Toxicology

Front 1

What are the factors that influence toxicity?

Back 1

1.) exposure variables of toxicant

2.) nature of toxicant

3.) Biological variables of indiv. ingesting intoxicant

4.) Toxicokinetics (major factor of toxicity)

Front 2

tox of 6

Back 2

<5 mg/kg

Front 3

tox of 5

Back 3

5-50 mg/kg

Front 4

tox of 4

Back 4

50-500 mg/kg

Front 5

tox of 3

Back 5

0.5-5 g/kg

Front 6

tox of 2

Back 6

5-15 g/kg

Front 7

tox of 1

Back 7

>15 g/kg

Front 8

TDM VS Toxicology list them.

Back 8

1.) assume it's presence 1.) screen for presence

2.)Quantitative 2.) qualitative

3.) Invasive (serum) 3.) noninvasive (urine)

4.)SLOW TAT 4.) Fast TAT

5.) Metabolites may interfere 5.) metabolites =

measured

6.)Expensive 6.) cheap

7.) Dynamic range 7.) min. analyst. sens. =

(therapeutic range) symptomatic (min diag)

Front 9

is toxic to 50% of population

Back 9

TD50

Front 10

Salicylate (aspirin) describe it?

Treatment?

Back 10

Higher TI

ASA, Active ingredient (Salicylic acid)

analgesic, antipyretic, anti-inflamm.

Interferes w/ platelet aggregation & GI func.

Overdose --> initially reap. alkalosis --> converts pyruvate to lactate, breakdown fatty acids= ketoacids --> metabolic acidosis

Mixed acid base disorder

-Treatment: neutralization/elimation of acid & maintain electrolyte balance

Front 11

Levels of Aspirin:

1.) serum levels > 100 , 6 hours following ingestion =

2.) > 500 microgram/ml =

3.)Theraputic range?

4.) 40 -50 =

Back 11

1.) toxic

2.) lethal

3.) 15-30

4.) symptoms

Front 12

What are ways to measure salicylate (aspirin)?

Back 12

1.) Trinder rxn - purple color w/ FeCl3 (spectophotometry)

2.) Enzymatic - NADH linked run measure at A 340 nm

Front 13

Describe Tylenol (acetaminophen)?

Back 13

-analgesic

-Overdose = severe heptatoxcity, metabolized/conjugated/ eliminated by liver.

Front 14

What is another name for Tylenol or acetaminophen?

Back 14

paracetamol

Front 15

Hepatic damage is indicated when for Tylenol?

Therapetuic range?

Back 15

-3-5 days after ingestion

-> 150 microgram/ml @ 4 hrs is toxic

Theraputic range: 10-20

Front 16

Acetominophine overdose results in?

Back 16

-Inability for the liver to adequately conjugate the metabolite of acetaminophen (acetamidoquinone) = reactive intermediate produced by glutathione.

-excess N-acetylbenzoquinoneimine =hepatic necrosis
-Antidote = N-acetylecysteine (NAC) helps breaks down metabolic product

Front 17

What is CO, symptoms and treatment?

Back 17

-colorless, tasteless, odorless gas

-has a 200-250 times more affinity for Hgb

-suffocation, tissue hypoxia, death

Treatment: remove source of CO, admin. O2 mask.

Front 18

What happens during CO poisoning?

Treatment?

Back 18

Hgb cannot adequately exchange CO2 for O2 cuz of increased ant of CO --> increases COHB and decreases oxyhemglbin.

-remove source of CO, admins. O2 mask.

Front 19

List the % COHb & symptoms.

Back 19

1.)0-5% = city, non-smokers

2.) 15% = smokers = headache, SOB

3.) 30% =severe headaches, SOB, fatigue, impairment of judgement

4.) 40-50% = confusion, loss consciousness

5.) 60-70% = unconciousness, resp. failure, death (cont. exposure)

6.) 70-80% = lethal, immed. fatal

Front 20

Name three ways to measure CO?Which of the methods is the best to measure CO?

Back 20

1.) Spot CO check - cherry red appearance ( 5 ml of 40% NaOH + 5ml of 1;20 blood)

-persistence of pink solution => 20% COhb

2.) Spectrophotometry - measure 4-7 wavelength (measure color of blood)

3.) differential spectroscopy (best method)

-Hemolysate of WB, reducing agent to reduce oxyhgb & methehgb --> only COhb & reduced Hb in solution.

