Organophosphate and Carbamate Insecticides

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Questions and Answers

What is the primary consequence of the inhibition of acetylcholine esterase (AchE) by organophosphates and carbamates?

  • Blockage of epinephrine receptors
  • Decrease in acetylcholine levels at synapses
  • Reduction in muscarinic receptor activity
  • Increase in acetylcholine levels at synapses (correct)

Which of the following is NOT a classification of pesticides?

  • Herbicides
  • Antibiotics (correct)
  • Fungicides
  • Insecticides

What receptors are primarily affected by the increase of acetylcholine at the neuromuscular junction due to organophosphate exposure?

  • Beta-adrenergic receptors
  • Serotonin receptors
  • Nicotinic receptors (correct)
  • Dopaminergic receptors

Which physiological system is primarily stimulated by high levels of acetylcholine in the parasympathetic response?

<p>Gastrointestinal tract (C)</p> Signup and view all the answers

Which of the following is a major risk factor for acute poisoning by organophosphates?

<p>Self-ingestion or injection (A)</p> Signup and view all the answers

What effect does high acetylcholine have on the sympathetic ganglia?

<p>Blockage of neuromuscular transmission (A)</p> Signup and view all the answers

Which type of receptors are primarily found on smooth muscles and glands?

<p>Muscarinic receptors (B)</p> Signup and view all the answers

What is the estimated number of human poisoning cases attributable to organophosphate and carbamate exposure annually?

<p>3 million (D)</p> Signup and view all the answers

What are signs of local corrosive action in stage 1 of Paraquat poisoning?

<p>Hemoptysis and ulceration of mucous membranes (B)</p> Signup and view all the answers

Which symptom is not associated with stage 2 of Paraquat poisoning?

<p>Pulmonary fibrosis (D)</p> Signup and view all the answers

Which treatment option is aimed specifically at increasing elimination in cases of Paraquat poisoning?

<p>Hemodialysis/Hemoperfusion (C)</p> Signup and view all the answers

What biochemical change is primarily caused by Paraquat poisoning in lung cells?

<p>Lipid peroxidation (C)</p> Signup and view all the answers

Which vitamin is used in the prevention of oxidation during Paraquat poisoning treatment?

<p>Vitamin C (B)</p> Signup and view all the answers

What is the immediate action taken to prevent absorption in Paraquat poisoning?

<p>Gastric lavage (D)</p> Signup and view all the answers

In stage 3 of Paraquat poisoning, what is a common respiratory symptom observed?

<p>Low arterial oxygen tension (D)</p> Signup and view all the answers

What role do corticosteroids play in the management of Paraquat poisoning?

<p>Modulating inflammatory responses (A)</p> Signup and view all the answers

What is the main method to evaluate cholinesterase activity in cases of suspected poisoning?

<p>Blood sample analysis (C)</p> Signup and view all the answers

Which medication is considered the drug of choice for treating severe poisoning due to cholinesterase inhibition?

<p>Atropine (A)</p> Signup and view all the answers

What is a potential long-term complication following acute intoxication from nerve agents?

<p>Insomnia (C)</p> Signup and view all the answers

What is the fatal dose of paraquat that poses a significant risk of mortality?

<p>4 mg/kg (D)</p> Signup and view all the answers

How do oxime compounds function as antidotes for nerve agents?

<p>They reactivate acetylcholinesterase. (B)</p> Signup and view all the answers

What initial action is recommended for management following exposure to toxic agents?

<p>Washing contaminated skin with soap and water (A)</p> Signup and view all the answers

What is the primary mechanism by which organophosphates and carbamates cause toxicity?

<p>Inhibition of cholinesterases (A)</p> Signup and view all the answers

Which of the following statements about paraquat is incorrect?

<p>It is safe in low doses. (D)</p> Signup and view all the answers

What complication may arise 1-4 days after exposure to nerve agents?

<p>Cranial nerves and brain stem lesions (C)</p> Signup and view all the answers

What distinguishes carbamates from organophosphates in terms of their effects on cholinesterase?

