Pharmacology and Toxicology Quiz
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Questions and Answers

What does toxicity refer to in pharmacology?

  • The measure of a substance's benefits to health.
  • The ability of a substance to enhance biological processes.
  • The process of absorption, distribution, and excretion of drugs.
  • The ability of a substance to cause harm to a biological system. (correct)

Which branch of toxicology focuses on investigating the legal implications of toxic substances?

  • Regulatory Toxicology
  • Forensic Toxicology (correct)
  • Mechanistic Toxicology
  • Environmental Toxicology

What type of toxicologist would be most interested in the effects of pollutants on ecosystems?

  • Descriptive Toxicologist
  • Clinical Toxicologist
  • Environmental Toxicologist (correct)
  • Occupational Toxicologist

Which of the following is an application of clinical toxicology?

<p>Treating poisonings and injuries from xenobiotics. (D)</p> Signup and view all the answers

How does tetrodotoxin affect the human body?

<p>Blocks voltage-gated sodium channels, leading to numbness and respiratory failure. (B)</p> Signup and view all the answers

What does mechanistic toxicology primarily study?

<p>How chemicals are absorbed and excreted. (B)</p> Signup and view all the answers

Which toxicology branch evaluates the safety of drugs and other products?

<p>Descriptive Toxicology (B)</p> Signup and view all the answers

Who is considered the 'father' of toxicology?

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

Which of the following drugs can cause bradycardia and atrioventricular node block?

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

What type of toxicological analysis is primarily used for detecting acetaminophen poisoning?

<p>Thin layer chromatography (C)</p> Signup and view all the answers

Which of the following is NOT a principle of poisoning management?

<p>Immediate surgery (B)</p> Signup and view all the answers

Which drug is associated with QRS prolongation due to poisoning?

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

What method is used for detecting benzodiazepines (BZD) in toxicological analysis?

<p>Gas liquid chromatography (A)</p> Signup and view all the answers

Which of the following is a potential cause of ventricular tachyarrhythmias in cases of poisoning?

<p>Cardiac glycosides (D)</p> Signup and view all the answers

Which bioassay is NOT typically used for confirming drug poisoning?

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

What is the primary goal of preventing future poison absorption during poisoning management?

<p>To induce vomiting (B)</p> Signup and view all the answers

What is the intended urine pH range achieved by alkalinization with sodium bicarbonate?

<p>7.5 - 8.0 (D)</p> Signup and view all the answers

Which of the following is a contraindication for alkalinization therapy?

<p>Congestive heart failure (C)</p> Signup and view all the answers

Which substance is primarily eliminated by acidification of urine?

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

Which of the following statements about hemodialysis is true?

<p>It can help remove toxins absorbed by the gut. (B)</p> Signup and view all the answers

What is the main purpose of chelation therapy?

<p>To bind and excrete heavy metals (D)</p> Signup and view all the answers

Which of the following agents is commonly used as a chelating agent?

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

Which of the following toxins is NOT typically managed with hemodialysis?

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

What are the potential side effects of urine acidification?

<p>Metabolic acidosis (D)</p> Signup and view all the answers

What is the average decrease in ingestant absorption when gastric lavage is performed within 5 minutes of ingestion?

<p>52 % (C)</p> Signup and view all the answers

Which scenario is a contraindication for the use of ipecac syrup?

<p>CNS depression or seizures (B)</p> Signup and view all the answers

Which of the following is NOT a common complication associated with gastric lavage?

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

What is the recommended dose of activated charcoal per kilogram of body weight?

<p>1 g/kg (C)</p> Signup and view all the answers

What is a potential side effect of administering ipecac syrup?

<p>Protracted vomiting (D)</p> Signup and view all the answers

Which of the following is a contraindication for gastric lavage?

<p>Unprotected airway (C), Corrosive poisoning (D)</p> Signup and view all the answers

Which of the following statements about activated charcoal is false?

<p>It decreases absorption by 70 %. (A)</p> Signup and view all the answers

What fundamental principle of toxicology is illustrated by the phrase 'the dose makes the poison'?

<p>The right dose differentiates a poison from a remedy. (D)</p> Signup and view all the answers

When can gastric lavage achieve only a 16% decrease in absorption?

<p>If performed at 60 minutes (A)</p> Signup and view all the answers

Which of the following factors does NOT influence toxicity?

<p>Color of the substance (B)</p> Signup and view all the answers

What differentiates acute effects from chronic effects in toxicology?

<p>Acute effects occur immediately; chronic effects appear over time. (D)</p> Signup and view all the answers

Which substance is likely to have local effects at the point of contact?

