Back 6

carbon monoxide

Front 7

clinical scenario:
~gas exposure
~presentation: oral secretions, salivation, lacrimation, miosis, sweating, nausea, wheezing, and copious sputum, weakness

Back 7

sarin

Front 8

counsel for pregnant woman using lisinopril (ACE inhibitor)

Back 8

fetus may have hypotensive effects from drug
~tell mom to stop using the drug

Front 9

salicylate elimination curve?

Back 9

Figure C

Front 10

cause for homelessness and seizures

Back 10

withdrawal from alcohol

Front 11

location of renal failure from suspected toxicant + reactive metabolites

Back 11

proximal convoluted tubule

Front 12

clinical scenario:
presentation: confused, agitated, picking at things in the air
HR 150bts/min, dilated pupils, flushed, dry skin, absent bowel sounds

Back 12

anticholinergic toxidrome

Front 13

diquat toxicity

Back 13

renal

Front 14

black widow spider bite

Back 14

enhances ACh release

Front 15

clinical scenario:
facial grimacing, dystonia, gyric movements of eyes and tongue, conscious

Back 15

benztropine mesylate
(antidote for dystonia by anticholinergic mechanism)

Front 16

clinical scenario:
abdominal pain, gastroenteritis
2 wks into illness: hair comes out in clumps, eyebrow lost hair, weak, sensorimotor polyneuropathy

Back 16

ferric hexacyanoferrate (thallium poisoning)

Front 17

arisolachia fangchi associated with ...

Back 17

kidney damage and renal cancer

Front 18

clinical scenario: alcoholic runs out of alcohol
decreased consciousness, vomiting, gastric bleeding, no anion gap acidosis -- ketoisis and osmolar gap

Back 18

isopropanol

Front 19

antifreeze poisoning, anion gap (methanol)

Back 19

fomepizole treatment

Front 20

clinical scenario:
agitation, confusion, hyperreflexia, tremors, inducible clonus, diaphoresis, ocular clonus, fluctuations in HR and BP, normal WBC, CK

Back 20

fluoxetine and dextromethorphan

Front 21

clinical scenario:
apparent hepatitis, all viral Ag and Ab markers are negative. Liver biopsy: centrilobular necrosis

Back 21

dose-related hepatic toxicity

Front 22

distal renal tubular acidosis, cerebral atrophy (on MRI) and hepatotoxicity...

Back 22

toluene abuse

Front 23

What characteristic of a chemical or drug makes it more amenable to removal by hemodialysis?

Back 23

MW of <500 daltons

Front 24

clinical scenario: exposure to unknown gas
cough, difficulty breathing, pulmonary edema, no upper airway or mucous membrane irritation, no tearing or throat irritation

Back 24

phosgene

Front 25

BAL can be administered with calcium disodium EDTA for what kind of poisoning?

Back 25

lead

Front 26

clinical scenario: child treat with lindane lotion for head lice and wrapped in plastic wrap. Developed toxicity

In addition to dermal decontamination, what other treatment is indication?

Back 26

benzodiazepine (i.e. lorazepam or diazepam)

Front 27

clinical scenario: works in a lead smelter, notices during pregnancy a lactation increase in bld lead level.

Source of lead mobilization?

Back 27

deep bone compartment

Front 28

clinical scenario: ingests cyclic antidepressant
sinus tachycardia, wide QRS, long QT, Vtach, hypotension

Treat with?

Back 28

sodium bicarbonate

Front 29

Patient has acute onset of cranial nerve dysfunction and symmetric and descending paralysis

characteristic of?

Back 29

botulism

Front 30

muscle rigidity, hyperthermia, recent use of haloperidol, elevated CK (>1,000U/L), Tach

signs consistent with?

Back 30

NMS

Front 31

after an hour of indigestion, GI decontamination is...

Back 31

not likely to be much of a benefit

Front 32

What is the preferred method for confirmation of positive drug test?

Back 32

gas chromatography-mass spectrometry (GC/MS)

Front 33

clinical scenario: bite on foot
swollen, less muscle strength, no piloerection, no rigidity, bite site discolored

Back 33

crotalinae (pit vipe) snake envenomation

Front 34

Patients of Mediterranean descent with a history of G6PD deficiency should avoid...

Back 34

methylene blue

Front 35

clinical scenario: overdose of multiple medicines, cocaine body packs, lead, sustained release meds

Back 35

1. whole bowel irrigation
2. protection of airway (due to risk of aspiration)

Front 36

clinical scenario: took medicine for cold, anxiety and mood effects
confused, agitated, ocular clonus, hyperreflexis, diaphoretic, suspect serotonin toxicity

caused by...

