Toxicology Exam 3
As of 2014, How much U.S. sales was generated on Electronic Cigarette use?
$2,757 million dollars
What is the EPA arsenic standard for drinking water?
.01 parts per million
Within the past 5 years, approximately what percentage of children tested had high blood lead levels?
0.5%
How long does it usually take to clear low levels of arsenic from the body?
1 week
LI is a 25 YO woman admitted to the ER after ingesting a cake contaminated with lead, her blood lead level is 80 mcg/dl, and she is showing signs of lead toxicity. She has normal hepatic and renal function. Which following dosing regimen for Edetate Calcium Disodium would you recommend to the physician?
1000 mg/m2/day or 2550 mg/kg/day for 5 days in conjunction with dimercaprol treatment
Tricyclic antidepressants medications account for ______ of suicidal antidepressant ingestions.
14.7%
What year was the LeadBased Paint Poisoning Prevention Act passed?
1971
What is the most common age group that abuses bath salts?
20-29
Based on the material presented in class, what year had the highest incidence of human exposures to bath salts reported to Poison Control Centers?
2011 There were over 6,000 reports in 2011, which declined to 582 reports in 2014
When was MDPV categorized permanently as a schedule 1 drug?
2012
When using dimercaprol to treat acute arsenic and elemental/inorganic mercury poisoning, what is the main way to monitor the improvement of these acute conditions?
24 hour urine test
What is the recommended dietary allowances (RDAs) for iron during pregnancy?
27 mg
What is the lethal dose of Nicotine in adults?
30 mg
What age range do you see the most iron toxicity?
< 6 years old
Adult blood lead levels are considered elevated at what reference range?
>25mcg/dL
Which of the following patients is succimer used to treat?
A child with lead poisoning and blood concentration > 45 mcg/dl
Which of the following are considered a synthetic cathinone?
A. Methylone B. Mephedrone C. MDPV
When considering a treatment regimen for bath salt intoxication, you must consider:
A. The signs and symptoms presented by the patient B. The seizure lowering potential of the drug regimen
If the inorganic mercury form is in a liquid or edible form (not encased like a battery), the best treatment option is
Activated charcoal
Deferasirox can cause of which of the following acute adverse effects?
Acute renal failure
Which of the following is TRUE ?
Adolescents are twice as likely to use ecigs due to their perceived safety
Which of the following is false about Acrodynia
Also known as red disease
All of the following statements are appropriate tips for prevention of nicotine poisoning, EXCEP
Always keep electronic cigarettes and liquid nicotine on your nightstand
Theoretically, why is the administration of ascorbic acid beneficial for patients presenting with iron toxicity?
Ascorbic acid facilitates the conversion of ferrous ion to ferric ions.
Which of the following is not considered a top line treatment for CCB toxicity?
Atropine
What is the trade name for Dimercaprol?
BAL in Oil
Which symptoms of lead poisoning do children exhibit that adults do not?
Behavioral changes
What type of analysis can be used to differentiate between organic or inorganic mercury toxicity?
Blood
Which diagnostic tool is most commonly used for lead poisoning?
Blood lead level
Acute lead toxicity in children often manifests as which of the following symptoms?
CNS toxicity
What heavy metal poisoning is dimercaprol NOT used for treatment?
Cadmium
Which calcium salt used for treatment in calcium channel blocker overdose, contains approximately 3 times the amount of calcium as calcium chloride?
Calcium gluconate
When taking succimer, pharmacist should educate patient:
Capsules can be sprinkled on soft foods or liquids
Calcium channel blocker overdose is associated with which of the following?
Cardiac failure
Which of following statements regarding electronic cigarettes is TRUE ?
Ceramics, plastics, and foams have been found in the aerosol
What is the gold standard treatment for patients with BLL > 45 μg/dL? a. Iron
Chelation therapy
Which class of drugs should be MOST avoided in TCA overdose?
Class 1a and 1c antiarrhythmics
Which of the following are symptoms of mercury toxicity
Cough, Visual disturbance
What are the common treatments for irondeficiency anemia?
DIetary Supplementation, Iron Supplementation
Treatment of inorganic mercuric toxicity includes all of the following except
DMSO
Which of the following is not an effect of nicotine?
Decreased heart rate
Which of the following is INCORRECTLY MATCHED with it's side effect profile?
