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Hi-Yield Tox Flashcards

Flashcards aid in memory repetition of difficult to memorize things that may show up on boards and in-service exam. This list will grow as I distill my readings and notes into only the highest yield memorization points.

note: all images used are public domain, unless otherwise cited within the flashcard

Iron(II,III) hexacyanoferrate(II,III)
File:HexacyanidoferratIII 2.svg
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The IUPAC name for Iron(II,III) hexacyanoferrate(II,III)  is Prussian Blue. This form of Prussian blue is insoluble and administered orally.

Enhances elimination of cesium (Cs) from the GI tract, which is useful for radioactive fallout.

Prussian blue is also the treatment for thallium (Th) toxicity, via a similar mechanism.

Constipation is also commonly reported, and stools may be blue in color. The medication should be taken with food to enhance biliary secretion of Cs.

Adult dosing is 3 grams PO taken 3 times a day with food.

Although pregnancy category C, pregnant patients should likely still be treated as the benefits likely outweigh the risks.

Iron(II,III) hexacyanoferrate(II,III)
Toxicology of the Pancreatic Beta Cell

Describe the cellular mechanism of sulfonylureas, octreotide, and calcium channel blockers on the pancreatic beta cell.

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    Toxicology of the pancreatic beta cell, demonstrating the effect of sulfonylureas, octreotide, and calcium channel blockers. PDB file = 1zni
Toxicology of the Pancreatic Beta Cell
tear gas

Active ingredient? Mechanism? Treatment?

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  • -Aerosolized liquids or solids (not actually a gas), 2-chlorobenzalmolonotrile is an example, but there are many other related compounds.
  • -Activates TRP receptors and induce substance P release leading to pain and mucosal irritation
  • -Complications include ocular irritation, keratitis. Requires very high concentrations to cause life threatening injury.
  • -Extraction from environment, decontamination and supportive care?
tear gas
Chlorine Gas

Symptoms? Fatal dosing? Mechanism? Treatment?

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  • Humans can smell at 3 ppm, this causes mild mucus membrane
  • As concentration increases, smell strength increases, which is associated with worse lung injury
  • -@400 ppm; 30 minutes is fatal, @>1000ppm, instantly fatal.
  • Creates HOCl leading to direct injury of the lung tissue
  • Supportive, nebulized Bicarb is a safe approach
Chlorine Gas
Phosgene
  • -Mechanism of action? Structure? Clinical effects? Treatment? History?
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  • -Causes a delayed ARDS type picture and respiratory irritation (typically around ppm>4.8).
  • -Causes acylation of cells in the alveoli as well as formation of ROS.  It is not readily water soluble so production of HOCl is less likely.
  • -Supportive care, high dose steroids, ARDS net protocol, but theoretically antioxidant support with NAC maybe of benefit, ECMO for complete lung failure
  • -History: chemical weapon used during World War 1

 

Phosgene
Serum Osmolarity
What is the formula to calculate serum osmolarity?
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normal is < 10

 

Serum Osmolarity
Enterohepatic recirculation
  • What are 5 important enterohepatically recirculated drugs?
  • And what should you give in a significant overdose?

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  • Phenobarbital
  • Theophylline
  • Carbamazepine
  • Dapsone
  • Quinine
  • Colchicine
  • They need MDAC to bind xenobiotic before it is recirculated
Enterohepatic recirculation
Naloxone for non-opioid overdoses

Off-label use for Naloxone to reverse non-opioid overdose has been substantiated at the case series/report level for which xenobiotics?

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Valproic acid (PMID=17711961; theoretical mechanism: empiric evidence, no theory)

Ace-inhibitor overdose (PMID=1928887; theoretical mechanism: inhibition of digestion of endogenous endorphins)

Imidazolines (PMDI=29544366; higher dose, theoretical mechanism: reversal of brain stem Beta-endorphin release)

 

Naloxone for non-opioid overdoses
Beta Blockers for Tox induced Tachycardia
For which poisonings that result in tachycardia might Beta Blockade be a good idea?

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methyl xanthines (caffeine, theophylline, aminophylline; they increase beta1&2 signaling as a downstream effect of phosphodiesterase activity and adenosine antagonism )
albuterol, clenbuterol (iatrogenic) 
glucagon (iatrogenic) 
halogenated hydrocarbons (huffers) 
Beta Blockers for Tox induced Tachycardia
CroFab
  • What are the common and scientific names of the 4 species used to produces CroFab?

  • What structure does Fab have?

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  • Mohave Rattlesnake (Crotalus scutulatus)

  • Diambondback Rattlesnake (Crotalus atrox)

  • Eastern Diamonback Rattlesnake (Crotalus adamanteus)

  • Cottonmouth/Water moccasin (Agkistrodon piscivorus)

  • Ovine papain digested Ab results in cleavage at the hinge site resulting in 2 linear Fab’s per antibody. This is comparison to pepsin cleavage resulting in a v-shaped Fab.

CroFab

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