Pharm Heavy Metals/management Of The Poisoned Pt

Front 1

Question: A child with severe lead poisoning with encephalopathy. What is the treatment?

Back 1

EDTA

Note: oral succimer is used in children with mild to moderate lead poisoning.

Front 2

Question: An dental technician has conjunctivitis, skin irritation, and hair loss. She has a perforated nasal septum and "milk and roses" complexion. This is due from?

Back 2

Chronic inorganic arsenic poisoning. Other signs of aresnic poisoning are GI distress, hyperpigmentation, and white lines on the nails.

"Milk and roses" complexion is form vasodilation and anemia.

Stem of question was suppose to make you think of mercury. . . . Tricky question . .

Lead poisoning would have a gray pallor.

Front 3

Question: PT has chronic headache, fatigue, loss of appetite, and constipation. He has slight weakness of the extensor muscles in the upper limb. What is the poison?

Back 3

Inorganic lead.

Lead decreases heme synthesis.

Front 4

Question: Treatment of inorganic arsenic poisoning?

Back 4

Dimercaprol.

Note: although succimer is less toxic, it is only available in oral formulation and its absorption may be impaired by severe gastroenteritis from arsenic poisoning.

Front 5

Question: An employee who worked with semiconductors presents with nausea, vomiting, headache, hypotension, and shivering. He has hemoglobinuria and free hemoglobin greater than 1.4 g/dL What was he exposed to?

Back 5

ArsineArsine gas binds to hemoglobin and decreases erythrocyte glutathione levels, causing mm fragility and resulting hemolysis.

Front 6

Question: A child ingested tablets from a container. He has marked GI distress, vomiting (with hematemesis), and epigastric pain. Also, metabolic acidosis and leukocytosis. What did he digest?

Back 6

Iron

Point to the question: ingestion of iron tablets is relatively common cause of accidental poisoning in young children.

Front 7

Question: This toxic compound can be produced in seawater by the action of bacteria and algae. It is synthesized chemically for commercial use as a fungicide.

Back 7

Methylmercury. It is used as a fungicide to prevent mold growth in seed grain.

Front 8

Question: What agent causes SLE and hemolytic anemia?

Back 8

Penicillamine.

Front 9

Question: High doses of this agent cause histamine release and extreme vasodilation.

Back 9

Deferoxamine, which can cause shock with rapid IV infusion.

Front 10

Question: Gingivitis, discolored gums, and loose teeth are common with this agent?

Back 10

Inorganic mercury.

Oral and GI complaints are common in chronic mercury exposure. Tremor involving the fingers and arms are often present.

Front 11

Question: 2 year girl has lethargy, increased respiratory rate, elevated temp from drug poisoning. Glucose 36; Na 148; K 5; Cl 111; HCO3 12; BUN 21; osmolality 300

What is the anion gap? The osmolar gap is? What poison was given?

Back 11

30

-5

Aspirin (ethylene glycol could have produce an increased anion gap, but there would have been a significant osmolar gap)

Front 12

Question: 18 mo-old boy is in a semiconscious state with profound hypotension and bradycardia after ingesting metoprolol. What is the antidote?

Back 12

Glucagon, which does so by adenylyl cyclase and cAMP pathway without the need of beta receptors.

Front 13

Question: 81 y with T2DM is in a coma, with tachypnea, tachycardia, hypotension, severe lactic acidosis after ingesting metformin tablets 9 hours ago. Glucose is 148. Metformin is a base with a pKa of 12.4. What should be given?

Back 13

Hemodialysis since metformin would have been absorbed and efforts to decontaminate her via charcoal and gastric lavage would be unsuccessful.

Front 14

Question: What drug is most likely to cause hypotension, strong antimuscarinic effects, seizures, and cardiac arrhythmia when taken in OD?

