Pharm S2B3 - Toxicology 1

Front 1

Describe Acute Toxicity

Back 1

1-2 days with a single or multiple exposures

Front 2

Describe Subacute Toxicity

Back 2

repeated exposure of less than 3 months

Front 3

Describe Chronic Toxicity

Back 3

repeated exposure of greater than 3 months

Front 4

What is the Therapeutic Index?

Back 4

LD50/ED50

Front 5

What is the Margin of Safety?

Back 5

LD1/ED99

Front 6

Define "Risk"

Back 6

the probability that injury will result from exposure to a substance under SPECIFIED CONDITIONS of DOSE & ROUTE of administration

Front 7

Define "Threshold Limit Values"

Back 7

Safe ambient air concentrations in the work place

Front 8

Drugs whose toxic mechanism of thru Receptor-ligand interactions

Back 8

Nicotine

Most drugs

Front 9

Drugs whose toxic mechanism of thru membrane function (2)

Back 9

General anesthetics

Hydrocarbons

Front 10

Drugs whose toxic mechanism is via cellular energy

Back 10

Cyanide

Pentachlorophenol

Front 11

Drugs whose general mechanism of toxicity is via Covalent binding to biomolecules

Back 11

Organophosphates

Alkylating agents

Reactive intermediates

Front 12

Drugs whose general mechanism of toxicity is via Calcium Homeostasis

Back 12

Oxalates

Front 13

Drugs whose general mechanism of toxicity is via non-lethal alterations in somatic cells

Back 13

Aflatoxin

Front 14

Drugs whose general mechanism of toxicity is via Ligand-activated transcription factors

Back 14

Dioxins

Glucocorticoids

Front 15

Drugs whose general mechanism of toxicity is via Programmed cell death (apoptosis)

Back 15

Acetaminophen

Etoposide

Front 16

List the 4 primary determinants of toxicity

Back 16

1. dose & dose rate

2. duration of exposure

3. route of exposure

4. CONCENTRATION X TIME = MOST IMPORTANT

Front 17

List the "ABCD's" in the management of a poisoned patient

Back 17

Airway = should be cleared of vomitus or any other obstruction & an airway or endotracheal tube inserted

Breathing = assessed by observation & by measurements of arterial gases = pulse-oximetry; intubate & mechanically ventilage if needed

Circulation
-monitor pulse rate, blood pressure, & urinary output
-start IV & draw blood for glucose & other laboratory determinants

Dextrose
-every patient with altered mental status
-100 mg of Thiamine to alcoholic & malnourished patients to prevent Wernicke-Korsakoff syndrome

Front 18

What group of people are most frequently poisoned?

Back 18

Children

Front 19

What drugs cause CNS depression as their route of death to the patient?

Back 19

Narcotics
Barbiturates
Alcohol

*lose airway protective reflexex & respiratory drive
*likely to die as a result of airway obstruction, aspiration, or respiratory arrest

Front 20

What drugs can cause Hypotension as their mode of mortality?

Back 20

1. TCA's = alpha blockade
2. Phenothiazines (Chlorpromazine) = alpha blockade
3. Beta-blockers
4. CCA's
5. Theophylline = increases cAMP
6. Barbiturates

Front 21

What drugs can cause Cardiac Arrhythmias as their mode of mortality? (5)

Back 21

1. Amphetamines = releases stored catecholamines
2. Cocaine = uptake inhibitor
3. TCA's = anticholinergic effects = tachycardia
4. Digitalis
5. Theophylline

Front 22

What drugs may cause Cellular Hypoxia and result in death?

Back 22

1. Cyanide

2. Hydrogen Sulfide

3. Carbon Monoxide

*evident by: tachycardia, hypotension, acidosis, & cardiac ischemia

Front 23

What drugs may cause a combination of HYPERTENSION & TACHYCARDIA as vital signs?

Back 23

1. Amphetamines = releases of Catecholamines

2. Cocaine

3. Antimuscarinics
-Atropine
-Scopolamine
-Ipratropium
-Tolterodine

Front 24

What drugs may cause a combination of HYPOTENSION & BRADYCARDIA as vital signs?

Back 24

1. Beta blockers
2. CCA's
3. Clonidine
4. Sedative-hypnotics

Front 25

What drugs may cause a combination of HYPOTENSION & TACHYCARDIA? (4)

Back 25

1. TCA's
2. Phenothiazines (Chlorpromazine)
3. Theophylline (Acute)
4. Beta-agonists = Beta-1 on heart; Beta-2 on venous smooth muscle

Front 26

What drugs may cause rapid respiration as a vital sign?

