Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
Environmental risks of Lead in patients
|
1) Lead in gasoline (banned in US in 1981)
2) Lead-based paint in residences older than 1970, even if repainted 3) Lead more easily absorbed if around divalent cations (iron, zinc or calcium) |
|
Toxic mechanisms of Lead
|
1) Interferes with sulfhydryl groups of many enzymes
2) Inhibit heme synthesis resulting in anemia 3) Blood smear shows basophilic stippling (blue-purple staining granules that are precipitated ribosomal protein common to any hemoglobin synthesis impairment) |
|
Lead Poisoning Symptoms
|
GI Symptoms
- Vomiting, colicky abdominal pain, constipation - Gingival "lead lines" Bone Marrow - Reduced hemoglobin synthesis and frank microcytic anemia Nervous System - Acute: headache, irritability then lethargy, seizure, coma then encephalopathy - Chronic: Lower IQ, hearing and growth, behavioral problems - Peripheral motor neuropathy Kidney - Chronic nephropathy - "Fanconi syndrome" - isolated proximal tubule absorption defects - "saturnine gout" - Hypertension Reproductive - Male infertility Long Bones - "Lead Lines" in knee/elbow, resulting from increased Ca+2 deposition, NOT Lead deposition |
|
Lead Poisoning Symptoms Acronym
|
Anorexia, Anemia, Apathy
Behavioral disturbances Clumsiness Developmental deterioration Emesis and colic |
|
Arsenic Risk Areas
|
1) Well water contamination - Bangladesh, Taiwan, New England, Great Lakes, Texas panhandle, Desert Southwest
2) Airborne contamination from coal burning, Southern Kentucky |
|
Arsenic Uses
|
1) Dopant in semiconductors
2) Wood preservative (with chromium and copper) 3) Insecticides, fungicides, herbicides 4) Homeopathic/traditional medication 5) Arsenic trioxide used to treat acute promyelocytic leukemia |
|
Types of Arsenic and their relative toxicity
|
Toxicity: Trivalent (arsenite) > Pentavalent (arsenate) > Organic arsenic
|
|
Chelator for Arsenic poisoning
|
BAL
|
|
Arsenic Poisoning Symptoms
|
Rapid onset of severe gastroenteritis
- Burning lips - Intense thirst - Dysphagia (difficulty swallowing) - Projectile vomiting - "Rice-water-like" diarrhea - Excruciating abdominal pain Other Acute Symptoms - Sudden drop in blood pressure - Encephalopathy or coma - Muscle cramps, facial edema, bronchitis, dyspnea and chest pain Later symptoms - Rhabdomyolysis - Cardiomyopathy - Renal failure - Hepatic injury - Bone marrow depression of all cell lines Long term effects - Sensory-motor peripheral neuropathy - Skin eruptions - Alopecia - Mee's lines |
|
Mees' lines
|
1) Transverse bands on the nails
2) Show up 5-6 weeks after poisoning 3) Caused by Arsenic and Thallium poisoning |
|
Chronic Arsenic Poisoning Symptoms
|
Non-specific Symptoms
- Weakness, malaise, anorexia, GI complaints - Mild encephalopathy, tremors, ataxia, lack of coordination, confusion - Peripheral neuropathy, painful paresthesias, muscle weakness and pain - Hyper pigmentation, palmar/plantar hyperkeratosis, peripheral edema and squamous cell carcinoma of the skin - Cancers of the skin, lung and bladder - Chelation is not effective in chronic poisoning |
|
Elemental Mercury (Exposure risks, symptoms)
|
Exposure risks
- Found in thermometers, dental amalgam, electronics - Broken objects can leak elemental Hg Symptoms - Acute: pneumonitis after inhalation, ingestion is non-toxic - Chronic: Renal failure, gingivitis, stomatitis, ptyalism (excessive saliva production), psychiatric abnormalities - "erethrism" - personality changes, Acrodynia: "pink disease" |
|
Acrodynia: "Pink Disease"
|
Symptoms
- Painful, bright pink desquamating rash on hands and feet - Peripheral neuropathy - Excessive catecholamines in blood - Hyper-adrenergic response - Possibly hypersensitivity reaction to Hg Cause - Chronic Hg exposure |
