Pharm Topic 27: Metals And Pesticides

Front 1

Iron Overload

Back 1

Chronic: aka hemochromatosis. causes cardiomyopathy, liver cirrhosis and diabetes.
Acute: Corrosion of GI, shock, and multi organ failure.

Front 2

Manganese Exposure

Back 2

Causes oxygen radical damage in the basal ganglia which leads to parkinsons disease.

Front 3

What are the heavy metals and what is their general tox mech

Back 3

Mercury, thallium, lead, cadmium, arsenic.
Cause tox via electrophilic interference with sulfhydryl groups in enzymes and free radical generation.

Front 4

Lead poisoning mech

Back 4

Interferes with sulfhydryl groups of many enzymes and affects multiplle organs.

Front 5

Effects of Lead on Bone marrow

Back 5

Reduces hemoglobin synth and causes microcytic anemia. Also get increased Delta ALA and zinc protoporphyrin. Also get basohpilic stippling from precipitated ribosomal protein.

Front 6

Effects of Lead on the GI

Back 6

Vomiting, colicky abdominal pain, constipation, blue-black lead lines on gums.

Front 7

Effects of Lead on NS

Back 7

Acute CNS: Headache, irritability, seizure, coma, encephalopathy.
Chronic CNS children: IQ impairment, hearing, growth, behavior impairment.
Adults: Foot/wrist drop

Front 8

Effects of lead on Kidney

Back 8

Chronic neuropathy
Fanconi Syndrome - Isolated prox tubule absorption defect
Saturnine gout
Hypertension

Front 9

Effects of lead on reproductive systems

Back 9

Male - Infertility

Front 10

Effects of lead on long bones

Back 10

Lead lines in metaphyses of growing bones especially elbow and knee. Can actually be a normal variant when kids are exposed to sun after winter.

Front 11

Common symptoms of lead poisoning in kids

Back 11

A norexia, A nemia, A pathy
B ehavioral disturbances
C lumsiness
D evelopmental deterioration
E mesis and colic

Front 12

EDTA

Back 12

Antidote, chelates lead. Can be used unless blood lead > 70 or encephalopathy. If encephalopathy, give with dimercaprol (BAL).

Front 13

DMSA

Back 13

Antidote for childhood lead poisoning for [] between 45-70. Also for arsenic, mercury and other heavy metals. Is water soluble chelator. and has a better safety profile than the lipid soluable chelators.

Front 14

Penicillamine

Back 14

Antidote, oral chelator for mercury, lead and cadmium. DMSA is preferred b/c its safer. Has many SEs:
Fever, CNS depression, myalgia, proteinuria, BM abnormalities, hepatitis, autoimmune responses.

Front 15

Early acute arsenic poisoning

Back 15

Is life threatening, BAL given one its suspected. Get burning lips, intense thirst, dysphagia (cant swallow), projectile vomiting, ricewater diarrhea and severe abdominal pain. Followed by BP drop, encephalopathy, and coma.

Front 16

BAL

Back 16

Chelator used for arsenic, mercury, or gold poisoning. Also for severe lead poisoning when combined with EDTA.
NEVER use with iron, cadmium, or selenium, chelated metal is actually more toxic.
SE: Peanut allergy (made in peanut oil), transient hypertension, tachycardia, headache, weakness.

Front 17

Late acute arsenic poisoning

Back 17

-Cardiomyopathy
-rhabdomyolysis
-Renal failure
-Hepatic Injury
-BM depression
-Peripheral neuropathy
-Skin erruptions, alopecia, and Mee's lines on nails (5-6 weeks later)

Front 18

Chronic Arsenic poisoning

Back 18

Non specific symptoms plus:
Mild encephalopathy - tremors, ataxia, incoordination, confusion
Peripheral neuropathy - Painful parenthesias, muscle weakness, pain
Dematopathology - hyperpigmentation, palmar and plantar hyperkeratosis, peripheral edema.
Increased risk of skin, lung, bladder cancer. Chelation is not effective in chronic poisoning.

