Term
| Has is oxidative stress defined? |
|
Definition
| the ratio of oxidant activity to antioxidant activity |
|
|
Term
| How do Vitamins C and E function as antioxidants? |
|
Definition
| They form a cycle with the tripeptide-glutathione to keep it in its antioxidant state (reduced form)- Glutathione-SH |
|
|
Term
| What vitamin has a good antioxidant effect against nitrosative stress? |
|
Definition
|
|
Term
| What's the daily requirement of Vitamin A, and in which situations does it vary? |
|
Definition
| About 900 mg/day; in lactating females it's 1300 mg/day |
|
|
Term
| What vitamin A can be consumed PO for psoriasis? |
|
Definition
|
|
Term
| How are all trans-retinoic acids (Retin-A) typically available? |
|
Definition
|
|
Term
| What's the recommended Vitamin D dosage in severe cases? |
|
Definition
|
|
Term
| What is the most potent antioxidant form of Vitamin E? |
|
Definition
|
|
Term
| Excessive Vitamin E can have what adverse effect? |
|
Definition
|
|
Term
| What has been a recent discovery of Vitamin K's function? |
|
Definition
| it activates calcium binding of osteocalcin, which is involved in bone healing or remodeling |
|
|
Term
| What is the thiamine requirement proportional to? |
|
Definition
|
|
Term
| Riboflavin is a structural component of what two co-enzmes? |
|
Definition
|
|
Term
| Deficiency of Riboflavin leads to what three common symptoms? |
|
Definition
| angular chelitis, glossitis, and dermatitis |
|
|
Term
| What functions does nicotinic acid have that niacinamide doesn't? |
|
Definition
| can lower cholesterol and triglycerides |
|
|
Term
| What are the four key functions of niacin deficiency? |
|
Definition
| glossitis, dermatitis, dementia, and diarrhea (the latter three make up pellagra) |
|
|
Term
| For what function is the NAD cofactor crucial? |
|
Definition
| for repairing ssDNA breaks |
|
|
Term
| B6 deficiency typically produces symptoms of depression, irritability, and nervousness. Why is this so? |
|
Definition
| B6 is needed for the synthesis of neurotransmitters serotonin,norepinephrine, and sphingolipid-myelin |
|
|
Term
| What type of anemia is caused by PYP deficiency? |
|
Definition
| sideroblastic/microcytic anemia |
|
|
Term
| What constituents make up the oxidized form of folic acid? |
|
Definition
| gluatamic acid, paba, and two-ring pteridine |
|
|
Term
| What is the function of methylated B12? |
|
Definition
| converts homocysteine to methionine (derivative causes methyl malonyl CoA to be converted to Succinyl CoA) |
|
|
Term
| Panthotenic acid (Vitamin B5) is a portion of what two substances? |
|
Definition
| coenzyme A and fatty acid synthase |
|
|
Term
| What is the recommended daily amount of Vit. B5? |
|
Definition
|
|
Term
| How does Vitamin C help protect catecholamines? |
|
Definition
| It is stored in large amounts in the adrenal glands to prevent oxidation of epinephrine and norepinephrine |
|
|
Term
| How does Vitamin C aid in the absorption of iron? |
|
Definition
| reduces iron to the ferrous state in the stomach |
|
|
Term
| What is the effect of smoking on Vitamin C? |
|
Definition
| Massively reduces Vitamin C levels |
|
|
Term
| Name two oxidants that serve helpful functions for the body? |
|
Definition
| peroxynitrite and myeloperoxidase |
|
|
Term
| What substance acts as a major intracellular antioxidant? What part of it is the functional component? |
|
Definition
| glutathione/cysteine component is the one that contains the sulfhydryl group |
|
|
Term
| What is the RDA for calcium? |
|
Definition
|
|
Term
| What importance does magnesium have? |
|
Definition
| important for neuromuscular transmission |
|
|
Term
| What is excess iron + ascorbate a bad combo? |
|
Definition
| It causes Fenton chemistry-type toxicity |
|
|
Term
| Which groups are at risk for low iron levels? |
|
Definition
| young children and pregnant females |
|
|
Term
| What is the RDA for iodine? |
|
Definition
|
|
Term
| Zinc deficiency is oftne linked with a loss of what trait? |
|
Definition
|
|
Term
| Zinc transport is linked to what levels? |
|
Definition
| metallotheionein levels in intestinal mucosal cells |
|
|
Term
| Why is N-acetyl cysteine used as an antidote for tylenol overdose |
|
Definition
| it increases the amount of glutathioneu |
|
|
Term
| Who may need Coenzyme Q10 treatment? |