Back 36

paroxetine and dextromethorphan

Front 37

Most likely category of pharmaceutical deaths

Back 37

sedative/hypnotics/antipsychotics

Front 38

clinical scenario: infant born with myelomeningocele

exposed to ?

Back 38

valproic acid or carbamazepine

Front 39

ciguatera fish poisoning causes...

Back 39

cold/hot temperature sensation reversal

Front 40

When patient presents with hepatitis (neg for infection) periportal necrosis, heavy inflammatory infiltrate sparing the centrilobular zones....

course of action? (exclude...)

Back 40

exclude cytochrome P450 (centrilobular necrosis)

Front 41

Both _____ and _________ influence the risk of structural defects

Back 41

timing
dose of teratogen exposure

Front 42

acute ingestion of metal salts causes...

Back 42

gastroenteritis

Front 43

hyperkeratotic eruption of palms and soles is caused by ...

Back 43

arsenic poisoning

Front 44

Most likely toxic etiology of elevated anion gap metabolic acidosis

Back 44

salicylates

Front 45

Prominent detoxifier to free radical metabolites

Back 45

glutathione

Front 46

Agent increases incidence of primary liver cancer in dose related fashion

Back 46

ethanol

Front 47

The setting regulations for allowable concentration of toxins in environmental media or acceptable daily intake of toxins depends heavily on what parameter?

Back 47

highest NOEL modified by appropriate safety factors

Front 48

clinical scenario: sudden onset of gastroenteritis followed by shock, 5 hours later

administer? which route?

Back 48

BAL, intramuscularly

Front 49

childhood lead poisoning characterized by ...

Back 49

colic-like abdominal pain

Front 50

Ipecac has potential for ...

Back 50

abuse

Front 51

What may cause a false positive for marijuana on urine drug screens?

Back 51

efavirenz

Front 52

Recently started on ziprasidone and haloperidol can indicate what?

Back 52

NMS

Front 53

if a child develops ___________ from a snake bite, it is possible it will recur in __________.

Back 53

coagulopathy, 2 weeks

Front 54

_______ and _______ cause cellular hypoxia as an underlying mechanism of toxicity

Back 54

carbon monoxide and cyanide

Front 55

Clinical toxicity of organophosphate insecticides...

Back 55

excessive secretions

Front 56

poisoned with toxin that causes severe abdominal pain, profuse watery diarrhea and possible death from shock

Back 56

arsenic trioxide

Front 57

certain non-steroidal pain medication may give a _______ for benzodiazepines on some immunoassays

Back 57

false-positive

Front 58

the hazard of a chemical ...

Back 58

cannot be changed

Front 59

__________ is an effective antidotes for INH poisons and it is dosed on a __________ basis according to the estimated amount of INH ingested

Back 59

pyridoxine (B6) , gram for gram

Front 60

Use N-acetylcysteine for what overdoes?

Back 60

acetaminophen

Front 61

Liver biopsy of patient with 40 yr occupation exposure to cadmium =

Back 61

normal lobular architecture and hepatocytes

Front 62

Testicular toxin that impairs fertility

Back 62

ethanol

Front 63

Overdose of diarrhea medicine composed of naroctic belladonna alkaloids might cause...

Back 63

cyclic coma

Front 64

increase excretion of 2,4D- with urinary alkalinization with ...

Back 64

sodium bicarbonate (ion trapping)

Front 65

acetaminophen exhibits _______ order kinetics through overdose situations

Back 65

first order

Front 66

Iron causes what kind of toxic damage (mechanism)?

Back 66

O2 radical damage

Front 67

Pyrethroid insecticide toxicity

Back 67

paresthesia amenable by Vitamin E

Front 68

antidotal mechanism of atropine for poisoning by ACEi like nerve gases

Back 68

bind to toxin after its absorption

Front 69

clinical scenario: agitated delirium after "pharming" party

antidote?

Back 69

diazepam

Front 70

herbacide glyphosphate = (toxic or non toxic)

Back 70

non toxic

Front 71

clinical scenario: neck contorted to side for several hours after "pharming" party

antidote?

Back 71

diphenhydramine

Front 72

clinical scenario: ingests bottle of 100 enteric-coated aspirin tablets

What happens? treatment?

Back 72

prolonged absorption. Treat with sodium bicarbonate

Front 73

Pulmonary edema associated with ...

Back 73

heroin overdose or serious salicylate intoxication

Front 74

Amanita mushrooms exert their toxic mechanism via inhibition of...

Back 74

RNA polymerase II

Front 75

Butane, propane, and nitrous oxide may cause hypoxia by displacing ....

Back 75

alveolar O2

Front 76

A toxidrome of miosis, respiratory depression, and coma may be seen with...

Back 76

fentanyl patch abuse

Front 77

Transition metal association with O2 radical damage...

Back 77

Mn, Fe, Ch
manganese, iron, chromium