PHA 060 Pharmaceutical Toxicology Student Activity Sheet #2 PDF

Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________...

Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Lesson title: Introduction to Poisons Materials: Lesson Objectives: 1. Pen, Lecture Notebook, SAS At the end of this session, you will be able to: References: 1. Categorize poison according to different factors 1. Pillay, V.V. (2013). Modern 2. Classify toxic effects medical toxicology. New Delhi: 3. Identify poison based on certain evidences Jaypee Brothers Medical Publishers. 2. Casarett and Doull’s Toxicology The Basic Science of Poisons Productivity Tip: “Understand how your brain works and when you are most productive.” A. LESSON PREVIEW/REVIEW 1) Introduction (2 mins) The history of poisons and poisoning dates back several thousand years. Early poisons were almost exclusively plant and animal toxins, and some minerals. They were used mainly for hunting. Some were used as “ordeal poisons”(Ingestion of these substances were believed to be lethal to the guilty and harmless to the innocent) for e.g. physostigmine from Physostigma venenosum (Calabar bean), and amygdalin from peach pits. Arrow and dart poisons were very popular for hunting animals (and sometimes fellow humans). In fact it is said that the term “toxicology” is derived from toxicon, a Greek word which when translated reads, “poison into which arrowheads are dipped”. Common arrow poisons included strophanthin, aconitine, and extracts from Helleborus (a cardiotoxic plant), and snake venom. 2) Activity 1: What I Know Chart, part 1 (3 mins) Introductions: In this chart, reflect on what you know now. Answer only the first column, “What I Know”. What I Know Questions: What I Learned (Activity 4) 1. What is poison? 2. What are the different poison? 3. How can you identify poisons? This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ B.MAIN LESSON 1) Activity 2: Content Notes (20 mins) Poison - any agent capable of producing a deleterious response in a biological system, seriously injuring function or producing death. Sources -Industrial -Household -Environmental -Pharmacologic / Medicinal Industrial Pollutants Ex: Hydrocyanic acid Carbon dioxide / monoxide Chlorofluorocarbons Household Ex: Insecticides / Pesticides Cleaning agents Environmental Ex: Lead Sulfur dioxide Nitrogen Ozone Pharmacologic Ex: Clinically used drugs Substances for abuse KINDS OF POISONS Poisoning Effects -Local Effects -Remote Effects -Combined Effects This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Local Effects - The impression made by the poison to the body part it made contact - The effect is confined in the area of administration or contact Ex. -Corrosives Remote Effects - The effect is produced or developed in an area other than that of the site of application / administration Ex. -Atropine Combined Effects - The poison possesses both local & remote effects Ex. -Phosphorus cantharidin FACTORS AFFECTING POISONING EFFECTS -Solubility of Poison -Character of the Surface to which the poison is applied -Quantity of blood in the blood vessels A. Poison Related Factors -Route of administration - PO vs IV Ex: Saponin - hemolysis -Concentration - ↑ Concentration ↑ Toxicity -Solubility - ↑ Lipholicity ↑ Skin Absorption ↑ Hydrophilicity ↑ Oral Absorption B. Patient Related Factors -Age PEDIATRICS : Liver is not yet fully developed which may cause the accumulation of drugs even when given at normal doses Pediatrics : not equipped with metabolizing enymes Birth: sulfation 1st week : REDOX 1st month : Acetylation 2nd month : Glucuronidation This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ 3rd month : Glycine and Glutathione conjugation GERIATRICS : Low liver and Renal Function as compared to adults 20 – 40 yrs. old -Habit For chain smokers and alcoholics Enzyme induction -Tolerance You need more of the drug to produce the same effect Ex. Nicotine is considered a