|
Definition
| patients who taken statins |
|
|
Term
| What percent of hospital admissions is due to drug effects or nonadherence? |
|
Definition
|
|
Term
| What are phenytoin, warfarin, NSAID's, and thyroxine more dangerous in older people? |
|
Definition
| these are protein-bound drugs and in older people with less albumin, they're more available as free drugs |
|
|
Term
| What are drugs that are important to monitor in someone with renal impairment? |
|
Definition
| digoxin, aminoglycosides, cimetidine, lithium, and penicilin |
|
|
Term
| Swallowing function is affected as people age. Based on the lecture, what drug specifically should be avoided in people with known esophageal problems? |
|
Definition
|
|
Term
| Instead of a benzodiazepine, what should be the drug of choice for anxiety? |
|
Definition
|
|
Term
| What are the parameters for abdominal obesity in men and women? |
|
Definition
| waist circumference > 102 cm in men and >88 cm in women |
|
|
Term
| In metabolic syndrome, the fasting blood glucose is typically greater than what? |
|
Definition
|
|
Term
| What is the triad of defects found in Type 2 DM? |
|
Definition
| defective insulin secretion, insulin resistance, and increased hepatic glucose output |
|
|
Term
| Which anti-cholesterol drug class increases triglycerides and also cause constipation/flatulence? |
|
Definition
|
|
Term
| Which drugs have the greatest effect on LDL reduction? |
|
Definition
| HMG-CoA reductase inhibitors |
|
|
Term
| Which drug has the greatest drug on increasing HDL? |
|
Definition
|
|
Term
| Hepatotoxicity and gallstone formation are the major side effects of what anti-cholesterol drug class? |
|
Definition
|
|
Term
| With niaspan, what major side effects do we need to worry about? |
|
Definition
| flushing, worsened peptic ulcer disease, hyperglycemia, and hepatotoxicity |
|
|
Term
| For a person with CHD, at what LDL cholesterol level do we start to consider drug therapy? |
|
Definition
|
|
Term
| For a person with 0 to 1 risk factors, at what level do we start considering lifestyle modifications to reduce LDL cholesterol levels? |
|
Definition
|
|
Term
| Why might creatinine levels be "normal" in the elderly considering that renal function typically declines? |
|
Definition
| the lean body mass also decreases |
|
|
Term
| What neuropsychiatric effect is common among fluoroquinolones? |
|
Definition
|
|
Term
| In addition to dermatitis/sensitivity, what other adverse effect does the fungicide zineb have? What fungicidal class does it belong to? |
|
Definition
| Causes antabause-like reacitons/ is a thiocarbamate |
|
|
Term
| Name two substituted aromatics that are common fungicidal agents |
|
Definition
| chlorothalonil/ hexachlorobenzene |
|
|
Term
| How does zinc phosphide work as a rodenticide? |
|
Definition
| It helps disrupt the electorn transport chain when metabolized to a phosphine |
|
|
Term
| What is potentially possible with the dust of zinc phosphide? |
|
Definition
|
|
Term
| What do brodifacoum and difenacoum do as rodenticidal agents? |
|
Definition
| like warfarin, they help decrease clotting factor synthesis and increase capillary permeability |
|
|
Term
| With diethyltoluamide, what sort of potential adverse effects exist? |
|
Definition
| can cause skin irritaiton/blistering/erosions, more systemically it can cause toxic encephalopathy |
|
|
Term
| At what concentration do we limit DEET for children? |
|
Definition
|
|
Term
| What are the negative effects of DDT that cause it to be not available on the market? |
|
Definition
| it has anti-estrogenic effects and causes thinning of the egg shells |
|
|
Term
| In emergent situations involving organochlorines, why do we give diazepam and/or phenobarbital? |
|
Definition
| They help deal with the tremors/convulsions/irritability |
|
|
Term
| Describe the mechanism of action of neonicotinoids |
|
Definition
| it's an agonist for nicotinic acetylcholine receptors- binding causes paralysis |
|
|
Term
| What agents do we not give to treat neonicotinoids overexposure? |
|
Definition
| atropine and/or pralidoxime |
|
|
Term
| Name two organochlorines used as insecticides? |
|
Definition
|
|
Term
| Name the two neonictonoid agents used as insecticides? |
|
Definition
| imidacloprid, acetamiprid |
|
|
Term