-Absorptions spectrum 550 nm ( COhgb & reduced hgb), 541 nm ( only COhgb)

Front 21

Describe Ethanol.

Back 21

-Most common toxic exposure, and most common substance of abuse in the ER U.S.

-Associ. w/ trauma, loss of consicouness, other drug exposure

-Involves in medico-legal interventions

Front 22

Treatment for other alcohols, you use what?

Back 22

Ethanol

Front 23

Alcohol dehydrogenase(enzyme) only metabolized to which alcohol?

Back 23

Ethanol

Front 24

-Ethanol metabolism occurs where?

-Reaction Equation for it?

Back 24

-detoxication (liver)

-ethanol + NAD ---> (alcohol dehyrogenase) --->

Acetaldehyde (converts to acetate w/ALDH) +NADH

Front 25

Legal limit for ethanol?

What level is toxic for ethanol?

Back 25

-80-100 mg/dL

-0.1 g/dL (100 mg/dL

Front 26

Ethanol blood levels:

1.) 50-100 mg/dL

2.) 100-200 mg/dL

3.) 200-400 mg/dL

Back 26

1. reduced inhibitions, disorientation, confusion

2. progressive impairment of motor abilities

3. approaching unconcsiouness

Front 27

Long term consumption of ethanol may lead to _______ and then ______.

Back 27

alcoholic (toxic) hepatitis; cirrhosis

Front 28

Describe methanol?

Back 28

-methanol --> formaldehyde --> formic acid =

visual impairment, severe metabolic acidosis, pancreas necrossi

-more toxic than ETHANOL cuz metabolite (formaldehyde & formic acid)

-Visual impairment think METHANOL!!

Front 29

Describe Isopropanol?

Back 29

-(rubbing alcohol) --> acetone (metabolic product)(not usually toxic amts)

Front 30

Describe Ethylene glycol or 1,2 ethanediol (antifreeze)?

Back 30

-ethylene glycol --> formic acid, glycol acid & oxalic acid --> renal failure

-Will see urine has Ca oxalate crystals

Front 31

name the types of methods for alcohol testing?

Back 31

1.)ADH method (enzymatic alcohol dehyrogenase)
2.) estimation from Osmolalal gap

3.)GLC (gas liquid chromatography) reference/standard method.

Front 32

Describe Ezymatic alcohol dehydrogenase (ADH) method?

Back 32

-Sample serum

-clean venipuncture w/ alcohol free disinfectant

-sample capped avoid evaporation

-Ethanol + Nad (enzyme ADH) --> acetaldehye + NADH

-Measure NADH at 340 nm

-Methanol & isopropanol produces a Neg. or low result

Front 33

Describe osmolal gap method?

Back 33

-measure osmolal using freeze pt (osmometer)

-calc osmolal gap: measured - calculated

-Normal value: up to 10 mOsm/Kg

Front 34

-Serum osmolaltiy increases by ______ for each _________ of ethanol increase.

Back 34

10 mOsm/Kg; 60 mg/dl

Front 35

For alcohols other than ethanol use what formula?

Back 35

Calc osmo = 1.86 Na + gluc/18 +BUN/2.8 + ETOH/5

Front 36

Osmolal gap will increase for only ________ .

Back 36

non-ethanol alcohols or other compounds

Front 37

toxic at 300 mg/dL

Back 37

Ethanol

Front 38

toxic at 200 mg/dL

Back 38

Isoprpanol

Front 39

toxic at 50 mg/dL

Back 39

Methanol and EG

Front 40

increase osmolality
normal pH
no acetone

Back 40

Ethanol

Front 41

increase osmolality
normal pH
acetone

Back 41

Isopropanol

Front 42

increase osmolality
decrease blood pH

Back 42

Methanol

Front 43

increased osmolal gap
metabolic acidosis
increased Anion Gap

Back 43

Ethylene glycol

Front 44

with carrier gas

Back 44

mobile phase

Front 45

what is pre-column>?

Back 45

wad of glass wool to collect cooked particles of protein, lipid, glucose & salt.

Front 46

-oven column and high temp is called?

Back 46

liquid stationary phase

Front 47

name of the detector.

Back 47

FID

Front 48

time from injection of dample to peak vol in FID

Back 48

Rt (retention time)

Front 49

Qualitative (identification) of alcohol is made by...

Back 49

comparing to the calibrator Retention time

Front 50

Quantitate peak is made by?

Back 50

comparison btw calibrator peak and sample voltage peak in order to calculate the concentration of alcohol.