<p>Carbamates dissociate from the enzyme complex more quickly (A)</p> Signup and view all the answers

Which of the following factors does NOT influence the severity and speed of organophosphate poisoning?

<p>Duration of exposure to sunlight (A)</p> Signup and view all the answers

What clinical symptom is primarily associated with mild organophosphate poisoning?

<p>CNS stimulant effects like anxiety and dizziness (B)</p> Signup and view all the answers

Which symptom is characteristic of severe organophosphate poisoning?

<p>Convulsions and flaccid paralysis (B)</p> Signup and view all the answers

What is the outcome of the aging process in relation to organophosphate poisoning?

<p>It leads to irreversible inactivation of cholinesterase (A)</p> Signup and view all the answers

What is NOT a manifestation of systemic organophosphate poisoning?

<p>Blistering and redness of the skin (A)</p> Signup and view all the answers

Which statement accurately describes the effects of both organophosphate and carbamate poisoning?

<p>They cause a mixture of peripheral and central nervous system effects (C)</p> Signup and view all the answers

Flashcards

What are pesticides?

Chemicals used to kill unwanted pests, including plants and animals.

What are insecticides?

A type of pesticide that targets insects.

What are rodenticides?

A type of pesticide that targets rodents.

What are fungicides?

A type of pesticide that targets fungi.

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What are herbicides?

A type of pesticide that targets unwanted plants (weeds).

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What are organophosphates?

A group of chemicals used as pesticides that can be absorbed by the body through ingestion, inhalation, or the skin.

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How do organophosphates work?

A type of chemical that inhibits the enzyme acetylcholinesterase, leading to an accumulation of acetylcholine in the synapse.

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What are the symptoms of organophosphate poisoning?

Symptoms of organophosphate poisoning include: salivation, lacrimation, urination, defecation, gastrointestinal distress, bronchospasm, bradycardia, and muscle weakness.

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How do organophosphates and carbamates work?

Organophosphate (OP) and carbamate pesticides work by blocking the enzyme cholinesterase, which breaks down acetylcholine. This leads to a buildup of acetylcholine in the body, causing various symptoms.

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What is the effect of carbamates on cholinesterase?

Carbamates are pesticides that cause temporary blockage of cholinesterase, as the enzyme complex usually breaks down quickly.

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What determines how quickly poisoning occurs?

The severity and speed of poisoning depend on factors such as how quickly the enzyme is phosphorylated, how fast the phosphorylated enzyme breaks down, and whether the enzyme undergoes aging.

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What is the key difference between OPs and carbamates in terms of their effect?

One main difference between OPs and carbamates is that carbamates detach from the enzyme within 24 hours, while OPs can undergo aging, making the inactivation permanent.

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What are the general categories of symptoms in OP and carbamate poisoning?

The symptoms of OP and carbamate poisoning can be classified as muscarinic, nicotinic, or CNS effects, causing various bodily changes.

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What are the symptoms of mild poisoning?

Mild poisoning from OPs and carbamates can lead to both CNS stimulant (nicotinic) and muscarinic effects.

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What are the symptoms of moderate poisoning?

Moderate poisoning is characterized by muscle twitches, tremors, and weakness, primarily due to nicotinic effects.

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What are the symptoms of severe poisoning?

Severe poisoning is the most dangerous, leading to altered consciousness, paralysis, respiratory distress, and even convulsions.

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Nerve Agents

A group of chemicals that can cause severe, potentially fatal, effects by interfering with the nervous system, primarily by inhibiting the enzyme acetylcholinesterase. This leads to an accumulation of acetylcholine, causing a range of symptoms like muscle weakness, paralysis, and respiratory failure.

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Pralidoxime (2-PAM)

A medication used to treat nerve agent poisoning. It acts by reversing the effects of the nerve agent on acetylcholinesterase, restoring normal nerve function.