| How do pyrethrins and pyrethroids work? |
|
Definition
| They alter ion flux across neuronal membranes |
|
|
Term
| What is unusual about the tremors that may present with pyrethrin/pyrethroid overexposure? |
|
Definition
| they may come with hyperthermia |
|
|
Term
| What drug is commonly used to treat head lice? |
|
Definition
|
|
Term
| What agent should not be used to treat carabamate poisoning? |
|
Definition
|
|
Term
| What are the effects of somatic innervation of the nicotonic receptors on skeletal muscle? |
|
Definition
| fasciculations, twitching, cramps, weakness, and paralysis |
|
|
Term
| What is the primary reason for chronic neuropathy (organophosphate induced)? |
|
Definition
| inhibition of neurotoxic esterase (involved in maintaining myelin) |
|
|
Term
| What are the rare effects of OP poisoning that can occur 1-4 days after acute poisoning (intermediate)? |
|
Definition
| muscle weakness, respiratory distress |
|
|
Term
| What's the process of "aging" with regard to OP poisoning, and what is its significance? |
|
Definition
| When side chain leads the serine component of OP, meaning that pralidoxime cannot regenerate the AChase |
|
|
Term
| What is the general time frame for nerve gases to have an effect if transmitted via the skin? |
|
Definition
| 30 minutes to 18 hours after (2 Mark I kits for quick systemic effects, 1 Mark I kit for delayed effects) |
|
|
Term
| What type of malformations are seen during the embryonic period? |
|
Definition
| structural or functional malformations |
|
|
Term
| What are 3 biological facts that explain the body's extreme sensitivity to malformations during th embryonic period? |
|
Definition
| rapid cell turnover, immature biological barriers, and immature detoxification |
|
|
Term
| Currently, what three practical applications does thalidomide have? |
|
Definition
| used in complications of eprosy/ also treatment of multiple myeloma, cutaneous manifestations of SLE |
|
|
Term
| What is the reason for cocaine causing spontaneous abortions? |
|
Definition
| detachment of the placenta due to the vasoconstrictive effects of cocaine |
|
|
Term
| Regarding metal toxicity, what exposure route represents the greatest risk? |
|
Definition
|
|
Term
| How does the inhibition of enzyme activity in metal toxicity typically occur? |
|
Definition
| Via the metal binding of sulfhydryl gorups |
|
|
Term
| What typically happens to lead once it's absorbed by the body? |
|
Definition
| 90% of it goes to the bone (majority of the body burdne of lead has no toxicological consequence) |
|
|
Term
| GI effects of abdominal pain and metallic taste plus anorexia/constipation typically are associated with lead consumption in what amounts? |
|
Definition
| At least 80 mcg/dL (typically less than 100); otherwise you'd get colic |
|
|
Term
| With elemental mercury, what is the primary route of toxicity? |
|
Definition
|
|
Term
| In chronic elemental mercury toxicity, what are the primary target organs, and what sort of effects do they have? |
|
Definition
| The CNS/PNS (as elemental mercury is highly lipid soluble); CNS- neuropsychiatric, PNS- motor dysfunction/ Renal toxicity is rare |
|
|
Term
| What type of mercury toxicity is linked with renal proximal tubule damage? |
|
Definition
| inorganic form (which may be ingested) |
|
|
Term
| With organic mercury toxicity, what sort of CNS and PNS defects do we find? |
|
Definition
| With CNS- have primarily sensory defects, with PNS- have peripheral neuropathy in severe cases (but mainly motor dysfunction); renal toxicity almost non-existent |
|
|
Term
| Reproductive toxicity to the fetus is common with chronic exposure to what? |
|
Definition
| organic mercury (methyl mercury) |
|
|
Term
| What's the major target of inorganic mercury toxicity and why? |
|
Definition
| the kidneys followed by GI tract (inorganic mercury toxicity is largely via oral ingestion) |
|
|
Term
| Why are the CNS and PNS not significant targets of inorganic mercury toxicity? |
|
Definition
| The inorganic mercury is unable to effectively cross th eBBB |
|
|
Term
| Severe acute inorganic mercury toxicity can precede what? |
|
Definition
|
|
Term
| What's the main form of cadmium, the main route of exposure, and the main organ affected? |
|
Definition
| inorganic/ inhalation/ renal |