true poison, but due to constant exposure, the human body has well tolerated the poison, increasing threshold levels -Idiosyncracy Due to genetic defects may lead to toxicity ( the absence of enzyme such as G6PD , may cause hemolysis in some px taking drugs that are metabolized by this enzyme -Physical State & Mental State -Sex -Condition of the stomach -Character and amount of stomach contents Types of Poisoning -Acute -Prompt and there is marked disturbances of function or death within a short period of time - 3 months Subtype: Cumulative poisoning – suddenly increases in its intensity of action when a certain limit is reached Ex : metal poisons This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ According to Property -Corrosives -True Poisons -Cumulative Poisons Corrosives - local destruction of parts but not poisonous if diluted Ex: Acids Bases True Poisons - Highly toxic - no medicinal value Cumulative Poisons - Increases the intensity of a poison as the dose increases According to Mode of Action I. Local II. Systemic I. Local - Destroy or cause serious injury to mucous membrane or tissues Ex: Corrosives e.g. Acids & Bases Kinds of Local Effects -Corrosion -Irritation -Specific Effect Localization of Poisons - The remote action of poison following absorption on certain organs Factors Affecting Absorption of Poison -Solubility of Poison -Character of the Surface to which the poison is applied -Quantity of blood in the blood vessels Conditions which Modify the Action of Poisons -Physical state -Age -Sex -Idiosyncrasy -Habit -Mental & Physical State -Condition of the stomach -Character and amount of stomach contents This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Types of Poisoning ( Legal Point of View ) -ACCIDENTAL poison was taken out w/out intention to cause death -SUICIDAL poison was taken out by the victim voluntarily for the purpose of taking his own life -HOMICIDAL poison was given willfully and with intent to cause death to the victim -UNDETERMINED the history is hazy as to how the poison was obtained and why it was given EVIDENCES OF POISONING -CIRCUMSTANTIAL EVIDENCE -Evidence deduced from various events or facts -Not a strong evidence -POST-MORTEM EVIDENCE -Evidence gathered after an autopsy is performed -Examination of tissues, organs, body fluids after death -EXPERIMENTAL EVIDENCE -Administering the suspected substance to some living animal & noting the effect or symptom -CHEMICAL EVIDENCE -Detection of suspected substance via analysis of samples of body fluids collected TEST POISON DETECTED Beilstein Halogens (Cl) Benzoldt Gunning Acetone Bromine Water Aniline Brown-Ring Nitrite & Nitrate Lieben’s Iodoform Ethanol vs Methanol Marquis’ Opium & other commonly abused drugs TEST POISON DETECTED Marsh Arsenic Reinsch Heavy Metals Modified Duquenois Marijuana This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Nessler’s Chloral hydrate vs Choloroform Nylander Bismuth TEST POISON DETECTED Phenylisocyanide Nitrobenzene, Aniline, Chloroform Potassium iodide Mercury Radillon / Millon Phenol Scherer / Mitsherlich Phosphorus Schobein-Pagenstecher / Picrate Prussic acid TEST POISON DETECTED Schwartz Resorcinol Chloroform Tollen’s Reducing Sugars Xanthogenate Carbon disulfide vs Hydrogen sulfide -SYMPTOMATIC EVIDENCE Poisoning signs and symptoms or effects are observed -Blood Changes -Breath Odor -Skin Discoloration -Vomitus -Stool Color -Urinary Changes -Gum Discoloration -Visual Disturbances -Others BLOOD CHANGES SUBSTANCE ↓ Blood coagulability Heparin, Benzene, Fluorine, & Phosphorus Cherry Red Blood CO, CN-‾ Dark Red Blood Nicotine Chocolate Blood Aniline, Nitrites, Nitro derivatives BREATH ODOR SUBSTANCE Shoe polish Nitrobenzene Fruity odor Ethanol Garlic As, P, Malathion Mouse urine Coniine Stale Tobacco Nicotine BREATH ODOR SUBSTANCE Bitter Almonds CN‾ This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Sweet penetrating odor Acetone, Chloroform Pearl-like