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51 Cards in this Set

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What are the symptoms of Iron toxicity?
1. severe GI irritation
2. Inflammation
3. Necrosis & hemorrhage (mucosal block is destroyed) resulting in hypotension
4. Metabolic acidosis
5. Shock

"While pumping IRON, I had severe GI problems, started bleeding into my GI & went into Shock. I also had Metabolic Acidosis from working so hard from pumping all that Iron"
What is the treatment strategy for Iron toxicity?
1. Lavage only within the 1st hour after ingestion
2. administer DEFEROXAMINE parenterally (this may cause Histamine release)
3. treat symptomatically & support vital signs
Where is Cadmium found? What are the symptoms of toxicity?
Tobacco & batteries

1. Kidney
2. Lung
3. Cardiovascular
4. Immune
5. Carcinogen
What symptoms does Manganese toxicity cause?
Parkinson's like syndrome

**no chelator available
What is Calcium Disodium Edetate used to chelate?
1. Lead
2. Zinc
3. alternate choice for other metals
What are the possible toxic effects of Calcium Disodium Edetate? How can these be avoided?
1. Renal Damage
2. EKG abnormalities

*2 places where both Ca++ & Na+ are heavily used

-use less than 50 mg/kg/day
-urine flow must be maintained
-therapy should not exceed 5-7 days
-Do not used H2Na2EDTA, since it will bind Calcium & cause hypocalcemia
What is Dimercaprol (BAL) used to chelate?
1. Arsenic
2. Lead
3. Gold
4. Inorganic Mercury
What are the toxic effects of Dimercaprol (BAL)?
1. CNS disturbance
2. Cardiovascular disturbance = may produce shock due to capillary damage

*DIEmerCapillaries = shock from capillary damage
What do you not want to co-administer or prevent a patient from taking when taking Dimercaprol (BAL)? Why?
Iron b/c BAL-iron complex is toxic
How is Dimercaprol used?
1. usual course for metal poisoning is 7-14 days by deep IM injection

2. can be used with virtually complete Renal shutdown
What are the uses of Penicillamine?
1. Copper Chelator (alternate antidote for other metals, ie gold)
2. Wilson's disease
3. Rheumatoid Arthritis
What are the toxic effects of Penicillamine? (3)
1. Nephrotic Syndrome
2. Pyridoxine deficiency (B6)
3. Transient Eosinophilia
When is Penicillamine contraindicated?
Children or Adults with Chronic Renal Insufficiency
Lead chelator similar to Dimercaprol but can be given orally? What is the most common side effect of this drug?
Succimer = used for lead intoxication that is not that severe (lower conc.'s of lead)
-Calcium Disodium EDTA is used for higher conc.'s

GI disturbance
Metal chelator used specifically to chelate Iron
Deferoxamine

**can only be given Parenterally
-IM, IV
What are the toxic effects of Deferoxamine? (2)
1. Rapid infusion may induce shock via HISTAMINE release
-as do Vancomycin, Morphine, & d-Tubocurarine

2. Long-term therapy may cause Ocular damage
How is Deferoxamine used?
Oral dose is effective in binding Iron in the GI tract, but you must remove it by lavage or emesis b/c Deferoxamine-iron complex is more absorbable than iron itself

IV infusion is preferred
What are the 2 types of methemoglobin Inducing Agents?
Direct acting agents = Nitrites

Indirect acting agents = Aminophenols = converted to metabolites which, in vivo, oxidize Hemoglobin (Fe2+) to Methemoglobin (Fe3+)
What is a Carboxyhemoglobin producing agent?
Carbon Monoxide
List 2 Cytochrome Oxidase Inhibitors
1. Hydrogen Cyanide

2. Hydrogen Sulfide
What are the symptoms of Methoglobinemia cause by Nitrites?
1. Chocolate-colored blood
2. Hypotension
3. Hypoxia & Cyanosis
4. Convulsions
5. Coma
6. Respiratory failure
What is the treatment for Methoglobinemia?
Methylene Blue = converted Methoglobin back to Hb thru its effect on an intraerythrocytic enzymatic reducing mechanism
When does Methylene Blue not work?
In patients who are Glucose-6-Phosphate Dehydrogenase deficient
-can't make NADPH, which is needed to reduce Methylene Blue
Odorless & colorless gas that is the greatest single cause of lethal poisonings in the USA
Carbon Monoxide
Describe Carboxyhemoglobin percentage in Non-smokers, Smokers, & auto exhaust
Non-Smokers = 1%

Smokers = 5-10%

Auto exhaust = 4-7%
What is the mechanism of toxicity of Carbon Monoxide?
1. CO has a 200 times greater affinity for Hb than O2 & Carboxyhemoglobin cannot transport oxygen

2. Impairs the ability of Oxy-hemoglobin to give-up its oxygen to peripheral tissues = Left Shift
What are the symptoms of Carbon Monoxide poisoning?
Headache, dizziness, stupor = primarily due to progressive brain anoxia