|
Inorganic Mercury Salts (Symptoms)
|
Symptoms
- GI tract corrosion, shock, acute renal failure |
|
Organic Mercury Poisoning (Historical example, symptoms)
|
Historical Example
- Minimata Bay, Japan wide spread cerebral palsy Symptoms - Severe CNS dysfunction |
|
Sources of Mercury Exposure
|
1) Fish
2) Thimersol to preserve vaccines 3) Dental amalgams |
|
Chelators for Mercury Poisoning
|
Succimer, penicillamine or BAL
|
|
Thallium Poisoning Symptoms
|
Symptoms
- Severe acute gastroenteritis - several days/week later, sensorimotor polyneuropathy and CNS abnormalities - Complete baldness (alopecia) |
|
Thallium Chelator
|
Prussian Blue
|
|
2,4-D (and other chlorophenoxys) (Trade name, symptoms, how to facilitate excretion)
|
Trade Name: Weed be gone
Symptoms - Weak inhibitor of Ox Phos --> fever, tachypnea, tachycardia, flushing, sweating, metabolic acidosis - Muscle weakness, rhabdomyolysis - Lethargy, confusion, ataxia - peripheral neuropathy after long exposure - Weak organic acid, urinary alkalinization for enhanced excretion |
|
Glyphosate (Trade name, symptoms, MOA)
|
Trade Name: Roundup
Symptoms - NOT toxic, mixed with surfactant which is - Severe GI irritation, hypotension, pulmonary edema MOA Inhibits chlorophyll synthesis |
|
Paraquat (Symptoms, MOA)
|
Symptoms
- Diffuse pulmonary fibrosis from constant inflammation - No therapy, even lung transplant fails MOA - Initiates an oxygen superoxide radical attack on cell membrane lipids |
|
Pyrethrins and Pyrethroids (Symptoms, MOA, Method of inactivation)
|
Symptoms
- Paresthesias (altered cutaneous sensations) - Treat with Vitamin E topically, bronchospasm, oculo-rhinitis MOA - Delays closure of sodium channels causing prolonged after-depolarization Method of inactivation - Near-instantaneous hydrolysis and inactivation in humans |
|
Carbamates (Symptoms, MOA)
|
Symptoms
- Excess muscarinic symptoms MOA - Temporarily block AChE Treatment - Atropine |
|
Organochlorines (Site of accumulation, Symptoms and Uses)
|
Site of accumulation
- Fat Symptoms - Nausea, vomiting, headache, dizziness - Agitation, confusion tremor, seizures Uses - Lindane used topically for lice treatment - DDT used as pesticide |
|
Salicylate (OD Symptoms)
|
OD Symptoms
- Nausea, vomiting, epigastric pain - Decreased factor V, VII, X, Hypoprothrombinaemia - Increased capillary fragility - Decreased platelet adhesiveness, thrombocytopenia |
|
Salicylate (MW and meaning, pKa and absorption, Vd, protein binding, therapeutic level, normal half-life, OD half-life)
|
MW: 138 Daltons (easily dialyzable)
pKa: 3.5, rapid absorption in stomach Vd: 0.2 to 0.3 (stays in blood) Protein binding: 90% bound Normal half-life: 2-4 hours OD half-life: Possibly over 20 hours |
|
Salicylate (MOA)
|
MOA
- Interferes with Krebs cycle - Elevates anion-gap - Elevates lipid metabolism (elevated ketones) - Uncouples Ox Phos --> HR, Oxygen consumption, CO2 formation and heat production all go up |
|
Salicylate treatment
|
Sodium bicarbonate, alkalinization of urine
|
|
Acetaminophen OD (MOA)
|
MOA
- 4% Acetaminophen metabolized by CYP2E1 to NAPQI (Toxic) - NAPQI conjugated with glutathione and excreted - If glutathione reserves are depleted, NAPQI binds to hepatic macromolecules causing damage - May also damage renal cells that also have high levels of CYP2E1 |
|
Nonsteroidal anti-inflammatory drugs safety level
|
1 pill per kg
200mg/kg |
|
Nonsteroidal anti-inflammatory drug treatment
|
Over 200mg/kg ingestion use gastric emptying and administration of activated charcoal
|
|
Cyclic Antidepressant Side Effects
|
1) Anticholinergic effects