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Paraquat

A common herbicide used worldwide. When ingested, it is highly toxic to humans and can lead to serious respiratory problems, potentially leading to death.

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Acute Respiratory Distress Syndrome (ARDS)

A condition characterized by severe inflammation and fluid buildup in the lungs. This can occur due to exposure to certain substances like paraquat.

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Activated Charcoal

A substance that binds to and removes toxins from the body, often used in cases of poisoning.

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Gastric Lavage

A medical procedure involving the removal of the contents of the stomach through a tube inserted into the esophagus.

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Acetylcholinesterase

The enzyme responsible for breaking down acetylcholine, a neurotransmitter that plays a key role in nerve signaling.

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Atropine

A medication used to treat nerve agent poisoning. It acts by blocking the effects of acetylcholine, counteracting the overstimulation of the nervous system.

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Stage 1 of Paraquat Poisoning

This stage begins within 1-5 days after exposure and involves local corrosive effects, characterized by coughing up blood (hemoptysis), ulceration of mucous membranes, nausea, diarrhea, and decreased urine output (oliguria).

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Stage 2 of Paraquat Poisoning

This stage occurs 2-8 days post-exposure, marked by damage to the liver, kidneys, and heart. Symptoms include jaundice, fever, rapid heartbeat (tachycardia), inflammation of the heart muscle (myocarditis), respiratory distress with blue discoloration of the skin (cyanosis), elevated blood urea nitrogen (BUN), and high serum bilirubin levels.

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Stage 3 of Paraquat Poisoning

This stage, happening 3-14 days after exposure, is marked by lung fibrosis, a scarring of the lungs. This leads to symptoms like coughing, shortness of breath (dyspnea), rapid breathing (tachypnea), fluid build-up (edema), fluid in the chest cavity (pleural effusion), collapsed lung sections (atelectasis), low oxygen levels in the blood (low arterial O2 tension), and a widened gap between lung and blood oxygen levels (increased alveolar O2 tension gradient), ultimately leading to respiratory failure.

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Herbicides

This is a group of chemicals used to control unwanted plants, but some, like Paraquat, are highly toxic.

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Preventing Paraquat Absorption

This process involves reducing the absorption of the poison into the body. It includes techniques like stomach pumping (gastric lavage), administering Fuller's earth (a clay-like substance that binds to the poison), using magnesium oxide (MOM) to prevent absorption in the gut, and washing the skin to remove the chemical.

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Increasing Elimination of Paraquat

This aims to cleanse the body of the poison by filtering the blood. Techniques include hemodialysis (using a machine to clean the blood) and hemoperfusion (passing the blood through a special filter to remove toxins).

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Modifying Tissue Toxicities from Paraquat

This involves managing the harmful effects of the poison on the body. Examples include modulating inflammatory responses with medications like cyclophosphamide, dexamethasone, and chlorpheniramine, and preventing further oxidation with antioxidants like Vitamin C, Vitamin E, and N-acetylcysteine.

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Study Notes

Organophosphate and Carbamate Insecticides

  • Pesticides are chemicals used to kill undesirable pests (plants and animals).
  • Pesticides are classified into insecticides, rodenticides, fungicides, and herbicides.
  • Organophosphorus compounds are used as liquids or powders.
  • These compounds are absorbed through ingestion, inhalation, and skin contact.
  • Organophosphates and carbamates are widely used globally.
  • These compounds are involved in about 3 million cases of human poisoning and cause approximately 40,000 deaths.

Organophosphate Action

  • Organophosphates and carbamates inhibit cholinesterases.
  • This leads to an accumulation of acetylcholine at central and peripheral cholinergic nerve endings, including neuromuscular junctions.
  • Carbamates cause relatively short-lived inhibition of cholinesterase.
  • The carbomate enzyme complex tends to dissociate spontaneously.

Factors Affecting Poisoning Onset and Severity

  • The rate of enzyme phosphorylation.
  • The rate of spontaneous hydrolysis of the phosphorylated enzyme.
  • The rate of aging of the phosphorylated enzyme complex.

