toxicology
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| Poisoning | exposure to non pharmocological substances
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| Overdose | exposure to drugs (legal or olleagal
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| 70% of poisonings in what age | <6
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| 80% of suicides are | overdoses
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| routes | ingestion,injection,inhalation,absorption
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| Ingestion | most common route of entry
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| Immediate effects | corrosive substances (acids/alkalis)-burns to lips tongue,throat
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| Delayed effects | due to absorption from GI tract, most absorptions occurs in small intestine
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| inhalation absorption occurs | capillary alveolar membrane
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| Absorption occurs | through cappilaris in skin
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| Injected absorbption occurs | directly into body through break in the skin
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| Gastric Lavage to be done within | 1 hr
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| Decontamination | -reduce absorption of toxins -Enhance elimination of toxin-cathartics,whole bowel irrigation
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| Activated Charcoal | -most effective in 30 mins of ingestion -effective with ASA,amphetimines,strychnine,dilantin, theophylline and phenobarbitol
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| Cathartic Agent (in charcoal) | commonly sorbitol like lactulose -dangerous if aspirated, speeds passage thru GI
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| Emesis involves | -vomit center in medulla -CTZ Chemoreceptor triggering zone, stimulates vomiting indirectly, located in basal ganglia/midbrain
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| Gases and Vapors | miz with air and distribute freely throughout airway
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| Mists | liquid froplets in air-the larger the droplet the more exposure
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| Fumes | fine particles of dust in the air
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| Inhaled posions S/S | tachyapnea,dyspnea,CP,coughing, STRIDOR 80% occluded, wheezing, rales,rhonchi
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| Inhaled abuse-(Ipecac,charcoal and lavage not indicated) | -most common in 13-15yrs seen in 6-8 yrs -AKA-gateway substances -sniffed (from container),huffing(substance placed on cloth),bagging (placed in bag) -dilated pupils,tinnitus,n/v
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| Cyanide | -pits of cherries,peaches,apricots apples n pears -WPD, vapors disperse rapidly -enters thru resp n GI tracts n skin -heart n brain most sensitive to it -inhibits cellular respirations -bitter almond odor
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| Cyanide S/S | -cyanosis n cherry red skin,agitation,anxiety,confusion,HTN w/reflex brady,acidosis
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| Cyanide Antidote Kit | -2 amps of sodium nitrate 3% 300mg -2 vials of sodium Thiosulfate 25% 12.5 iv -Boric acid n or Sodium hydroxide to adjust pH -12 ampules of Amyl Nitrate inhalants USP 5min 0.3 ml
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| Nitrates (amyl and sodium) converts | iron in hemoglobin to trivalent (Fe3+) form called methemoglobin (loves cyanide)= = CN-Met-Hgb/still must be detoxified + Thiosulfate= Thiocyanate. then excreted by kidneys and returned to hemoglobin
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| Carbon Monoxide | -colorless,odorless,tasteless gas -200-250x >affinity for O2 -forms carboxyhemoglobin -cherry red skin and cyanosis -death from MI n ischemia due to hypoxia -half life in room air is 4-7hrs tx hyperbaric chamber
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| Alkalis cause | fat and lipids in cell membranes to dissolve, cells fall apart
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| Acid's cause | proteins to precipitate, forms dense clots over injured area
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| hydrofluoric Acid | -penetrates deeply like alkaline burn -deactivated by Calcium fluoride -cell fx is disruptes,bones are destroyed -Tx.Mg++/Ca++ or benzethonium chloride,immerse limb in ice water
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| hydrocarbons | Organic:carbon and hydrogens -s/s burns,wheezing,SOB,hypoxia,pneumonitis,HA,dizzy,cardiac dysryhtmias.tx-lavage
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| TCA's tricyclics | Tofranil,elavil,norpramin,pamelor,amitriptyline -blocks reuptake of NE/serotonin in presynaptic neuron A2 primarily -do not use flumazenil,may cause seizures
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| SSRI's | prozac,zoloft,paxil -do not block cholinergic receptors
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| MAO-I | Nardil
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| overdose common in ages | 20-29
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| Tachycardia in OD's are | an early sign of toxicity
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| Monoamine Oxidase | breaks down tyramine in liver tyramine increases relase of NE potent vasopressor)