Back 14

TCAs

Front 15

Question: OD on digoxin and is 8 x higher than the threshold for toxicity. The clearance is 7 L/h and half-life of 56 h. If nothing is done, what is the time taken to reach a safe level?

Back 15

For 3 1/2 lifes and at a level of 12.5%, would take 7 days.

Front 16

Question: Plasma levels of theophylline is 80 mg/L. Oral bioavailability of theophylline is 98%, clearance is 50 mL/min, volume of distribution is 35 L, and half life is 7.5 h. How much did he digest?

Back 16

2.8 g

Ingestion dose = peak plasma level of drug (80 mg/L) x Vd (35 L) = 2800 mg

Front 17

Question: Short-acting antidote for a PT with tachycardia who OD on theophylline?

Back 17

Esmolol, a short acting beta-blocker.

Front 18

Question: What is the contraindication to use gastric lavage for the removal of drugs form the stomach of victim of poisoning with?

Back 18

Ingestion of a corrosive because of the risk of esophageal damage.

Front 19

Question: atropine is an antidote for?

What is the antidote for acetaminophen? What about methanol?

Back 19

Acetylcholinesterase inhibitors (physostigmine), organophosphate insecticides (malathion). Use pralidoxime (in addition to atropine) to regenerate the inactivated enzyme in poisoning from organophosphates.

Acetylcysteine

Fomepizole

Front 20

What is the difference between large volume of distribution vs. low volume in terms of dialysis for drug removal?

Back 20

Large Vd (antidepressants, antimalarials) cannot be removed by dialysis vs. a small Vd that can (lithium, phenytoin, salicylates).

Front 21

How can you eliminate a drug that is a weak acid or base?

Back 21

Weak acid is removed by alkalinization of the urine.

Weak base is removed by acidification of the urine.

Front 22

OD that causes the following can be caused by?

Hypertension and tachycardia

Hypotension with bradycardia

Hypotension with tachycardia

Back 22

Amphetamines, cocaine, antimuscarinic

CCB, sedative-hypnotics

TCA, phenothiazines, theophylline

Front 23

OD that causes the following can be caused by what?

Hyperthermia

Hypothermia

Increased respiration rate

Back 23

Antimuscarnic, salicylates, or sympathmomimetics

Ethanol

Carbon monoxide, salicylates, or other drugs that can cause metabolic acidosis or cellular asphyxia.

Front 24

Sedative hypnotics and opioids can cause?

Cocaine, PCP, TCAs theophylline can cause?

TCA and cardiac glycosides can cause?

Acetaminophen?

Back 24

Respiratory depression, coma, aspiration of gastric contents

Seizures, which may lead to vomiting and aspiration of gastric contents and postictal respiratory depression.

Frequently lethal arrhythmias.

*Severe hypotension can occur with any of these drugs.

Hepatitis

Front 25

What are the ABCDs, anion gap, and osmolar gap?

Back 25

Airway, Breathing, Circulation, Dextrose, Decontamination

Caused by metabolic acidosis that results from extra anions; (Na + K) - (HCO3 - Cl); gap is usually 12 - 16

Difference between serum osmolality and the osmolality calculated Gap = Osm (measured) - (2 x Na + glucose/18 + BUN/3); which is usually zero. Increased osmolar gap is due to ethanol and other alcohols.

Front 26

What can produce an increase anion gap?

Back 26

Diabetic ketoacidosis, renal failure, metabolic acidosis, cyanide, ethanol, ethylene glycol, ibuprofen, isoniazid, iron, methanol, phenelzine, salicylates, tranylcypromine, valproic acid and verapami

Front 27

What drugs can cause hyperkalemia and hypokalemia?

Back 27

Beta-blockers, digitalis, fluoride, lithium, and K-sparing diuretics [aldosterone receptor inhibitors (spironolactone, eplerenone) and Na channel inhibitors in cortical collecting duct (amiloride and triamterene)]

Beta-agonist, methylxanthines, most diuretics, and toluene.