<p>Sulphuric acid causing burns on skin (D)</p> Signup and view all the answers

Which statement correctly describes carcinogenic and teratogenic effects?

<p>They are typically irreversible. (D)</p> Signup and view all the answers

What is a major complication in linking cause and effect in toxicology?

<p>Effects may manifest long after exposure, complicating attribution. (D)</p> Signup and view all the answers

What characteristic of a chemical determines if its toxic effects are reversible or irreversible?

<p>The ability of the affected tissue to repair itself (A)</p> Signup and view all the answers

Why is detailed toxicological information often lacking for many substances?

<p>Research on substances is limited and sometimes non-existent. (B)</p> Signup and view all the answers

What is one of the main advantages of extracorporeal blood rewarming?

<p>It allows for rapid rewarming by directly warming the blood. (B)</p> Signup and view all the answers

In which scenarios should more invasive methods of active rewarming be considered?

<p>Severe and refractory cases including hypothermic cardiac arrest. (B)</p> Signup and view all the answers

What are common complications associated with internal cooling techniques?

<p>Difficulty in managing the procedures. (A)</p> Signup and view all the answers

Which medication can be used to treat pulmonary edema by reducing pressure caused by excess fluid?

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

What is the role of vasodilators like Nitroglycerin in managing pulmonary edema?

<p>To decrease pressure in the heart and lungs. (C)</p> Signup and view all the answers

Which of the following is NOT an internal cooling technique?

<p>External immersion in iced saline bath (C)</p> Signup and view all the answers

What is a key characteristic of cavity lavage used in active rewarming?

<p>It involves the use of warm fluids. (B)</p> Signup and view all the answers

Why is active rewarming using more invasive methods reserved for specific cases?

<p>They are complex and carry higher risks. (D)</p> Signup and view all the answers

Flashcards

What is Toxicology?

The study of how substances can cause harm to living organisms, including the likelihood of harm under specific conditions.

What is Toxicity?

The ability of a substance to cause harm to a biological system.

What is Mechanistic Toxicology?

Focuses on understanding how a chemical causes harm by analyzing its absorption, distribution, excretion, and biochemical effects.

What is Forensic Toxicology?

Applies toxicology to legal investigations, such as determining the cause of death.

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What is Clinical Toxicology?

Deals with the treatment of poisonings and toxic injuries, often by doctors and veterinarians.

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What is Environmental Toxicology?

Studies the effects of pollutants on organisms, ecosystems, and the environment.

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What is Descriptive Toxicology?

Evaluates the toxicity of various products like drugs, foods, and household items.

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What is Regulatory Toxicology?

Uses scientific data to create regulations and guidelines for protecting people from excessive risk from harmful substances.

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Dose makes the poison

The amount of a substance that determines whether it acts as a poison or a remedy. A small dose might be harmless, while a large dose can be deadly.

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Poison

A substance that causes harm when it enters the body. It can be naturally occurring or man-made.

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Toxicology

The study of how poisons affect living organisms. It focuses on the harmful effects of chemicals on the body.

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Acute effects

Effects that occur immediately or shortly after exposure to a harmful substance. They are often caused by a high dose and tend to be temporary.

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Chronic effects

Effects that occur over a long period after repeated exposure to a harmful substance. They are usually caused by lower doses and tend to be permanent.

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Local effects

Harmful effects that occur specifically at the point of contact with a substance.

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Reversible Toxic Effects

The ability of a tissue to recover from damage caused by a harmful substance.

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Irreversible Toxic Effects

The inability of a tissue to recover from damage caused by a harmful substance.

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Initial Resuscitation and Stabilization

The first step in treating a poisoning is to stabilize the patient's condition, focusing on breathing, circulation, and vital signs.

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Removal of Toxin from the Body

This involves trying to remove the poison from the body as quickly as possible, minimizing further exposure.

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Prevention of Further Poison Absorption

Strategies that prevent the poison from being absorbed further into the body, often by preventing further contact with the toxin or by using substances to bind to the poison.

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Enhancement of Poison Elimination

Methods that enhance the body's natural ability to eliminate the poison, such as increasing urination, changing the pH levels, or using artificial filtration.

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Administration of Antidote

A specific substance given to counteract the effects of the poison by binding to it or interfering with its mechanism of action.

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Pharmacology

This refers to the study of the properties and effects of medicinal substances and their interactions with the body.

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GI Decontamination

The process of removing ingested poison from the body.

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Gastric Lavage

A procedure that involves flushing the stomach with water or saline solution to remove ingested poison.

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Gastric Lavage Effectiveness

Gastric Lavage is most effective when performed within 5 minutes of ingestion. Its effectiveness decreases significantly after 30 minutes. It is almost ineffective after 60 minutes.