Back 26

1. Salicylates

2. Carbon Monoxide

3. Chemical producing Metabolic Acidosis or Cellular Asphyxia

Front 27

What drugs can cause Hyperthermia?

Back 27

1. Sympathomimetics
2. Anticholinergics = atropine
3. Salicylates
4. Pentachlorophenol = uncoupler of oxidative phosphorylation
5. chemicals producing seizures or muscular rigidity

Front 28

What drugs can cause Hypothermia or Poikilothermy? (2)

Back 28

1. Phenothiazines (Typical Antipsychotics)

2. Ethanol & other sedatives

Front 29

What drugs can cause Pupil constriction (miosis)? (4)

Back 29

1. Opioids
2. Phenothiazines (alpha-blockade)
3. Cholinesterase inhbitors
4. Alpha-blockers

*Miosis is caused by Parasympathetic activation or Sympathetic inactivation

Front 30

What drugs can cause Pupil Dilation (Mydriasis)?

Back 30

1. Amphetamines
2. Cocaine
3. LSD
4. Anticholinergics
5. Phencyclidine

*Mydriasis = caused by sympathetic activation or parasympathetic blockade

Front 31

What drugs can cause HORIZONTAL NYSTAGMUS?

Back 31

Sedative-hyptonics
1. PHENYTOIN
2. Alcohol
3. Barbiturates

Front 32

What drug do Vertical & Horizontal nystagmus strongly suggest?

Back 32

Phenyclidine (PCP)

Front 33

What drugs can cause Flushed, hot & dry skin?

Back 33

Atropine

Antimuscarinics

Front 34

What drugs can cause Excessive sweating?

Back 34

1. Cholinesterase inhibitors

2. Sympathomimetics

3. Nicotine

Front 35

What drugs can cause Cyanosis?

Back 35

1. Hypoxemia

2. Methemglobinemia

Front 36

What drugs can cause Jaundice (liver toxicity)?

Back 36

1. Acetaminophen
2. Erythromycin estolate (cholestatic)
3. Carbon Tetrachloride

Front 37

What drugs can cause Ileus? (3)

Back 37

1. Antimuscarinics
2. Opioids
3. Sedatives

Front 38

What drugs can cause Hyperactive bowel sounds, cramping, & diarrhea?

Back 38

1. Organophosphates
2. Iron
3. Arsenic
4. Theophylline
5. Mushrooms

Front 39

What drugs can cause twitching & muscular hyperactivity? (3)

Back 39

1. Anticholinergics
2. Sympathomimetics
3. Cocaine

Front 40

What drugs can cause Muscular Rigidity? (2)

Back 40

1. Antipsychotics (esp. Haloperidol)

2. Strychnine

Front 41

What drugs can cause Seizures? (7)

What do you usually treat with?

Back 41

Tx = Diazepam or Lorazepam

1. Theophylline
2. Isoniazid (treat with Pyridoxine = B6)
3. Cocaine
4. Amphetamines
5. TCA's
6. Diphenhydramine
7. Lidocaine (treat with Thiopental)

Front 42

How do you treat seizures caused by Isoniazid? Lidocaine?

Back 42

Isoniazid = Pyridoxine (B6)

Lidocaine = Thiopental

Front 43

What drugs can cause Flaccid coma?

Back 43

1. Opioids

2. Sedative-hypnotics

3. CNS depressants

Front 44

pO2 may appear normal in this poisoning b/c Arterial blood gases only measures dissolved oxygen & not oxyhemoglobin saturation

Back 44

Carbon Monoxide

Front 45

How do you calculate the Anion Gap? What is the normal range?

Back 45

Anion Gap = (Na + K) - (HCO3 + Cl)

Normal = 12 +/- 4

Front 46

What conditions can cause an elevated Anion Gap?

Back 46

1. Renal failure
2. Diabetic Ketoacidosis
3. Shock-induced lactic acidosis
4. Drug-induced Metabolic Acidosis
-Salicylates
-Methanol -> formic acid
-Ethylene glycol -> Oxalic acid
-Isoniazid
-Iron
-Metformin -> lactic acidosis

Front 47

What 2 drugs cause both an Anion Gap & Osmolar Gap?

Back 47

1. Methanol

2. Ethylene glycol

Front 48

What drugs cause an Osmolar Gap?

Back 48

1. Ethanol
2. Methanol (also Anion gap)
3. Ethylene glycol (also Anion gap)

Front 49

How does one calculate the Osmolar Gap?