Front 19

Mercury Inhilation

Back 19

Acute: pneumonitis.
Chronic: Renal failure, gingivitis, stomatitis, excessive salivation. Erythrism - Extreme excitability, withdrawl, no self control, insomnia, anorexia, altered taste and smell and bad memory.

Front 20

Mercury Hypersensitivity

Back 20

Acrodynia aka Pink Disease. Due to chronic mercury exposure. Painful pink rash on hands and feet, peripheral neuropathy, excessive sweating, tremors, weakness, anorexia, insomnia.

Front 21

Mercury Ingestion

Back 21

Acute of inorganic: GI corrosion, shock, acute renal failure.
Chronic of Organic: Severe CNS impairment (methyl mercury in japan)

Front 22

Mercury antidotes

Back 22

DMSA, penicillamine, or BAL

Front 23

Thallium Tox

Back 23

-Severe gastroenteritis
-sensorimotor neuropathy and CNS abnormalities
-Hair Loss, usually beginning 2nd week and progressing to complete baldness.
Antidote is prussian Blue.

Front 24

Prussian Blue

Back 24

Treats thallium and radioactive cesium (dirty bomb). Breaks the gut liver bile absorption circle, reducing half life.

Front 25

Herbicides: 2,4-D tox

Back 25

Inhibits ox phos - Fever, tachycardia, acidosis, flushing.
Striated muscle toxin - Myalgia, muscle weakness, rhabdomyolysis
Central neurotoxin - lethargy, confusion, ataxia
Peripheral neuropathy.
Susceptible to urinary alkalinization for enhanced excretion.

Front 26

Herbicide: Glyphosate tox

Back 26

Interferes with chlorophyl synth. Not toxic to mammals but surfactant can cause Gi probs, hypotension, pulmonary edema. Considered environmentally friendly.

Front 27

Herbicides: Paraquat tox

Back 27

Taken up into pulmonary cells via active transport. Initiates oxygen superoxide radical attack on membrane. Process regenerates toxin.
Inflammation leads to alveoli destruction and fibrous deposition causing suffocation. No therapy, not even lung transplant.

Front 28

Insecticide: Pyrethroids

Back 28

Raid. Mammals are protected b/c we hydrolyze. Can get parethesias on skin contact treated with vit E. Possible rep allergy causing hay fever.

Front 29

Organophosphates (insecticide and nerve agent) examples and tox

Back 29

Insecticides - Malathion and diazinon.
Nerve agents - Sarin, soman, tabun, Vx
Penetrates skin easily. Permanent Ach esterase inhibitor. Effects All receptors and the effects ud expect including coma seizures, and central resp depression.
Antidotes = atropine and pralidoxime.

Front 30

Atropine

Back 30

Antidote Ach esterase inhibition on muscarinic receptors. Competitive Ach antagonist. End point is dry respiratory secretions/airway control.

Front 31

Pralidoxime Chloride

Back 31

Use for Severe ant Ach esterase poisoning by organophosphates. Works on NMJ fixing the fascicultations and weakness. Dont administer too fast or hypotensiion and cardiac arrest.

Front 32

Insecticide: Carbamates tox

Back 32

Carbaryl, aldicarb, baygon.
Temporarily inhibit Ach esterase. Atropine is antidote.

Front 33

Organochlorines ex and tox

Back 33

DDT, chlordane, endrin, lindane, mirex.
CNS stimulants, NV, headache, dizziness, confusion, tremor, seizure. Deposits in body fat.

Front 34

Pesticides: Rodenticides tox

Back 34

Used to contain things like arsenic, thallium and barium, krebs cycle poisoin, and vacor. Most are now long acting anticoagulants; superwarfarins. ex. brodifacoum.
Treat with vit K, if hemorrhaging, treat with frozen plasma.

Front 35

Vit K

Back 35

Reverses hypocoaguability caused by warfarin like drugs like rodenticides. Also used in aspirin and acetaminophen OD.