|
|
Term
| Why does chelation not work with cadmium? |
|
Definition
| Chelator releases the cadmium in the kidneys, exacerbates the renal toxic effects |
|
|
Term
| What is a characteristic biomarker of chronic arsenic toxicity? |
|
Definition
| skin lesions (hyperpigmentation, hyperkeratosis, and allergic contact dermatitis) |
|
|
Term
| Groundwater contamination with arsenic in places like Western US, Taiwan, and Bangladesh has been associated with what pathology? |
|
Definition
| obliterative arterial disease of the extremities (producing black foot disease) |
|
|
Term
| What chelating agents are used to deal with arsenic? |
|
Definition
|
|
Term
| The initial reaction of acute iron toxicity involves what? |
|
Definition
| GI tract irritation and hemorrhage, followed by liver damage if very severe acute toxicity (even more severe- convulsions, coma, and death) |
|
|
Term
| What two metals discussed in the lecture are associated with type IV hypersensitivity reactions? |
|
Definition
|
|
Term
| What's the typical outcome of metal fume fever? |
|
Definition
| complete recovery occurs w/o significant intervention in 1-2 days (but long-term consequences of repeated metal flume fever are unknown) |
|
|
Term
| What exceptions are there to the idea that little drug actually remains in the stomach past 4 hours since consumption? |
|
Definition
| aspirin and some anti-cholinergics |
|
|
Term
| What are the active ingredients in ipecac? |
|
Definition
| cephaline and emetine- alkaloids |
|
|
Term
| Why should ipecac not be given with activated charcoal? |
|
Definition
| the activated charcoal will bind the ipecac, rendering it inert |
|
|
Term
| What two major toxicities exist with ipecac? |
|
Definition
| cardiotoxic, CNS depression at higher doses |
|
|
Term
| Which toxic substances should not be recovered via emesis? |
|
Definition
| convulsants, hydrocarbons, and corrosive chemicals |
|
|
Term
| Which characteristics of the patient contraindicate emesis? |
|
Definition
| no gag reflex, unconsciousness, <6 months, severe CV disease, emphysema, or weakened blood vessels |
|
|
Term
| What are the three main contraindications to gastric lavage? |
|
Definition
| corrosives, petroleum distillates, seizures |
|
|
Term
| In addition to removing the unabsorbed poison, name two other functions of activated charcoal? |
|
Definition
| increase systemic clearance of the poison and interrupt the entero-hepatic cycle |
|
|
Term
| What 3 options do we have to promote iv Alkaline diuresis? |
|
Definition
| Na-HCO3/ Na-lactate/ CA (acetazolamide) |
|
|
Term
| What agent is best absorbed by activated charcoal? |
|
Definition
|
|
Term
| Name all the compounds that are poorly absorbed by activated charcoal? |
|
Definition
| alkali, boric acid, cyanide, DDT, electrolytes, ferrous sulfate, lithium salts, malathion, mercury, mineral acids, potassium, tolbutamide, water-insoluble compounds |
|
|
Term
| What substances cannot be removed through forced diuresis? |
|
Definition
| acetaminophen, barbiturates, ethchlorvynol, glutethimide, methaqualone, phenothiazines, and TCA's |
|
|
Term
| If toxic manifestations are related to the concentration of the poison, what form of rescue is advised? |
|
Definition
|
|
Term
| What conditions represent indications for hemoperfusion? |
|
Definition
| deep coma, hypotension,marked osmolality, electrolyte/ acid base disturbances |
|
|
Term
| Cathartics are commonly used in conjunction with other substance? |
|
Definition
|
|
Term
| What contra-indications are there to catharthics use? |
|
Definition
| following caustic ingestion, bowel sounds are absent, history of recent bowel surgery |
|
|
Term
| What is the antidote used for arsenic poisoning? |
|
Definition
|
|
Term
| EDTA alone is used as an antidote to what metal poisoning? |
|
Definition
|
|
Term
| How does thiosulfate help treat cyanide poisoning? |
|
Definition
| it accelerates conversion of cyanide to a nontoxic product |
|
|
Term
| How does cystine deal with selenocystathione poisoning? |
|
Definition
| Selenocystathione is formed from a precursor, which is metabolized. Cystine blocks that precursor metabolism |
|
|
Term
| What is the function of methylene blue as a antidotal therapeutic? |
|
Definition
| Helps deal with agents that produce methemoglobinemia |
|