Back 49

Calc. OG = 2(Na+) + (Glucose/18) + (BUN/2.8)

Osmolar Gap = Measured - Calculated

Front 50

Widening of the QRS complex

TCA's = Amytriptyline

Antidote = IV Sodium Bicarbonate

Back 50

What is seen here? What drugs can cause this? What is the Antidote?

Front 51

Torsades de Pointes

Caused by:
1. Quinidine
2. TCA's
3. Phenothiazines
4. "Non-sedating" Antihistamines
-Astemizole
-Terfenadine
5. Cisapride = 5-HT4 agonist used for GERD

Prolonged QT caused by:
1. Beta-1 stimulationm (Epi, NE, Isoproterenol, Dobutamine, etc)
2. Intense sympathetic activation

Back 51

What is seen here?
What drugs can cause it? (5)

Front 52

What are 5 factors that can contribute to Torsades de Pointes?

Back 52

1. Hypokalemia
2. Hypomagnesemia
3. Hypocalcemia
4. Ischemia
5. Tissue hypoxia

**low everything

Front 53

What is the treatment for Torsades de Pointes?

Back 53

Magnesium Sulfate

Front 54

When is Gastric Lavage not recommended?

Back 54

after 30 minutes to 4 hours

Front 55

What are the Contraindications for Gastric Lavage & Induced Emesis?

Back 55

1. More than 30 minutes have elapsed since ingestion of a CORROSIVE material
2. Hydrocarbon solvents have been ingested (ethanol, methanol)
3. Coma, stupor, delerium, or convulsions

Front 56

What is sometimes used to induce emesis?

Back 56

Ipecac syrup

*often not recommended today

Front 57

This substance will absorb many toxins if given in slurry immediately before or after lavage

Back 57

Activated Charcoal

Front 58

What drugs are used as cathartics (laxatives) to enhance elimination of toxic drugs?

Back 58

1. MgSO4

2. Sorbitol

Front 59

What drugs are given to get rid of Weak Acids in the urine?

Back 59

Bases = HA -> A-

1. NaHCO3 = Sodium Bicarb
2. Acetazolamide

Front 60

This is used to Acidify the urine and increase the excretion of Weak Organis Bases

Back 60

Ammonium Chloride

Front 61

What is the rule of thumb in Hemodialysis & trying to remove a toxic drug?

Back 61

the smaller the Vd = the more effective is Hemodialysis

Front 62

Osmotic diuretic used to enhance the elimination of toxic drugs

Back 62

Mannitol

Front 63

Drug used as a chelator for Iron Poisoning

Back 63

Deferoxamine mesylate

Front 64

Drug used for Arsenic, gold, mercury, & acute lead poisoning

Back 64

Dimercaprol

Front 65

Metal chelator used for Lead poisoning

Back 65

Edetate, Calcium Disodium = CaNa2(EDTA)

Front 66

Chelating agent used for Wilson's disease (copper), cystinuria, & resistant cases of Rheumatoid Arthritis

Chelates copper; also used for lead

Back 66

Penicillamine

Front 67

Oral chelator used for lead

Back 67

Succimer

Front 68

Drug that inactivates toxins & is used in Acetaminophen poisoning

Back 68

N-acetylcysteine

Front 69

Inactivating-toxin drug that is used for Cardiac Glycoside toxicity

Back 69

Digoxin-specific FAB antibodies

Front 70

Antidote to Cholinesterase Inhibitor poisons
-Neostigmine
-Pyridostigmine
-Physostigmine
-Echothiophate

Back 70

Atropine = antimuscarinic

Front 71

Cholinesterase reactivator given only for Organophosphates

Back 71

Pralidoxime chloride = 2-PAM

Front 72

Antidote for Benzodiazepine overdoses

Back 72

Flumazenil

Front 73

Opioid antidote

Back 73

Naloxone

Front 74

Cyanide antidote package = ?

Back 74

Sodium nitrite
Sodium Thiosulfate
Amyl Nitrite

Front 75

Antidote for Beta-blocker poisoning

Back 75

Glucagon

Front 76

Antidote for Methanol or Ethylene glycol poisoning

Back 76

Ethanol

Front 77

Alcohol Dehydrogenase inhibitor used for treatment of Methanol & Ethylene glycol poisoning

Back 77

Fomepizole

Front 78

Antidote for poisoning with Cardiac Depressants:
-TCA's
-Quinidine

Back 78

Sodium Bicarbonate

Front 79

Antidote for chemical-induced convulsions

Back 79

Diazepam or Lorazepam

Front 80

Antidote for Isoniazid poisoning

Back 80

Pyridoxine

Front 81

Antidote for Anticholinergic poisoning

Back 81

Physostigmine