Front 36

Metal Fume Inhalation

Back 36

Can get flu like symptoms called metal fume fever. 6-8 hour delayed onset. Welding glavanized metals is high risk from zinc oxide fumes.

Front 37

Chemical asphyxiants

Back 37

Impair aerobic energy metab despite aqequate O2 content in air.
-Methemoglobin formers
-carbon monoxide
-cyanide
-hydrogen sulfide
O2 is antidote

Front 38

O2

Back 38

Used for carbon monoxide, cyanide, H2S hydrogen sulfide and methemoglobin formers but good anytime there is CNs, resp or cardiac compromise.

Front 39

Methemoglobin Formers

Back 39

Organic nitrite/nitrate compounds. Dosent carry O2. While will reverse when the toxin is released, can treat with methylene blue (not necessary if they are <20% methemoglobin.

Front 40

Methylene Blue

Back 40

Converts methemoglobin back to hemoglobin. Is first converted to Leukometheylene blue, then reacts with oxidized Fe3+ with NADPH dependent MetHb reductase to turn back to hemoglobin. In toxic amounts, methylene blue actually creates methemoglobin itself.

Front 41

Cyanide Tox

Back 41

Inactivates tissue cytochromes therefore can no longer accept O2. Rapid energy failure in brain and heart. Endogenous detox can be enhanced via sodium nitrite followed by sodium thiosulfate, or hydroxocobalamin.

Front 42

Hydroxocobalamin

Back 42

Antidote for Cyanide. Attracts cyanide to form Vit B12. Turns patients skin, serum and urine bright red.

Front 43

Nitrite plus thiosulfate

Back 43

Antidote for cyanide poisoning. Nitrites induce methemoglobin attracting cyanide away from cytochrome complex. Thiosulfate provides a substrate for enzyme rhodanese which converts cyanide to thiocyanate which is less toxic and can be excreted.
Nitrite causes hypotension.

Front 44

Carbon Monoxide Tox

Back 44

Replaces O2 on hemoglobin forming carboxyhemoglobin which also prevents unloading.
Fetus is especially susceptible because fHg has higher affin for CO.
10-20: Headache, fatigue
20-30: Nasea, weakness, dizziness
30-40: Fainting confusion
40-60: Seizures, coma
60-80: Cardiovasc colapse.
Treat with O2

Front 45

Hyperbaric O2

Back 45

100% O2 in a preassurized chamber. Hyperoxygenates the blood by increasing O2 dissolved in plasma by 10x.
Considered for Carbon monoxide, hydrogen sulfide and cyanide. The jurys still out on if it works.

Front 46

Simple Asphyxiants

Back 46

Displace alveolar O2 leading to hypoxemia. CO2, methane, Nitrogen. Treatment is removal from exposre and supplemental O2.

Front 47

Pulmonary Irritants

Back 47

Water soluable gasses such as chlorine, ammonia, and sulfur dioxide. Damage the upper rep. tract and lung.
Remove exposure, possibly give O2.

Front 48

Sulfur Dioxide

Back 48

Water soluable air polutant gas, irritating to eye and upper rep, aerosol droplet gets to lower. Air pollution causes inflammation and spasm of airways, especially in asthmatics.

Front 49

Phosgene (COCl2) tox

Back 49

Gas, produced in any high heat decomposition of chlorine. Does not react with moisture in upper tract, goes to alveoli.
Progressive pulmonary edema, tachypnea, dyspnea, frothy cough, cyanosis.

Front 50

Nitrogen Oxide Tox

Back 50

Silo fillers disease. Caused by green crops which oxidise in storage and emmit the toxin. Penetrates deeply into the lungs. Get chemical alveolitis - inflammation of alveolar tissue. Cough, dyspnea, chest pain, pulmonary edema. Can relapse with bronchiolitis obliterans. Give steroids and O2

Front 51

Bronchiolitis Obliterans

Back 51

Lung condition where bronchioles are plugged by fibrous tissue. Cause by NO2 exposure. Also called popcorn workers lung b/c caused by inhillation of diacetyl.