Deferasirox: discoloration of the urine
The following are anticholinergic side effects EXCEPT :
Diarrhea
Which of the following was lead NOT found in?
Diet Coke
All of the following are clinical presentations of ACUTE arsenic toxicity, except:
Euphoria
Which of the following is correct regarding the mechanism of action of deferoxamine?
Extracts iron from ferritin, hemosiderin, and transferrin
Which of the following is responsible for making bath salts illegal in the US?
FDA Safety & Innovation Act
What is the most appropriate treatment option for iron deficiency anemia during pregnancy?
Ferrous sulfate 325 mg PO once daily
Which of the following shows the correct order for chelation therapy given to a symptomatic lead poisoning patient?
First dose of Dimercaprol followed by EDTA initiation
What pharmaceutical company manufactures Sativex and Epidiolex?
GW
During cardiovascular collapse, what is used as the alternate fuel instead of the oxidation of free fatty acids?
Glucose
When treating lead poisoning with succimer which of the monitoring parameters NOT correct?
Goal lead level of >45 mcg/dL
Which types of fish from the ocean should be eaten only a few times a month due to higher levels of mercury?
Halibut, shark, pike, albacore
What is a contraindication in treatments using dimercaprol?
Hepatic impairment
What would be the preferred route of administration of deferoxamine for a patient who is in shock?
IV
Why is intramuscular injection preferred over intravenous injection for patient with lead encephalopathy or cerebral edema?
IV administration might cause possible lethal increase in intracranial pressure in patient with lead encephalopathy or cerebral edema
What was the first tricyclic antidepressant discovered?
Imipramine
How may patients benefit from with the use of Sativex for multiple sclerosis?
Improvement of spasticity
The mechanism of action for CCB include all of the following EXCEPT:
Increased cardiac automaticity
Which of the following statement is FALSE regarding the effects of electronic cigarettes on users?
Increases FeNO (fractional exhaled nitric oxide)
Which of these measures does not aid in preventing lead poisoning?
Increasing Mg2+ intake
The first step in the treatment of mercury toxicity involves all of the following except
Induce emesis
What is the primary route of exposure for Lead?
Ingestion
What route of exposure absorbs the most mercury?
Inhalation
What is an alternate treatment to calcium channel blocker overdose that may possibly help reverse calcium channel blocker toxicity?
Insulin
According to the Rocky Mountain Poison and Drug Center, what is the most common reason for calls relating to calcium channel blocker overdose?
Intentional overdose
Prussian Blue is indicated for which of the following?
Internal contamination with radioactive cesium, Internal overdose of digoxin
What are the two most common causes of anemia during pregnancy?
Iron deficiency, Folate deficiency
What is the main toxic effect of lead on children?
Irreversible nervous system toxicity
Succimer is less toxic than dimercaprol because of all of the following EXCEPT:
It is not associated with gastrointestinal upset
How is EDTA metabolised?
Kidney
The chemical most commonly found in "bath salts" is structurally similar to which of these pair of drugs?
MDMA and Amphetamine (MDPV contains the methylenedioxy on the aromatic ring, along with a substituted amine on the 2phenylethylamine template. This means it is most similar to MDMA and amphetamine.)
What is a notable concern when administering glucagon as a treatment option for CCB toxicity?
Nausea/Vomiting
What is the major side effect of EDTA toxicity?
Nephrotoxicity
Which of the following is a contraindication for using penicillamine in Wilson's disease?
None of the above
Which two neurotransmitter reuptake inhibitors are primarily affected in the central nervous system by MDPV?
Norepinephrine and Dopamine
What does mercury smell like?
Odorless
The following are sources of dietary iron EXCEPT:
Olive oil
What dosage form is succimer available in?
Oral capsules
Which is NOT a reason for use of bath salts?
Paranoia
When is an infusion of dextrose indicated?
Patient is starting HIET with a blood glucose of < 200 mg/dL
Deferasirox usage is contraindicated in which of the following?
Patient with a creatinine clearance of 39ml/min
What is the safety rating for adults using Sativex?
Possibly Safe
The MAIN cause of arsenic hepatotoxicity and nephrotoxicity is by an increase in:
Reactive oxygen species
Blocking Ltype calcium channels causes which of the following?
Relaxation of arteriolar smooth muscle causing vasodilation
Edetate Calcium Disodium is contraindicated in patients with:
Renal failure
Once succimber chelates the target heavy metal it is excreted
Renally
What schedule is cannabidiol?
