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Toxicology

branch of pharmacology which deals with the undesirable effects of chemicals on living systems, from individual cells to complex ecosystems

Corpus delecti

• Body of evidence

• any agent which may cause serious body injury, disease or death when applied, introduced into, or developed within the body

PARACELSUS (PATBvH)

“What is there that is not a poison”

MATHIEU ORFILA

Lex cornelia

First book regarding poisoning

Intoxication

toxicity associated with any chemical substance

POISONING

a clinical toxicity secondary to accidental exposure

OVERDOSE

an intentional exposure with the intent of causing self-injury or death

Hazard

likelihood that injury will occur in a given situation or setting

Risk

expected frequency of the occurrence of an undesirable effect arising from exposure to a chemical or physical agent

MUTAGENESIS

heritable changes in genetic material that are limited to the effects on the nucleic acid

Haptens

chemicals with molecular weights of less than 1000 and generally react with endogenous carrier molecules to become antigens before they exhibit immunogenicity

Clastogenesis

chromosomal breakage resulting in rearrangement of pieces of chromosomes

• Decriptive, mechanistic, regulatory

• Forensic, environmental, clinical, occupational

• Descriptive

• Mechanistic

• Regulatory

• Forensic

• Occupational

• Clinical

• Environmentally

• Local/remote

• Systemic

• Combination

Dispositional antagonism

A type of antagonism where the effect of the drug is cancelled through ADME

• EX: Ipecac, AC

• Route of ad, conc.

• Age, habit, idiosyncracy, tolerance

• Oral

• Dermal

• Inhalation

• Intravenous

• Antimalarial

• Sulfa drugs

• ASA

• Acetanilide

• Nalidix acid

• INH

• Nitrofurantoin

G6PD Deficiency causes hemolytic anemia. What are the triggers?

• Acute

• Chronic

• Cumulative

• <24 hours

• Dietary

• < Or = 1 month

• 1-3 months

• >3 months

• Circumstantial (Moral evidence)

• Post mortem

• Experimental

• Chemical

• Symptomatic

• Initial assessment

• Evaluate and support

• A

• B

• C

• Diagnosis/Decontamination

General Management of Poisoned Patient

• Physiologic

• Chemical

• Mechanical

General types of antidote

Gastric lavage

<60 mins

Emesis as a mechanical antiodite is only effective —

Two tbsp of soap in 100 mL water

Syrup of ipecac alternative

• 5 mL

• 10 mL

• 15 ml

• 30 mL

Cathartics

Mechanical antidote to induce evacuation of bowel

Precipitation

Alter the poison by forming an insoluble substance

2:1:1 AC/Tannic acid/MgO

What are the components of the universal antidote

CELLIMEMOPSS

Activated charcoal binds to toxins except:

• NaHCO3

• NH4Cl, Vit C,HCl

Hemodialysis

Extracorporeal method

Hemoperfusion

Extracorporeal method

• Gastric lavage

• Emesis

• Cathartics

• Precipitation

• Activated charcoal

• Hemodialysis

• Hemoperfusion

• Forced diuresis/pH manipulation

What are the mechanical antidotes

• Succimer (Dimercaptosuccinic acid/DMSA)

• Unithiol

what are the water soluble analogs of dimercaprol

Dimercaprol

EDTA/Edetate calcium Disodium

Unithiol/Dimercaptopropanesulfonic acid DMPS

• Penicillamine (Cuprimine)

• D-DImethylcysteine

Deferoxamine

Deferasirox

tridentate chelator with a high affinity for iron

• Prussian blue

• Ferric ferrocyanide

• Ferric hexacyanoferrate

has high affinity for certain univalent cations, particularly cesium and thallium

Irritants

Neurotics

Carcinogens

Asphyxiants

Lacrimators

Sternutator

Asthenics

Narcotics