odor Chloral hydrate Rotten egg Hydrogen sulfide Mothballs Naphthalene Oil of Wintergreen Methylsalicylate SKIN DISCOLORATION SUBSTANCE Yellow Picric acid Bleaching White Phenol Ash Gray Physostigmine, HgCl2 Deep Brown Bromine Brown Black H2SO4, I2, AgNO3 SKIN DISCOLORATION SUBSTANCE Bluish Gray Boiled Lobster Appearance Blue Opium, Aniline, Sulfides Pale bond on fingernails As Boiled Lobster Appearance Boric acid VOMITUS SUBSTANCE Blue green Cu Ground coffee Sulfuric acid Luminous P, As Yellow-green Chromium STOOL/FECAL APPEARANCE SUBSTANCE Black Fe, Charcoal, Bi, Pb, MgO, AgNO3 Clay-like Alcohol, Ba White Al(OH)3 Blue Boric acid, Methylene blue, I2 Green Indomethacin, CuSO4 Red Hemolytic substance URINARY CHANGES SUBSTANCE Dark Yellow Picric acid Yellow Brown Aloe, Senna Blue Green Phenol & Derivatives, Methylene blue Wine or Red Brown Caffeine, Benzene, Rifampin, Pb, Hg, CCl4 GUM DISCOLORATION SUBSTANCE Blue line gum Bi, Pb Black line gum Hg, As This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ VISUAL DISTURBANCES SUBSTANCE Purple Vision Digitalis, Marijuana Blurred Vision Anticholinergics Partial / Total blindness Methanol, Formic acid, Solanine Optic Neuritis Ethambutol Blood Shot Eyes Marijuana OTHER CHANGES SUBSTANCE Violent sneezing Veratrine Irritation SO2 Dyspnea CO General Respiratory Depression Opium, Barbiturates, Benzodiazepines, CN‾ Alopecia As Tinnitus Salicylates, Quinine Ototoxicity Aminoglycosides, Loop Diuretics II. Systemic - Following local action, absorbed into the bloodstream, furthermore, produces harmful effects on vital organs Ex: Heavy metals Routes -Oral -Intravenous -Subcutaneous -Absorption through the skin -Inhalation Quantitative Toxicity -Median Lethal Dose (LD50) -Median Lethal Concentration (LC50) -Threshold Limit Value (TLV) Types of Poisoning I. Acute taken in excess in a single dose or small doses with high frequency resulting to death or injury over a short span of time Ex: -Sleeping pills II. Chronic produced by taking over the course of a long period of time producing gradual but progressive deterioration of tissue functions Ex: -Heavy metals This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Classification of Toxic Effects -Pharmacological - exaggeration of effects -Pathological - injury to tissue -Genotoxic - damage to DNA -Chronic -Acute -Immediate - rapid effects after exposure -Delayed - occurrence of effects over a period of time -Direct - caused directly by a specific substance -Indirect - effects are only consequences of the direct effects Evidences of Poisoning 1. Circumstantial Circumstance or deduced from various consequences and facts 2. Symptomatic Exhibited by the patient 3. Chemical Evidence by means of chemical analysis Ex: Tyrotoxin Tyrotoxicon 4. Ante-mortem Obtained right before death 5. Post-mortem Examinations of organs or tissues after death Ex: blackening and severe corrosion - corrosive discolored lips - caustic alkali swollen lips - ammonia whitened mucous membrane - oxalic acid desiccated inflammation - cantharides 6. Experimental Examinations of organs or tissues after death Ex: -Obtained by administering suspected substance to some living animals and observing the effects -discoloration of Feces Ex: Antacids - Whitish speckles This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Anticoagulant - Red to black Bismuth and Iron - Black Pirvinium pamoate - Red Rifampicin - Red Salicylates - Red to black -discoloration of Urine Ex: Cascara sagrada - Red in alkaline urine Chloroquine - Yellow to brown Chlorpromazine - Pink to red Furazolidone - Yellow to brown Metronidazole - Dark Nitrofurantoin - Yellow to brown Riboflavin & Rifampicin - Yellow Levodopa - Dark urine upon standing 2) Activity 3: Skill-building Activities (15 mins + 2 mins checking) TEST YOURSELF Instructions: Select the letter of the correct answer and write before the number. A. Identify if Acute or Chronic Poisoning A. Acute B. Chronic ____1.Chinese