2) Excessive block of norepinephrine reuptake 3) Quinidine-like effects on myocardium |
|
Cyclic Antidepressant Poisoning Symptoms
|
Symptoms
- Dry mouth, decreased GI motility - Tachycardia, hypertension, ventricular dysrhythmias - Increased QRS duration, increased QT interval, increased PR interval |
|
Cyclic Antidepressant MOA
|
MOA
- Blocks Sodium ion channel - Blocks Chloride ion channel of the GABAA Receptor |
|
Iron OD MOA
|
MOA
- Catalyze redox reactions leading to lipid peroxidation and free radical formation |
|
Iron OD Symptoms
|
Local Symptoms
- mucosal irritation, corrosive effect --> perforation - mucosal congestion, venous thrombosis, infarction, mucosal ulceration and petechial hemorrhage Systemic Symptoms - Venodilation - Increased capillary membrane permeability - Increased clot time - Metabolic acidosis - Disruption of Ox Phos |
|
Anticonvulsant OD Symptoms
|
Symptoms
- Nystagmus (involuntary eye movement), ataxia, depressed sensorium, blurred vision, convulsions and coma |
|
Carbamazepine (Type of Drug, side effects)
|
Type of Drug
- Anticonvulsant Symptoms - Nystagmus (involuntary eye movement), ataxia, depressed sensorium, blurred vision, convulsions and coma - Crosses placenta, causes asymmetric growth retardation, spina bifida |
|
Opiate/Opioid OD Symptoms
|
Symptoms
- Respiratory compromise - Coma - Loss of corneal and deep tendon reflex - Bilateral miosis (pinpoint pupils) - Seizures from meperidine |
|
Cocaine OD Symptoms
|
Symptoms
- Seizures in children - Pulmonary edema - CNS, cardiovascular and respiratory symptoms |
|
Cocaine MOA
|
MOA
- Blocks reuptake of NE in the CNS - Blocks reuptake of dopamine |
|
Amphetamines MOA
|
MOA
- Disrupt vesicle pH gradients allowing vesicular DA to redistribute into cytoplasm - DA exits neuron via reverse transport or channel-like activity |
|
Amphetamine OD Symptoms
|
Symptoms
- Tachycardia - Hypertension - Hyperthermia - Agitation - Seizures - CNS hemorrhage - Rhabdomyolysis |
|
Phencyclindine (PCP) Symptoms
|
Symptoms
- Dissociation, agitation and violent behavior - Tachycardia - Hypertension |
|
Phencyclindine (PCP) MOA
|
MOA
- Antagonizes the effect of glutamate at the NMDA receptor by binding within the ion channel and blocking Ca++ influx |
|
Antipsychotic OD Symptoms
|
Symptoms
- Somnolence - Coma - Agitation - Insomnia - Difficulty concentrating - Hypotension - Tachycardia - Prolonged QT - Widened QRS - Neuroleptic Malignant Syndrome |
|
Aripiprazole MOA
|
MOA
- Stabilizes Dopamine levels |
|
Digoxin OD Symptoms
|
Symptoms
- Bradycardia/arrhythmias - Vomiting is common - Altered color vision - Hyperkalemia |
|
Digoxin OD MOA
|
MOA
- Poisons the NA+/K+ ATPase pump |
|
Digoxin OD Treatment
|
Treatment
- Correction of electrolytes and Fab antibodies |
|
Warfarin OD Symptoms
|
Symptoms
- Vitamin K problems |
|
Warfarin OD Treatment
|
Treatment
- Stop Warfarin - Administer Vitamin K active form |
|
Ethanol OD Symptoms
|
Symptoms
- Ataxia - Lethargy - Coma - Seizures - Loss of deep tendon reflexes - Hypothermia - Hypoglycemia leading to convulsions |
|
Known causes of hepato-carcinogenesis
|
Viral hepatitis
Ethanol Aflatoxin (Aspergillus flavus mycotoxin from infected grain and legumes) Vinyl Chloride |
|
Renal Toxins (Therapeutic agents and Chemicals)
|
Therapeutic agents
- Antimicrobials - Antineoplastics - Iodinated radiocontrast agents - Analgesics Chemicals - Metals (Hg, Cd, Pb) - solvents (CCl4, toluene) - aniline dyes - Diquat herbicide - Ethylene glycol |
|
Proximal convoluted tubule toxins
|
High CYP450 -> free radical damage
CCl4, acetominophen |
|
Distal renal tubule toxins
|
Chronic toluene
|
|
Interstitial nephritis
|
Analgesics
|
|
Glomerular toxins
|
Gold
|