|
Term
| For dealing with the adverse effects of digitalis diglycosides, what agents do we employ? |
|
Definition
|
|
Term
| How is benzene linked with generation of ROS? |
|
Definition
| Its metabolites hydroquinone and benzoquinone interconvert into each other, and that process yields reactive oxygen species |
|
|
Term
| What CV effect may C2S have? |
|
Definition
|
|
Term
| What two solvents are linked with atherosclerosis and increased risk of MI? |
|
Definition
|
|
Term
| What sort of cardiac effect that chloroform have? |
|
Definition
| sensitizes myocardium to epinephrine-induced arrhythmia |
|
|
Term
| What metabolizes ethylene glycol, and what is formed by the metabolism? |
|
Definition
| ADH metabolizes ethylene glycol to oxalic acid |
|
|
Term
| What similar feature do chloroform and trichloroethyelene share? |
|
Definition
| They both sensitize myocardium to the arrhythmogenic effects of catecholamines |
|
|
Term
| What does propylene glycol get metabolized by ADH to? |
|
Definition
|
|
Term
| What two substances have been linked to retinoid embryopathy? |
|
Definition
| Vitamin A and isotretinoin |
|
|
Term
| What are the main side effects of 2,4 dichlorophenoxyacetic acid? |
|
Definition
| muscle weakness, aching, tenderness, and renal failure |
|
|
Term
| What type of herbicide is paraquat, and what is its main toxicity? |
|
Definition
| It's a bipyridyl; monitor it for lung toxicity |
|
|
Term
| What's the MOA of glyphosphate? |
|
Definition
| inhibits amino acid synthesis by shikimate pathway |
|
|
Term
| What class of fungicides does captan belong to? |
|
Definition
|
|
Term
| What's the recommended treatment for overexposure to organochlorines? |
|
Definition
|
|
Term
| Why is pralidoxime contraindicated in neonicotinoid exposure? |
|
Definition
| It can lead to hypotension |
|
|
Term
| What are the 2 main effects of 2-PAM? |
|
Definition
| arrhythmias, hypertension |
|
|
Term
| What are the 4 main renal effects of lead toxicity? |
|
Definition
| impairs proximal tubular function, aminoaciduria, glucosuria, and hyperphosphoturia |
|
|
Term
| What is the antidote to beryllium poisoning? |
|
Definition
|
|
Term
| What potential toxicity concern exists with manganeses? |
|
Definition
| It can cause Parkinson's like symptoms |
|
|
Term
| For likely sinusitis, what is the recommended treatment regimen? |
|
Definition
| amoxicillin 3 weeks (takes a while to get to the sinuses) |
|
|
Term
| What's the therapy of choice for pyelonephritis and why? |
|
Definition
| gentamicin + ampicillin (more likely to be E.coli, but if Enterococcus then the combo works) |
|
|
Term
| For CA pneumonia in an older patient, what's the drug combo? |
|
Definition
| azithromycin + ceftriaxone (see smoking, think z-pack) |
|
|
Term
| What's the drug regimen for a healthy patient with bacterial meningitis? What about if they're immunocompromised? |
|
Definition
| vanc + ceftriazone/ if immunocompromised add ampicillin (to treat L. monocytogenes) |
|
|
Term
| If a patient comes to you in the summer with headache/malaise, and you think there's environmental exposure, what's your plan of attack? |
|
Definition
| vanc + ceft + doxy (maybe add ampicillin) |
|
|
Term
| What's the replication signal for Coxiella Burnetti? |
|
Definition
|
|
Term
| Where's coxiella burnetti usually located? |
|
Definition
| intra-vacuolarly (Rickettsia is intra-cytoplasmic) |
|
|
Term
| What type of transmission do both dengue and bunyavirus have? |
|
Definition
|
|
Term
| T or F- there's no effective vaccine for Yellow Fever? |
|
Definition
| False, there is an effective live-attenuated vaccine for Yellow Fever |
|
|
Term
| What conditions support CYP 2E1 metabolism of carbon tetrachloride and chloroform to toxic intermediates? |
|
Definition
| fasting, EtOH exposure, and poorly controlled diabetes |
|
|
Term
| Name three potentially adverse effects of trichloroethylene overexposure? |
|
Definition
| renal cancer, cardiac teratogenesis, and impaired intrauterine growth |
|
|
Term
| What are the key effects of ingestion of zinc phosphide in the gut? |
|
Definition
| hypocalcemia, renal tubular damage (nausea, vomiting) |
|
|
Term
| What are the potential cardiovascular effects of zinc phosphide ingestion? |
|
Definition
| cardiomyopathy, ventricular arrhythmias |
|
|