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| Lithium | for bipolar,moves into cells like Na+ but not pumped out easily, changes reuptake of NE causing anti adrenergic effects -tx-control seizures,alkaline urine w.sodium bicarb, osmotic diuresis with mannitol,possible hemodyalisis
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| Salicylate Toxicity amount ingested | mild-<150 mg/kg mod-severe-150-300 mg/kg Severe->300 mg/kg Fatal ->500 mg/kg
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| Acetaminophen | -Rx analgesic/antipyretic agent -forms a hepatotoxic metabolite if no mngd in 16-24hrs -30 tablets are toxic-Tx mucomist
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| Iron | -exceeds bodys ability to store, causes disruption of cellular functions,anaerobic metabolism and acidosis -leads to Myocardial depression,venodilation and cerebral edema -corrosive to intestinal mucosa,liver injury -20 mg/kg van be lethatl, CV collaps
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| Iron OD treatment | Deferoxamide-Chelating Agent -binds to iron less moves into cells and tissie,Charcoal contraindicates
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| Lead-slow onset | kids most common victims-paint chip ingestion -causes brain and nervous system damage -adults exposed thru inhalation
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| Mercury poisoning | -only metallic element that is liquid at rm temp,inhalation most common route -accumalates in organs mainly brain n kidneys
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| Food/Plant poisonings tx | -activated charcoal -lavage
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| Food posioning due to | Bacteria,Virus, toxic chemical
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| Salmonella | -swells stomach and intestinal linings -incubation-6-48 hrs -lasts 5-7days -abd pain,fever,diarrhea,N/V -tx.Antibiotics -sudden ABD pain
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| Shigellosis | Acute bacterial infection of bowel,resistant to stomach acid,infects colin leading to colitis -diarrhea,fever,abd pain,rectal pain -incubation 1-7 days,lasts 7 days
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| Complications of Shigella | toxic Megacolon: severe inflammation causes colon to dilate or stretch, thin colon will eventually tear -diaffhea suddenly stops, abd swells -causes dysentary
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| Botulisim (bacterial) | -life threatning, caused by clostridium botulinum -blocks ACh release from motor neurons, leads to muscle paralysis from head to toe, develops w/out gastric upset, severe CNS symptoms -incubation 4hrs-8days
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| Norwalk Virus (Viral) | causes intestinal ilness, swallowing food or water contaminated with stool,raw shellfish -S/S occur 1-2 days post ingestion, recovery 2-3 days
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| Mushrooms-7 toxic classes | Cylopeptide group (deadly) -contains amanita (cause 90% of deaths) toxic to liver -s/s-excess saliva,tears,sweating,abd cramps,n/v,diarrhea brady.
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| Food posioning onsets | Chemical-30mins bacterial-1-12 hrs Viral-12-48hrs
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| Poisonis plants onset | several hrs post ingestion, some delayed 1-3 days
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| Family hymenoptera | Wasps,bees,hornets, fire ant
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| Serum Sickness symptoms (delayed reaction) | occurs 10-14 days after sting fever,malaise,HA,urticaria,polarthiritis
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| Brown Recluse | -local tissue necrosis -dark,dry spots-violin mark on back, unaware of bite, becomes ischemic and ulcerates
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| Brown recluse S/S | -Local/ pain, redness,swelling, tissue necrosis -Systemic/chills, fever,n/v,joint pain, bleeding disorder, disseminated intravascular coagulation, hepatic injury
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| Black Widow | orange red hourglass,black abdomen,very potent venom, causes excessive neurotransmitter release-severity influenced by age,weight,gen health
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| Black Widow S/S | immediate localized pain,redness swelling within 1 hr-muscle cramps,abd rididity without tenderness -TX. Calcium Gluconate, antihypertensives, antiserum,valium 2.5-10mg
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| Scorpion Tx-active April-August | constricting band 3/4-1.5 inches wide, occlude lymphatic flow only, cool compress,venom stored at bulb tail -Only Bark scopion is fatal-pain occurs 3hrs post bite
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| Scorpion Venoms effects | Effects Na+ channels, ACh released from preganaglionic neuron, depolarization occurs and SNS is stimulated, leads to hyperactivity and convulsions -Severe envenomation-Propranolol-SNS blockage, no analgesic-systemic symptoms? antiserum
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| Pit vipers | Rattlesnakes, cottonmouths, and copperheads -distinct pit between eye and nostril
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| Vipers venom | contains destructive proteins, polypeptides, hydroclytic acid -destroys cell membranes, proteins, n other tissue, affects blood clotting,can cause renal failure-produces infection and tissure necrosis at site