Schedule I
What is the mechanism of a dihydropyridine calcium channel blocker?
Selectively block calcium channels in the vasculature
Which of the following is a contraindication for the use of Deferoxamine?
Severe renal impairment
Regarding the use of Sativex© for cannabis withdrawal, what is the most appropriate role in therapy?
Should only be used in select patients since placebos are as effective in preventing withdrawal symptoms
What is the most common route of administration?
Sniffing/snorting according to the DEA and other reports
Which of following is FALSE?
Succimer is available in capsules, SC, and IM injections.
How do you treat bath salt intoxication?
Supportive care there is no antidote. Supportive care is the recommended treatment
Deferoxamine is absorbed best when?
Taken 30 minutes before first meal of the day
Where does the high CBD content strain of marijuana called "Charlottes Web" derive its name?
The 3 year old girl that the drug reportedly helped treat for seizures
Which of the following statements regarding ecigarettes is TRUE ?
The US Department of Transportation has a proposed ban on the use of ecigarettes on planes
Which of the following statements about dimercaprol is TRUE?
The sulfhydryl groups of dimercaprol form complexes with certain heavy metals
According to the Montana Adult Tobacco Survey, all of the following are reasons why adults use electronic cigarettes EXCEPT :
They look cooler than traditional cigarettes
All of the following are followup recommendations to arsenic toxicity, except:
Total lipid panel
Which of the following is true regarding the pharmacodynamics in calcium channel blockers (CCB)?
Undergoes extensive firstpass metabolism
What do you NOT need to monitor in bath salts toxicity?
Urine Output
Which of the following statements regarding the use of ecigarettes is FALSE ?
Use by nonsmokers will decrease the risk of addiction and cardiovascular toxicity
Prevention of lead toxicity can include all of the following except:
Using only warm water from pipes
Which CCB would have the highest level of toxicity?
Verapamil
Deferoxamine interacts with which of the following?
Vitamin C
What should be monitored during penicillamine use?
WBC
Arsenic toxicities are associated with all of the following EXCEPT :
Wernicke's encephalopathy
Which of the following is MOST consistent regarding the mechanism of toxicity of iron?
Which of the following is MOST consistent regarding the mechanism of toxicity of iron?
Activated Charcoal is most effective when used in CCB toxicity .
Within 1 hour
Cyclic antidepressants overdose occur mostly in _____ and is prevalent in ages ____ years old.
Women 20 to 29
These groups are at risk of obtaining excess iron EXCEPT:
Young children
Typically ecigarettes have the following components:
a) A cartridge or reservoir containing solution b) Atomizer c) A battery
When calling to the Poison Control Center of a possible nicotine toxicity, which of the following should you report?
a) Patient's age, weight, and condition b) Product name of the substance c) When and how much the substance was swallowed
Which of the following is the common symptom of chronic mercury exposure?
a. Acrodynia b. Pink disease c. Renal failure
Response to lead toxicity is affected by which of the following?
a. Age b. Genetic susceptibility c. Low calcium or iron
What are symptoms of acute respiratory system exposure of mercury?
a. Cough b. Sore throat c. Shortness of breath d. Chest pain
The level of harm from arsenic toxicity is determined by:
a. Dose b. Route of exposure c. Duration
What type(s) of Epilepsy has FDA approved the study of cannabidiol in?
a. Dravet Syndrome b. LennoxGastaut Syndrome
Analysis of which of the following is best for longterm exposure of mercury?
a. Hair b. Toenail
Which of the following symptoms could a patient present with in a TCA overdose?
a. Mydriasis b. Agitation c. Coma
TCA antidepressants act on which receptor?
a. NET b. SERT c. Muscarinic d. alpha1 adrenergic
Radiogardase capsules may be
a. Opened and mixed with bland food/liquid b. Swallowed whole
Patients need to be evaluated in the emergency department (ED) if:
a. Patients who are neglected and exposed to CCB with malicious intent b. Patients who have ingested a CCB dose greater than the therapeutic dose or a dose that is equal to or greater than the toxic dose c. Patients who expose to CCB with intent to selfharm or intentional abuse d. Patients with signs/symptoms of hypotension or hyperglycemic
What is a sign/symptom of chronic health effects of mercury?