Difference Between Organophosphates and Carbamates

  • Carbamates are hydrolyzed from the acetylcholinesterase (AchE) site within 24 hours.
  • Organophosphates undergo aging when the phosphorylated AchE loses an alkyl side chain, becoming irreversibly inactivated.

Manifestations of Organophosphate/Carbamate Poisoning

  • Local: Blistering and redness of the skin. Eye splashes lead to miosis and blurred vision.
  • Systemic: Speed of onset depends on route and magnitude of exposure. Symptoms include peripheral muscarinic effects (e.g., gastrointestinal tract, bronchi, heart, bladder, sweat, salivary, and lacrimal glands) – nicotinic actions at neuromuscular junctions, and sympathetic ganglia and CNS effects.

Mild Organophosphate/Carbamate Poisoning Symptoms

  • Symptoms include central nervous system stimulant symptoms such as anxiety, restlessness, insomnia, nightmares, tiredness, dizziness, and headache.

Moderate Organophosphate/Carbamate Poisoning Symptoms

  • Twitches, muscle fasciculations, tremors, and paralysis, including respiratory muscles.
  • Fatigue, generalized weakness causing difficulty walking and impaired speech are also present.

Severe Organophosphate/Carbamate Poisoning Symptoms

  • Impaired consciousness. Flaccid paralysis of limb muscles (affecting proximal groups more than distal ones).
  • Pulmonary edema. Cyanosis. Convulsions. Atrial fibrillation. Depressed respiration and asphyxia.

Diagnosis of Organophosphate/Carbamate Poisoning

  • Diagnosis is difficult if there is no prior exposure history.
  • Gastrointestinal symptoms with fever and polymorph leucocytosis may lead to a mistaken diagnosis of gastroenteritis.
  • Low cholinesterase activity confirms the diagnosis.
  • In severe cases, activity may be less than 10% of normal.

Management of Organophosphate/Carbamate Poisoning

  • Removal of clothing, and washing the contaminated skin with soap and water.
  • Gastric lavage.
  • Blood sample analysis to assess cholinesterase activity and measure respiratory secretions to check for hypoxia
  • Replace lost fluids caused by vomiting, diarrhea, and pulmonary edema.
  • Atropine is the treatment of choice, given intravenously in 2 mg doses every 10–30 minutes (or as adjusted for children).
  • Diazepam (5–10 mg IV) can reduce anxiety and restlessness.
  • Oximes like pralidoxime (2-PAM) are used as antidotes to reactivate acetylcholinesterase.

Late Organophosphate/Carbamate Poisoning Complications

  • Cranial nerves and brain stem lesions (develop within 1–4 days).
  • Peripheral neuropathy (develops 2–3 weeks after exposure, due to axonal degeneration).
  • Insomnia, inability to concentrate, and depression.

Paraquat (Bipyridyl Compound)

  • Paraquat is a herbicide, a widely used pesticide.
  • 93% of paraquat poisoning fatalities are suicides.
  • Fatal dose is 4 mg/kg.
  • Pure paraquat is highly toxic to mammals, causing acute respiratory distress syndrome (ARDS).
  • Fuller's earth or activated charcoal are effective treatments, if given in time.
  • Death may occur up to 30 days after ingestion.

Clinical Presentation of Paraquat Poisoning

  • Stage 1 (1–5 days): Local corrosive action, hemoptysis (coughing up blood), ulceration of mucous membranes, nausea, diarrhea, and oliguria.
  • Stage 2 (2–8 days): Signs of liver, kidney, and cardiac damage; jaundice, fever, tachycardia, myocarditis, respiratory distress, cyanosis, and elevated BUN and serum bilirubin.
  • Stage 3 (3–14 days): Pulmonary fibrosis, cough, dyspnea (shortness of breath), tachypnea (rapid breathing), edema, pleural effusion, atelectasis, low arterial oxygen tension, increased alveolar oxygen tension, and respiratory failure.

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