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85 Cards in this Set
- Front
- Back
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Substance: Organophosphate
Antidote: ? |
Atropine; Pralidoxime
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Narcotics (opiod)
Antidote: ? |
Naloxone
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Oral Hypoglycemics
Antidote: ? |
Glucose
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Isoniazid (and family)
Antidote: ? |
Pyridoxine (Vit B6)
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Alcohol Intoxication
Antidote: ? |
Thiamine (Vit B1)
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Iodine
Antidote: ? |
Starch
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Silver Poisoning
Antidote: ? |
NSS
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Acetaminophen/Paracetamol
Antidote: ? |
N-acetylcysteine
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Copper sulfate/Thioglycolate
Antidote: ? |
Milk
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Heavy Metals (Mercury)
Antidote: ? |
Penicillamine;
Dimercaptosuccinic Acid Dimercaprol |
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Iron Toxicity
Antidote: ? |
Desferroxamine
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Cyanide
Antidote: ? |
Dicobalt Edetate (EDTA);
Sodium Thiosulfate; Hydroxocobalamine |
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Benzodiazepines
Antidote: ? |
Flumazenil
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Anticoagulants
Antidote: ? |
Vitamin K
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Lead Poisoning
Antidote: ? |
Ca-Na-EDTA
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Malignant Hyperthermia
Antidote: ? |
Dantrolene Na
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Theophylline
Antidote: ? |
Propanolol (and Beta-Adrenergic Blocking Agents)
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Cardiac Glycosides (digitalis)
Antidote: ? |
Digoxin Specific Antibodies
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Beta-Adrenergic Blockers
Antidote: ? |
Glucagon
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Theophylline
Toxic Dose? |
Single dose of 50 mg/kg --> Toxicity
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Theophylline
Therapeutic Dose? |
Acute single dose of 8-10 mg/kg
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Theophylline
Antidote: ? Dose, Route of Admistration, Precautions |
Propanolol, 0.01 - 0.03 mg/kg IV
Use with care in Px with asthma |
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Theophylline Poisoning
Signs and Symptoms (5) |
vomiting, tremor, anxiety, tachycardia, seizures (severe)
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Salicylates
Mechanism of Toxicity? (4) |
(1) Central stimulation of respiratory center --> hyperventilation --> respiratory alkalosis and compensatory metabolic acidosis --> dehydration
(2) Intracellular effects: uncoupling of oxidative phosphorylation, interruption of glucose and fatty acid metabolism (3) Pulmonary and cerebral edema, maybe caused by alteration in capillary permeability (4) Alter platelet function and bleeding time; may prolong prothrombin time |
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Salicylates
Toxic Dosing? |
Mild intoxication - 150-200 mg/kg
Severe intoxication - 300-500 mg/kg Chronic Intoxication - 100 mg/kg if used for 2 or more days |
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Salicylate Poisoning
Signs and Symptoms? |
Ingestion (acute): vomiting, hyperpnea, tinnitus, lethargy.
Severe: coma, seizures, hypoglycemia, hyperthermia, pulmonary edema Death: CNS failure Chronic Intoxication: Confusion, dehydration, metabolic acidosis, pneumonia, gastroenteritis. Cerebral and pulmonary edema |
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Salicylate Poisoning
Antidote? |
NONE
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White/Yellow Phosphorus Poisoning
Antidote? |
NONE, but may give egg white to prevent absorption and to protect gastric mucosa
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White/Yellow Phosphorus Poisoning
Signs and Symptoms |
Cutaneous burns, garlic odor of vomitus and feces; "smoking" and luminescence of feces and vomitus
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White/Yellow Phosphorus Poisoning
Mortality rate? |
10-20%
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Organophosphates
Mechamnism of Toxicity |
Absorbed by inhalation and ingestion and skin, sulfoxidation derivatives inhibit AChesterase, allowing excessive ACh at muscarinic, nicotinic, and CNS receptors
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Organophosphates
Toxic Dosing |
Low Tox:
Medium Tox: High Tox: |
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Organophosphates
Sx and Sx, Time after exposure Enumerate types |
Occur 1-2 hrs post-exposure
1. Muscarinic - vomiting, diarrhea, abd cramps, bronchospasm 2. Nicotinic - muscle fasciculations, tremor, weakness. DEATH due to resp muscle paralysis 3. CNS - agitation, seizures, coma, peripheral neuropathies |
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Organophosphates
Antidote and dosing |
Atropine Sulfate
Initial 0.5-2 mg IV, then repeated every 5-10 min until full atropinization |
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Lead
Mechanism of Toxicity |
Displaces other metals: iron, zinc, copper from normal binding sites --> biochemical effects ex. heme synthesis interruption
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Lead