a. Permanent nervous system damage b. Permanent kidney damage c. Neuropsychiatric effects
Exposure to arsenic can occur via which route?
a. Sawing or sanding CCB treated wood b. Inhaling volcanic fumes or fumes from burning ore c. Direct contact with certain pesticides used for cotton crops
Which of the following is/are appropriate treatments for acute exposure to arsenic?
a. aggressive IV fluid replacement b. Hemodialysis c. Activated charcoal and a cathartic
People are exposed to arsenic via
a. contaminated food b. water c. air
Unithiol has been used to treat the following poisonings:
a. mercury b. lead c. arsenic
All of the following are recommended for treatment of iron toxicity except:
activated charcoal
Which of the following is not an indicated use for penicillamine?
all are: a. Wilson's disease b. arsenic toxicity c. cystinuria d. lead toxicity
What is the most common nicotinic receptor in the brain that is thought to be associated with nicotine dependence and the rewarding effects of nicotine?
alpha 4, beta 2
What can be given to a patient to minimize some side effects of dimercaprol?
antihistamine
The cardiotoxic effects of TCAs are due to:
blockade of fast sodium channels
Radiogardase comes in the following dosage forms
capsules
Acute ingestion of arsenic 10 mg/kg/day will cause
cerebral edema
____________ is a compound containing a ligand (typically organic) bonded to a central metal atom at two or more points.
chelator
All of the following are adverse effects of penicillamine except:
constipation
In a patient with chronic arsenic toxicity, which of the following abnormalities would be expected?
elevated liver enzymes
True or false: Benzodiazepines are the antidote for "bath salts" intoxication.
f
True or false: Buprenorphine is the only cathinone derivative for prescription use in the US and Europe.
f
When managing a patient with suspected bath salt intoxication, it is imperative that you hold off on any therapeutic treatment until you receive a lab identifying its presence.
f
CBD is highly bioavailable (>70%)
false
Cannabidiol has the same effect as a placebo in reducing anxiety and discomfort during the simulated public speaking test.
false
Cannabidiol is effective for the treatment of resistant schizophrenia?
false
Hallucinations, difficulty speaking, and blurred vision are side effects that do not require medical attention?
false
Like THC, cannabidiol is psychoactive.
false
The use of cannabidiol in huntington's patients has shown promising results for halting disease progression.
false
Unithiol is FDA approved in the US
false
Most arsenic sources are produced by
humans
Which of the following is NOT an adverse effect associated with the use of Radiogardase?
hyperkalemia
What adverse effects should one monitor for while implementing HIET?
hypokalemia
Bath salts are commonly marketed as which of the following?
iPod screen cleaner, Jewelry cleaner
What is the route of administration of dimercaprol and is it available as an outpatient drug or given inpatient?
intramuscular, inpatient
Edetate Calcium Disodium is a useful chelator for the management of all the following heavy metal poisoning except:
mercury
Iron is a biological component of:
myoglobin, hemoglobin
Flavorings in electronic cigarettes will never contain:
none of the above
What is the lethal dose of MDPV?
none of the above
Which is NOT a physical or behavioral effect of "bath salts?"
none of: Mydriasis B. Paranoia C. Seizure D. Anxiety
Diagnosis of tricyclic antidepressant poisoning is based on all of the following EXCEPT :
none: a. History of psychiatric disease b. Dry mucous membranes c. Abnormal ECG findings
Which of the following tricyclic antidepressants can be used as first line treatment for obsessive compulsive disorder?
none: clomipramine, imipramine, amitriptyline
What effect(s) caused by THC are NOT mediated by CBD?
paranoia, memory impairment
Prussian Blue should be caution in patients with the following EXCEPT:
renal failure
How is unithol/metal chelate eliminated from the body?
renally
What is the standard treatment for TCA overdose?
sodium bicarbonate
Deferasirox comes in which of the following dosage forms? a. tablet
tablet
Which of the following is/are symptom(s) of TCA overdose?
tachycardia
Ingestion of elemental mercury (for example from a broken thermometer) usually has no effects on gastrointestinal cells unless the gastrointestinal tract is damaged (for example, people with ulcerative colitis or fistulas)
true
Mercury toxicity is irreversible.
true
T/F Chronic arsenic toxicity can cause malignancies (cancer).
true
When should gastric lavage be administered to bring out most efficacy?
within 1 hour