cosmetics that whitens the skin due to Mercury Content ____2.Toys that contains high traces of lead ____3. Paracetamol 500mg given every 2 hrs ____4.Eating large quantity of shrimp over the years ____5.Taking sleeping pills B.Identify if Local or Systemic A. Local B. Systemic ____6. chlorine gas reacts with lung tissue at the site of contact, causing damage and swelling of the tissue ____7. skin irritation due to poison ivy ____8.tetraethyl lead produces effects on skin at the site of absorption ____9. interferring with the cells ability to use oxygen due to KCN ____10. inhalation of carbon monoxide This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ C.Enumerate the following organs from the most to the least target organ of toxicity -Muscle and bone -Circulatory system -visceral organs such as the liver, kidney, and lung -CNS(brain and spinal cord) -blood and hematopoietic system - skin Answer: - - - - - - “Check your answers against the Key to Corrections found at the end of this SAS. 3) Activity 4: What I Know Chart, part 2 (2 mins) Instruction: To review what was learned from this lesson, please go back to Activity 1 and answer the “What I learned” column. Notice and reflect on any changes in your answers from what you know before answering your SAS and after answering your SAS. 4) Activity 5: Check for Understanding (12 mins) Instructions: Now it’s time for you to figure this one out on your own! Take time to read, analyze and understand the following scenarios. No more key to correction for you to check if you understood the lesson. A. Identify if Acute or Chronic Poisoning A. Acute B. Chronic ____1. Ibuprofen 400mg every hour ____2. High chlorine content of swimming pools ____3. Eating raw cassava for years ____4. Workers producing turpentine ____5. Using of old amalgams B.Identify if Local or Systemic A. Local B. Systemic ____6. Liquid sosa This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ ____7. Muriatic acid ____8. tetraethyl lead effects on the CNS and other organs ____9. Benzene causing anemia ____10. Lethargy caused by alcohol C. LESSON WRAP-UP 1) Activity 6: Thinking about Learning (5 mins) A. Work Tracker You are done with this session! Let’s track your progress. Shade the session number you just completed. B. Think about your Learning Tell me about your thoughts! How do you define poison before reading the module and how do you define it after reading the module? Is it the same definition that you have in mind before the lesson? FAQs 1. Can a poison produce both local and systemic effect? Answer: Yes, For example, tetraethyl lead produces effects on skin at the site of absorption and then is transported systemically to produce its typical effects on the CNS and other organs. 2. If the local effect is marked, can there be indirect systemic effects? This document is the property of PHINMA EDUCATION  Course Code: PHA 060 (Pharmaceutical Toxicology) Student Activity Sheet #2 Name:_______________________________________________________ Class number: ______ Section: _________ Schedule:____________________________________ Date:______________ Answer: Yes, For example, kidney damage after a severe acid burn is an indirect systemic effect because the toxicant does not reach the kidney. KEY TO CORRECTIONS Activity 3 TEST YOURSELF A. 1. B 2. B 3. A 4. B 5. A B. 6. A 7. A 8. A 9. B 10. B Enumeration: 1. The target organ of toxicity most frequently involved in systemic toxicity is the CNS (brain and spinal cord). Even with many compounds having a prominent effect elsewhere, damage to the CNS can be demonstrated by the use of appropriate and sensitive methods. Next in order of frequency of involvement in systemic toxicity are the circulatory system; the blood and hematopoietic system; visceral organs such as the liver, kidney, and lung; and the skin. Muscle and bone are least often the target tissues for systemic effects. This document is the property of PHINMA EDUCATION