Toxic Doses (Inhalation, Ingestion) |
Ingestion: 0.5 mg/day over several days
Inhalation: 0.05 mg/cu.m. over 8 hrs |
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Lead Toxicity
Sx and Sx |
Abd pain, vomiting and diarrhea
Microcytic anemia, peripheral motor neuropathy, encephalopathy Inhalation of leaded gasoline --> ataxia, delirium, coma, convulsions, death |
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Lead
Antidote? |
Edetate Calcium Disodium (EDTA), may be combined with BAL (Dimercaprol)
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Mercury
Sources? |
Metallic - extraction of gold and silver from ore, in dental amalgams, tech equipment
Salts - some antiseptics and stool fixatives, component of diuretics Organomercurials - in fungicides and antiseptics |
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Mercury
Mech of Tox |
Hg reacts with sulhydryl groups, binding to proteins and inactivating enzymes
Nervous system is particularly sensitive. Methyl mercury is teratogenic |
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Mercury
Sx and Sx (Acute Inhalation, Acute Ingestion, Chronic Exposure) |
Acute Inhalation: Pulmonary edema, chemical pneumonitis
Acute Ingestion: Vomiting, bloody diarrhea, shock, renal failure Chronic Exposure: permanent CNS damage |
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Mercury
Antidote? Dosing? |
(BAL) Dimercaprol, 3-5 mg/kg IM every 6 hrs until Hg levels are below 50 mcg/L
Can also use oral penicillamine |
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Napthalene and Paradichlorobenzene
Mech of Tox? |
Both cause GIT upset and CNS stimulation
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Napthalene and Paradichlorobenzene
Toxic Dose? |
Napthalene: 1 mothball is fatal in those with G6PD deficiency.
Paradichlorobenzene: 20 g |
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Napthalene and Paradichlorobenzene Poisoning
Sx and Sx |
Napthalene: Agitation, lethargy, seizures, hemolysis
Paradichlorobenzene: Usually nontoxic, but hepatic necrosis has been reported in animals |
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Jellyfish (Phylum Cnidaria)
Mech of Tox |
Nematocyst has venom, containing serotonin, hyaluronidase, and neurotoxin
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Jellyfish (Phylum Cnidaria)
Toxic Dose |
Dependent upon the number of nematocysts released and penetrated
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Jellyfish (Phylum Cnidaria)
Sx and Sx |
Stinging, itching, burning pain and rash
Paresthesias, anaphylactoid rxns, nausea, vomiting, abd pain, myalgia, headache, dystonia, ataxia, paralysis, coma seizures, arrhythmia, death |
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Isoniazid
Mech of Tox |
Competes with brain pyridoxal-5-phosphate (active form of Vit B6)
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Isoniazid
Toxic Dose? |
80-150 mg/kg
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Isoniazid
Sx and Sx |
Slurred speech, ataxia, coma and seizures within 30-60 minutes
Profound metabolic acidosis (pH6.9) and hemolysis (in Px with G6PD deficiency) can occur |
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Isoniazid
Antidote |
Vitamin B6 (pyridoxine at 1:1 ratio)
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Cyanide
Toxic Dose (inhaled, ingested) |
Inhaled: 150-200 ppm
Ingested: 200 mg of Na or K salt |
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Cyanide
Sx and Sx |
Headache, nausea, dyspnea, confusion
Syncope, seizures, coma, agonal respirations Cardiovascular collapse |
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Cyanide
Antidote and Dosing? |
12.5 g IV Sodium Thiosulfate
Hydroxocobalamin (Vit B12) |
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Caustics and Corrosives
Toxic Dose? |
No specific dose
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Caustics and Corrosives
Sx and Sx : Inhalation, Dermal, Ingestion |
Inhalation - stridor, hoarseness, cough and wheezing
Dermal - pain and redness in exposed areas; burns and blindness Ingestion - dysphagia, drooling, pain in throat, chest and abdomen |
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Carbon Monoxide
Mech of Tox? |
Cellular hypoxia bc CO binds to Hb at a rate of 250X greater than O2
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Carbon Monoxide
Toxic Dose? |
Permissible Exposure Limit (PEL) is 35 PPM over 8 hr period
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Carbon Monoxide Poisoning
Sx and Sx |
Headache, dizziness, nausea (px with IHD), angina or MI
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Carbon Monoxide Poisoning
Antidote? |
O2 (100% if possible)
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Carbamate Insecticides
Mech of Tox |
Carbamates (like organophosphates) inhibit AChesterase, allowing for excessive ACh at musc, nic, and CNS recepotrs
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Difference between Organophosphates and Carbamates
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Carbamate AChesterase inhibition is short and reversible vs Organophosphate mech of action
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Carbamate Insecticides
Toxic dose |
Highly Toxic (LD50 <50mg/kg)
Moderately toxic (LD50 >50mg/kg) Low Toxicity (LD50 >1g/kg) |
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Carbamate Insecticide Poisoning
Sx and Sx |
Same as organophosphates but shorter duration of action and symptoms are self limited.