Carboxyhemoglobin is CHERRY RED = victims may have bright red, healthy-looking mucous membranes
What is the treatment strategy for Carbon Monoxide poisoning?
1. terminate exposure immediately
2. administer O2 by best means available
3. avoid respiratory stimulating drugs including Carbon Dioxide
4. DO NOT give Methylene Blue
5. treat symptoms & support vital signs
6. Only Severe Poisoning = Hyperbaric oxygen
What are the Mild, Moderate, Severe, & Extreme clinical symptoms of CO poisoning?
Mild = presence of symptoms, but w/ no loss of conscioussness, normal mental status, no cardica abnormalities, & no underlying conditions

Moderate = mild confusion, but no loss of conscioussness

Severe = loss of conscioussness, syncope, neurologic abnormalities (seizures), cardiac ischemia, arrhythmias

Extreme = Coma, respiratory failure, Acute MI, sustained Hypotension
What things can complicate CO poisoning?
1. Pregnancy
2. Coronary Artery Disease
3. Pulmonary disease
4. Significant Anemia
5. Children
6. Geriatric patients
Colorless gas with a penetrating odor resembling that of Almonds
Cyanide
What is the mechanism of toxicity of Cyanide?
Complexes with ferric iron of Cytochrome Oxidase & produces cellular anoxia by inhibiting Oxygen utilization in the Mitochondria

*one of the most rapid acting poisons & death can occur very rapidly after exposure
What are the symptoms of Cyanide poisoning?
1. Dizziness
2. Headache
3. Hypotension
4. Unconsciousness
5. Convulsions
6. Respiratory failure
What is the treatment strategy for Cyanide poisoning?
1. must be RAPID

2. Sodium Nitrite or Amyl Nitrite = forms Methemoglobin which competes with Cyanide ion for Cytochrome Oxidase
-Cyanide is converted to Thiocyanide by RHODANESE

3. administer Sodium Thiosulfate immediately after Nitrite administration
-limiting cofactor in Rhodanese reaction

4. Give artiricial respiration with 100% oxygen

5. treat symptoms & support vital signs
What is the role of Rhodanese in Cyanide poisoning?
CN- + S (thiosulfate) -> SCN- (Thiocyanide) which is excreted
How is Hydrogen Sulfide poisoning treated?
same as Cyanide poisoning
What are the particles that are in Air Pollution?
Carbon Monoxide = 52%
Sulfur Dioxide = 15%
Hydrocarbons = 12%
Particulate Matter = 10%
Nitrogen oxides = 6%
Describe "EAST COAST" Air Pollution
Reducing type of Air Pollution
-Most dangers (vs. W coast)
-SO2 & Smoke from coal
-Cardiac & Respiratory toxicity
Describe "West Coast" Air Pollution
Oxidizing Type of Air Pollution
-from Automotive exhaust
-causes Lung irritation (bad for people with Asthma or COPD)
What particles can cause Silicosis?
particles of free crystalline forms of Silica less than 5 micrometers in diameter are most important in causing Silicosis

Airborn particles may also play a role in promoting carcinogenesis
What are the symptoms in the 3 stages of Silicosis?
1st Stage: dyspnea & shortness of breath; discomfort

2nd Stage: weakness, respiratory impairment

3rd Stage: total disability; expirations are prolonged & difficult; induces a predisposition to TUBERCULOSIS; pt usually dies of RIGHT HEART FAILURE
What occupations commonly lead to Silicosis? What is the treatment?
Miners, Glass manufacturers, Stone Cutters

Symptomatic & supportive
What can exposure to Asbestos fibers lead to?
1. Linear fibrosis of the lungs
2. Pleural adhesions & calcifications
3. Tumors
What multiplies the risk of Lung Cancer in Asbestos exposed people?
Cigarette Smoking
What are the symptoms of Asbestos exposure?
1. Dyspnea
2. Respiratory impairment & disability
3. Bronchogenic Carcinoma (most common CA) & Pleural Mesothelioma (rare)
Naturally occuring, radioactive gas which cannot be seen or smelled that can be found in basements of homes
Radon
What are the symptoms of Radon toxicity?
1. increased risk of Lung Cancer

2. Risk of lung CA due to Radon exposure is multiplied when the person is a Smoker
List the Bioterrorism Category A Agents
1. Anthrax
2. Smallpox
3. Plague
4. Botulism
5. Tularemia
6. Viral Hemorrhagic Fevers
List the Chemical Terrorism agents that are vessicant/blister agents
Nitrogen Mustards
Sulfur Mustards
Lewisite

**spreading mustard on your skin gives you blisters
List the Chemical Terrorism Pulmonary agents
Ammonia
Chlorine
Phosgene
What are the 2 Chemical terrorism Nerve agents
Sarin

Soman