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Ipecac Syrup Induced Emesis

A syrup that induces vomiting when ingested, used to remove ingested poison from the body.

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Mechanism of Action (MOA) of Ipecac

Ipecac works by irritating the stomach and stimulating a part of the brain that triggers vomiting. It takes about 20 minutes to work.

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Activated Charcoal

A substance that binds to ingested poison in the gastrointestinal tract, preventing absorption into the body.

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How Activated Charcoal is Administered

Activated charcoal is administered orally in a suspension (mixed with water) or through a tube inserted into the stomach (nasogastric tube).

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Advantages of Activated Charcoal

Activated charcoal is more effective than Gastric Lavage, less invasive, and commonly used to remove ingested poison.

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Alkalinization of urine

This method aims to increase the pH of urine, making it more alkaline. It's useful for eliminating certain acidic drugs, which become more ionized and less reabsorbed in alkaline urine.

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How is urine alkalinization achieved?

Sodium bicarbonate (NaHCO3), a common baking soda, is administered intravenously to achieve an alkaline urine pH (7.5-8.0).

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What drugs are suitable for urine alkalinization?

This method is applied for specific drugs like chlorpropamide, phenobarbital, sulfonamides, and salicylates.

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When is urine alkalinization contraindicated?

Conditions like heart failure, kidney failure, and brain swelling (cerebral edema) prevent this method from being used due to potential complications.

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What is acidification of urine?

By lowering urine pH, this method enhances the elimination of weak bases, like Phencyclidine and amphetamines.

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Why is acidification of urine not used anymore?

This technique is no longer widely used due to potential side effects.

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What is hemodialysis/hemoperfusion?

This method focuses on removing toxins from the blood using a specialized machine. It's particularly useful for removing toxins like salicylates, methanol, ethylene glycol, lithium, and theophylline.

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What is Chelation?

Chelation involves using substances that bind to metals, forming a water-soluble complex that can be excreted by the kidneys. Examples include dimercaprol (BAL), EDTA, desferrioxamine, and DMSA.

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Cavity Lavage Rewarming

Using warm fluids to rewarm the body's core temperature, such as through gastric lavage or peritoneal lavage. This is a rapid, but invasive technique for severe hypothermia.

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Extracorporeal Blood Rewarming

Using a machine to rewarm the blood directly, often used for severe hypothermia that hasn't responded to other methods. This is a very effective method for quickly raising core temperature.

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External Cooling

Treating the body with cooling baths, ice packs, or other applications to reduce core temperature, typically for fever management or hyperthermia.

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Internal Cooling

Techniques to lower body temperature involving the introduction of cooling substances or techniques into the body.

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Pulmonary Edema

A condition characterized by excessive fluid buildup in the lungs. This can be a complication of various illnesses or injuries.

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Diuretics

Medications used to reduce fluid buildup in the body. They help to reduce pressure in the heart and lungs, often used for pulmonary edema.

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Vasodilators

Medications that widen blood vessels, allowing blood to flow more easily. These can be used to reduce pressure in the heart and lungs.

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O2 Inhalation

Supplying oxygen to a patient, typically by inhalation through a mask or breathing tube.

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Study Notes

Introduction to Toxicology

  • Toxicology is the study of the potential for a substance to produce adverse health effects on living organisms and the likelihood of those effects under specific conditions.
  • Toxicity is the ability of a substance to cause harm to a biological system.

Branches of Toxicology

  • Mechanistic: Investigates how chemicals cause toxic effects by examining absorption, distribution, excretion, and biochemical/molecular mechanisms.
  • Forensic: Applies toxicology to legal aspects, including investigating cause of death.
  • Clinical: Physicians or veterinarians focus on treating poisonings and injuries from xenobiotics.
  • Environmental: Studies the effects of pollutants on organisms, populations, ecosystems, and the biosphere.
  • Descriptive: Evaluates the toxicity of drugs, foods, and other products.
  • Regulatory: Uses scientific data to protect humans and animals from excessive risk, often employed in government bureaus.
  • Occupational: Applies toxicology to chemical hazards in the workplace.

Examples of Toxicological Cases

  • Eva Braun, in 1945, committed suicide using a cyanide capsule, an inhibitor of cytochrome c oxidase, hindering ATP production, leading to brain death and heart cessation.
  • Bando Mitsugoro, in 1975, a famous Japanese actor, died after eating pufferfish containing tetrodotoxin. Tetrodotoxin blocks voltage-gated sodium channels, suppressing neurotransmission and eventually leading to respiratory failure and death.