Front 51

What is used to correct the problems of the GLC?

Back 51

IS (internal standard) which is pure liquid, analyzed by same characteristics as analyte of interest, never found in pt's sample .

Front 52

errors in GLC

Back 52

change in flow rate (mobile), oven temp (liquid), null voltage of FID, precise volume of sample

Front 53

Every ________, ________, ________ & _______ is mixed with same amount of What?

Back 53

sample, standard, qc & patient

Front 54

The ratio of IS in ________ run and IS in ______ are used in GLC.

Back 54

calibrator; patient

Front 55

alcohol effects from Ethanol

Back 55

hypoglycemia if fasting
>ketoacidosis
hepatomegaly due to trig accuml from metab of ethanol instead of fa

Front 56

diag of chronic alcohol abuse?

poor nutrition in chronic alcoholics =?

Back 56

1.) increase plasma uric acid

2.) increase GGT

3.) increase triglyceride

-Plasma:

decrease folate, Mg, Ca, Phosphate, ATP

Front 57

methanol gives what metabolic product?

Back 57

formaldehyde>formic acid
severe metab acidosis, pancreatic necrosis and visual

Front 58

isopropanol gives what metabolic product?

Back 58

acetone

Front 59

Ethylene glycol gives what metabolic product?

Back 59

formic acid, glycolic acid, oxalic acid
renal failure

Front 60

poor nutrition in alcoholics >

Back 60

decr folate
decr Mg and Ca
decr phosphate

decrease ATP

Front 61

1 unit of alcohol =

Back 61

10 ml ETOH = 8g ETOH

Front 62

Barbiturates

Back 62

-sedative,

-depressantCNS
-Phenobarbital-epilepsy, slow acting

-Toxic: cardiac arrest/respiratory
-Treatment: aid respiration and cardiac output
-replaced by benzodiazepine (metabolite is oxazepam)

Front 63

Narcotics?

Back 63

-aka Opiates/opioids

-opium, morphine, codeine
-sleep and pain relief (analgesic)
-supress CNS,

Toxic: respiratory & coma

-Examples: heroin, morphine, codeine & methadone

Treatment: Naloxone, narcotic antagonist

Front 64

Heroin is metabolized by the _____ to form _____ and excreted by the _____ as ________.

Back 64

liver; morphine; kidney; morphine glucuronide

Front 65

Morphine is a metabolite of?

-Methadone is a commercially modified form of what?

Back 65

-opium/opiode

-heroin

Front 66

Pesticides?

Back 66

-organophosphates
-inhibits acetylcholinesterase>effects heart and lungs, cramps, CNS.

Front 67

Pesticides can be measured by?

Back 67

-measure pseudocholinesterase (isoenzyme of acetylcholinesterease)

Front 68

what is the largest group of pesticides?

Back 68

organophosphates

Front 69

Amphetimines?

Back 69

-CNS stimulants

-blocks dopamine receptors of brain
-treats narcolepsy and ADD
-metabolism in liver = benzoic acid
-Toxic: hypertension, cardiac arrythimias, death

Front 70

Cocaine

Back 70

-CNS stimulant (high dose) = euphoria & excitement

-Local anesthetic

-1/2 life = 0.5 - 1hr

-Toxicity: hypertension, arrythmia, seizure, AMI

Front 71

Cocaine is metabolized by ______ to ______ which excreted by the kidney.

Back 71

cholinesterase; benzoylecognine

Front 72

The metabolite of cocaine is measured in the ______ and confirmed by?

Back 72

urine; GCMS ( gas chromatography )

Front 73

Cannabinoids?

Back 73

-psychoactive compounds found in Marijuana ( HASHISH)

-THC (tetrahydrocannabinol) = potent & abundant

-produces physchological effects ( euphoria, sense of well being, short term memory = stored in fat cells (lipophilic) stays awhile in system

-1/2 life = 1 day

Front 74

THC is excreted in urine over an______.

Back 74

extended period of time

Front 75

Major urinary metabolite of THC?

Back 75

TCH-COOH

Front 76

PCP (phencyclidine)

Back 76

anesthetic illegally used as a hallucinogen

-effects; violence, seizures, reparatory, death

Front 77

ID of PCP occurs by the detection of what?

Back 77

parent drug in the urine

Front 78

Which of the groups are CNS depressants?

Back 78

Barbiturates, Narcotics, alcohols

Front 79

Which of the groups are CNS stimulant?

Back 79

amphetamines, cocaine, PCP (phencylcidine)