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| Snake bite Tx | -do not allow to walk, do not apply cold compress,give pain meds anything PO, or suction venom,. -restrict movement, keep limb below heart, immobilize, most deaths occur 6-30hrs , 90% within 1st 48hrs
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| Coral snake | red and black bands, red on yellow kill a fellow-hangs on and chews-venom is neuro toxic, blacks ACH receptor sites, no necrosis or edema-CNS S/s, causes respiratory and skeletal muscle paralyisis w/in 12-24 hrs
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| King snake | resembles a coral snake, red on black venom lack
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| Marine animals | Coelenterates,echinoderms, stingrays -vey painful inhuries
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| Nematocysts | Venomous stinging cells-hollow threadlike tube, serves as a hypodermic needle, contains venom
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| Jellyfish | portuguese man-of-was is the most dangerous -tentacles up to 100ft
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| Sea anemone Fire corals | bottom dwellers, flower like appearance, razor sharp exoskeleton
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| Colenterates Tx | rince with sea water, fresh water is bad, flush with alcohol(isopropyl), baking soda, meat tenderizer, remove with forceps,immobilize
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| Starfish | calcium carbonate crystals that secrete toxins, could result in sstemic reaction
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| Sea cucumber | produce liquid toxin from anal tentacle, Tx, apply heat or hot water
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| Stingray | sting produces laceration 15-20 cm long, localized and systemic reaction. TX-irrigation w/fresh water, remove stinger, immerse in hot water
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| Physiological dependence | removal of drug causes adverse physical reactions
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| Psychological dependence | use required to prevent or relieve tension or emotional stress
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| Tolerance | must use more to get desired effect
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| Narcotics | CNS depressants, cause respiratory distress S/S= PINPOINT pupils
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| Sedative hypnotics | Benzodiasepines (anxiety,stress, insomnia,alcohol withdrawl,epilepsy,) Barbituates (anxiety, insomnia) TX: lasiz, sodium bicarb
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| Amphetamines | benzedrine, dexedrine, cocaine, ritalin (S/S=DILATED pupils, SNS afects) TX: treat dysryhthmias, Valium 5-10 for seizures, Haldol for hyperactivity)
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| Drug ingestion OD | 1st-heroin, 2nd-alcohol,3rd-cocaine
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| Cocaine | CNS A2 blocker-produces profound SNS discharge- Freebase-cocaine mixed with alkaline soluion (dilated pupils)-fatal dose 1200mg.TX for seizures Valium 5-10mg
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| Hallucinogens | PCP and LSD,MDMA, weed,srooms-Dilated pupils-TX-valium and haldol
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| Rohypnol-potent benzo | causes sedation and amneisa
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| Alcohol | most abused drug-absorbed in intestines in 30-120 mins, inhibits ADH=increaseddiuresis TX: chemstrips, 25 gm og D50, 100 mg thiamine
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| 3 dependence factors | personality, environment, addictive nature
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| Alcohol Dependence | Stage 1-tolerance to drug, stage 2-memory lapses during drinking episodes, stage 3 lack of control, stage 4 prolonged binges, mental complications
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| Organophosphates | inhibits effects of AChE-cholinergic overdrive-TX: remove clothes, wash water n soap,Atropine, 2-5mg every 5-15min,diazepam 5-10mg for seizures, Pralidoximine 2pam chloride-600mg IM or 1-2 gm IVP over 15-30
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| Methanol tx: | PO/lavage, 30-60 ml of 80 proof ethanol-administer ethanol through lavage
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| Methanol posoining | wood alcohol, GAS lin Antifreeze,no more toxic than ethanol but metabolites are extremely toxic-10-15 ml of 40% solution can cause death, (4cc can cause blindness)-liver converts alcohol to formaldehyde n in mins to formic acid=metabolic acidosis,
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| Methanol " | onset f S/S-40mmin to 72 hrs, dilated sluggish pupils,blindness
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| Ethylene Glycol | in antifreezes, pains,-Lethal dose 60 ml, toxicity caused by glycolic and Oxalic acids, causes hypocalcemia, Oxalate prevents Ca++ from being absorbed
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| Ethylene S/S | CNS effects-1-12hrs, cardio pulm 12-30hrs-renal effetcs 24-72. TX gastric lavage within 1hr, charcoal, IV isotonic solution, sodium bicarb, 80% ethanol 30-60 ml,(blocks conversion to metabolites) Thiamine to degrade glycolic acid, calcium gluconate or
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| " | calcium chloride for hypocalcemia, diazepam for seizures
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