Front 28

How do the decontamination of activated charcoal, whole bowel irrigation, and cathartics work?

Back 28

Effective in adsorbing any toxin in the gut (minus iron, lithium or K).

With a balanced polyethylene-glycol electrolyte solution can enhance gut decontaminaiton of iron tablets, enteric-coated pills, and illicit drug filled packets.

Such as sorbitol, can decrease absorption and hasten removal of toxins from the GI

Front 29

Alkalization of the urine helps what what drugs? And urinary acidification helps what what drugs?

Back 29

Fluoride, isonizaid, fluoroquinolones, phenobarbital, and salicylates.

Amphetamines, nicotine, phenyclidine.

Front 30

Antidote for:

Acetaminophen

Cholinesterase inhibitors

Membrane depressant cardiotoxic drugs (quinidine, TCA)

Fluoride, CCB

Iron salts

Digoxin and related cardic glycoside

Caffeine, theophylline, sympathomimetics

Methanol, ethylene glycol

Back 30

Acetylcysteine

Atropine

Sodium bicarbonate

Ca

Deferoxamine

Digoxin ABs

Esmolol

Ethanol

Front 31

Antidote for:

BZ, zolpidem

Methanol, ethylene glycol

Beta blockers

Hypoglycemics

Cyanide

Opioid analgesics

Carbon monoxide

Muscarinic receptor blockers (NOT TCAs)

Organophosphate cholinesterase inhibitors

Back 31

Flumazenil

Fomepizole

Glucagon

Glucose

Hydroxocbalamin

Naloxone

Oxygen

Physostigmine

Pralidoxime

Front 32

What are the primary signs of acute lead poisoning? Chronic lead poisoning?

Back 32

Acute abdominal colic, CNS changes that include acute encephalopathy (esp with children).

Peripheral neuropathy (wrist-drop is characteristic)

Front 33

What is the treatment for lead poisoning?

Back 33

In children: Succimer

EDTA with or without dimercaprol.

Front 34

Describe acute and chronic arsenic poisoning. Also arsine gas. Treatment?

Back 34

Severe Gi discomfort, vomiting, "rice-water" stools, capillary damage with dehdyration and shock. Garlic breath!

Hair loss, bone marrow depression, anemia.

Acute or chronic: dimercaprol. Note: succimer may be used, not the DOC.

Arsine gas: semiconductor industry empolyee. Massive hemolysis. Treatment is supportive.

Front 35

How can one be exposed to mercury?

Treatment?

Back 35

Dental laboratories, manufacture of wood preservatives. Organic mercury is used in seed dressings (prevents fungal and bacterial infection of seeds) and fungicides.

Succimer and dimercaprol

Front 36

How does iron intoxication present in children? Treatment?

Back 36

Vomiting, GI bleeding, lethargy, gray cyanosis. Followed by GI necrosis, pneumonitis, jaundice, seizures, and coma.

Deferoxamine.

Front 37

What are the following mainly used for?

Dimercaprol

Succimer

Penicillamine

Ca-EDTA

Deferoxamine

Back 37

Acute arsenic and mercury poisoning, and with EDTA for lead.

Lead toxicity. Also Arsenic and mercury.

Copper poisoning and Wilson's disease. Sometimes adjunctive with with gold, arsenic, and lead intoxicity and in rheumatoid arthritis.

Lead

Iron or in iron overload caused by blood transfusions.

Front 38

SE:

Dimercaprol

Succimer

Penicillamine

EDTA

Deferoxamine

Back 38

May cause pain and hematomas at injection site. Thormbocytopenia and increased PT with long term use.

Less toxic than dimercaprol

SLE, hemolytic anemia, pancytopenia, nephrotoxicity

Renal tubular necrosis

Skin reaction. Long term use, retinal degeneration, hepatic and renal dysfunction, and severe coagulopathies. Rapid administration, histamine release and hypotensive shock.