History of Toxicology

  • Paracelsus (1493-1541), considered the "father of toxicology", determined that specific chemicals were the source of plant/animal toxicity. The right dose differentiates a poison and a remedy.
  • The dose makes the poison is fundamental to understanding the principles of toxicology and is important when trying to protect workers.

Problems Linking Cause and Effect

  • The effect of exposure may not be immediate.
  • Individual susceptibility varies based on factors like age, gender, and health status.
  • The combined effect of multiple substances can be complex and difficult to predict.
  • Toxicological information is often not readily available for many substances.
  • The major factors influencing toxicity include mode of administration, exposure duration/frequency, and dose/concentration.

Basic Toxicological Terms

  • Acute effects: Occur immediately after exposure, usually from a high dose, short-term, and generally reversible.
  • Chronic effects: Develop over time, often from repeated low doses, typically irreversible.
  • Reversible effects: Pathological injury to tissue; the extent of repair determines reversibility. Examples include rapid liver regeneration but less so the CNS.
  • Irreversible effects: Permanent effects on tissues and/or organs, such as carcinogenic and teratogenic effects.

Basic Toxicological Terms - Local and Systemic Effects

  • Local effects: Occur at the site of contact with the substance. Examples include skin irritation/burns, de-fatting (Xylene), and pulmonary inflammation (Chlorine).
  • Systemic effects: Occur at target organs remote from the point of contact. Examples include dizziness/unconsciousness, liver and CNS damage (Xylene), and kidney/bone marrow damage (Cadmium/Lead).
  • Xenobiotic: a substance not originally found or produced in a person's body.

Basic Toxicological Terms - Risk and Tolerance

  • Risk: The probability of harm under specific conditions.
  • Safety: The probability of harm not occurring under specified conditions.
  • Tolerance: A state of decreased responsiveness to a toxic effect, occurring after repeated exposure. There are two primary types: dispositional (decreased drug reaching the site), and cellular (reduced responsiveness of a tissue).

Main Types of Combined Effects

  • Additive: The combined effect equals the sum of the individual effects (e.g., toluene + xylene).
  • Independent: The combined effect equals the sum of the individual effects (e.g., lead + xylene).
  • Synergistic: The combined effect is greater than the sum of the individual effects (e.g., carbon tetrachloride + ethanol).
  • Potentiation: One substance has no toxic effect, but when combined with another, substantially increases the effect of the other substance (e.g., zero toxicity substance + another toxic substance).
  • Antagonism: Two substances administered together interfere with each other's action or one interferes with the other. (e.g., (2+2=2) or(4+0=2)).

Diagnosis of Poisoning - History Taking

  • Gather information from the patient (if conscious) or bystanders/witnesses
  • Note the substance, route, time of ingestion, dose, duration, symptoms, progression, previous medical issues.
  • Evaluate any medications patient is taking.

Diagnosis of Poisoning - Physical Examination

  • General appearance (conscious/unconscious, behaviour)
  • Neurological status (level of consciousness, neurological signs)
  • Pupils (size, shape, responsiveness)
  • Vital signs (heart rate, blood pressure, respiratory rate, body temperature)
  • Identify any specific signs or symptoms associated with a particular poison.

Diagnosis of Poisoning - Methods for Diagnosis

  • Physical Examination: include evaluation of odour, urine colour, and ECG abnormalities.
  • Toxicological analysis of samples: Urine, blood, and gastric contents. Methods include thin-layer chromatography, gas-liquid chromatography, high-performance liquid chromatography (HPLC), and mass spectrometry.
  • Enzyme assays: Assess blood cholinesterase levels to identify organophosphate poisoning.
  • Biochemical investigations: look for abnormalities like ECG, etc,
  • Radiological studies: Occasionally helpful, particularly when visualising suspected ingested material.

Fundamentals of Poisoning Management

  • Fundamentals of poisoning management:
    • Initial resuscitation and stabilization
    • Removal of toxin from the body
    • Prevention of further poison absorption
    • Enhancement of poison elimination
    • Administration of antidote
    • Supportive treatment (hemodynamic support, management of hypothermia/hyperthermia)
    • Prevention of re-exposure

Prevention of Poison Re-exposure

  • Adult education: Provide instructions on safe medication/chemical use.
  • Notification of regulatory agencies: Inform authorities in case of environmental/workplace exposures.
  • Psychiatric referral: Consider referrals for depressed/psychotic individuals.
  • Child proofing: Secure medications and other potentially hazardous substances out of reach of children.

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Description

Test your knowledge on key concepts in pharmacology and toxicology. This quiz covers various aspects including toxicity definitions, the branches of toxicology, and real-world applications. Challenge yourself with questions about drug effects, poisoning management, and notable figures in the field.

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