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Carbamate Insecticides
Specific Antidote? |
Atropine, NOT pralidoxime (as in organophosphates)
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Acetaminophen
Mech of Tox |
metabolite of acetaminophen by cytochrome p450 is HEPATOTOXIC
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Acetaminophen
Toxic dose? |
>140mg/kg in children
6 GRAMS IN ADULTS |
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Acetaminophen Poisoning
Sx and Sx |
Anorexia, nausea, VOMITING (EARLY),
HEPATIC NECROSIS, death (late) |
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Acetaminophen
Antidote and dose? |
N-acetylcysteine (NAC, Mucomyst), 140 mg/kg orally.
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Pharmaceutical Toxicity Rating
1-6 |
6 Super Toxic: 5 mg/kg or a taste
5 Extremely Toxic: 5-50 mg/kg (7gtts to a tsp) 4 Very Toxic: 50-500 mg/kg (1 tsp to 1 oz) 3 Moderately Toxic: 0.5-15 g/kg 2 Slightly Toxic: 5-15 g/kg 1 Non-Toxic: >15 g/kg to develop an ADE |
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Household Chemical Toxicity Ratings
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Extremely Toxic: Lethal in ONE swallow or <5mg/kg
Highly Lethal: Lethal in ONE or TWO swallows (50-150 mg/kg) Mild/Low Toxicity: <180 mL (>6 oz) needed to produce tox |
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Seven Common Banned Pesticides:
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Paraquat
Agent Orange (herbicide) Parathion Aldrin Chlordane DDT Dibromochlorpane |
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To minimize pesticide risks (4):
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DON'T USE
Use properly and only when needed Impose stronger regulatory laws Safer formulations |
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Tolerance Defn
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apparent state of decreased tolerance to a pharmacologically active agent, resulting from previous agent exposure
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Types of Tolerance
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DISPOSITIONAL TOLERANCE: result of change in one or more aspects of drug DISPOSITION. Ex. enhanced alcohol metabolism; enhanced metab of barbiturates; both from repeated administration
PHARMACODYNAMIC TOLERANCE - from change in target systems such that response to drug is reduced, requiring HIGHER doses for the SAME effect. Ex EtOH and opiate users |
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Factors affecting Drug EXCRETION (6)
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1. Renal blood flow
2. Volume 3. Plasma Protein Binding - incr --> decr renal filtration; lipophilics diffuse back into circulation; ionized and polars remain in tubules --> excreted. 4. Physicochemical properties of drug 5. Urine flow rate 6. Urinary pH |
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Factors affecting ABSORPTION (4)
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1. Delivery: dosage formulations, gastric emptying time, GI motility, GI contents, microbial flora
2. Transport - physicochemical properties of drug, mech of membrane transport, epith integrity (tight jxns decr transport), blood flow, pH, protein binding, intraepith metabolism 3. Age, Sex, Genetic Factors 4. Disease States |
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DISTRIBUTION factors (4)
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Blood flow - faster into highly perfused (brain, kidney, liver) than less (adipose, muscle)
Capillary membrane passage - usually fast, bc most drugs are smaller than albumin pH - as in absorption Protein binding - Van der Waals forces |
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Drug Metabolism (BIOTRANSFORMATION) factors (4)
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Age
Environment - exogenous substances, other drugs, etc Genetic - interindividual, ethnic (rapid acetylators) Pathophysiologic - disease: hepatobiliary, endocrine, systemic, estrogens inhibit hepatic enzymes. Primary hepatobiliary disease inhibits MEOS |
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Sources of Poisoning WITHIN a drug (5)
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1. Active ingredient
2. solvent 3. carrier 4. residues 5. batch impurities |
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Acute Exposure
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dose is delivered as a single event
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Chronic Exposure
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when small qtys of substance is exposed to Px over a long pd of time --> often accumulation in body
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Non-Toxic Substances: Ingestants
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Adhesives (paste)
Antacids antibiotics (most) baby cosmetics ballpoint ink bubble bath soaps candles (paraffin/beeswax) chalk (CaCO3) cigarettes/cigars (small amts) colognes (small amt) crayons (marked AP/CP) detergents (anionic) deodorants deodorizers (Glade) Elmer's glue-all hair products hand lotions/creams incense laxatives (small amts) lipstick magic markers makeup (facials/eye) newspaper paint (indoor/latex) pencil (lead/coloring) perfumes Vaseline Play-Doh Putty rubber cement shampoos/shaving cream soap/soap products suntan lotions teething rings toilet water toothpaste vitamins (w/o iron) watercolors |
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What is used to assess exposure?
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Threshold Limit Value (TLV)
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