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Across 3. the ________ of pesticides include increased crop yeilds, better food quality, and decrease in insect-borne disease 5. this group of OP are phosphorylcholines; X is a quaternary Nitrogen; weapons of war; volatile and highly toxic; stimulate cholinergic receptors and are ChE inhibitors 7. this syndrome, a delayed effect of OPs, involves weakness after intial improvement (1-4 days) and bulbar, resp., and proximal muscle weaknes which resolves in 2-3 wks 9. this is used to tx OP toxicity; is the only oxime approved in the US; prevents aging of OP-AChE complex; regenerates AChE; shortens time of OP effect 14. this type of pralidoxime dosing may be more effective in severe poisonings; is dosed 300 mg load then 150 mg/hr for adults and 15-50 mg/kg load then 10-20 mg/lg/hr for peds; follow clinical response and RBC ChE levels 15. this group of OP are the fluorophosphates; X = Fluorine; volatile and highly toxic; ex: sarin 16. summary of this class of pesticides is low environmental persistence, low toxicity in humans, synthetic are more toxic and cause Na+ channel blockade, seizures, treat w/benzodiazepines followed by phenytoin 18. pralidoxime kinetics for __________ individuals are Vd 2.8-8.8 l/kg, t1/2 3.44 hrs, Cl 0.57 L/kg/hr 20. these include insecticides (organophosphates, carbamates, organochlorines, pyrethrines, and nicotine), rodenticides, and herbicides 22. this is used in treatment of anticoags; replaces clotting factors, risks of blood products, only for bleeding or high risk of bleed 24. this is used to tx OP toxicity; is a competitieve antagonist at MR only; adult dose is 1-5 mg IV q 2-3 minutes until secretions dried; pedi dose is 0.05 mg/kg up to adult dose; may require up to 1 gm in 24 hrs 26. this type of treatment involves decontamination using soap and water, protection from caretakers, protecting airway, NG evacuation if intentional ingestion, activated charcol (> 1mg/kg), and cholestyramine 28. this group of OP has a cyanide or a halogen (except fluorine); cyanophasphates: tabun 29. this indicates properties of specific agents and attaches AChE and leaves thereby binding the OP to enzyme 30. the ______ of pesticides include development into chemical weapons, bioaccumulation, and persistence in environment 33. OP-induced delayed ___________ occurs 1-3 wks out, paresthesias then distal flaccidity, is agent specific, and may be due to inhibiton of neuronal target esterase 37. toxicity with this agent is caused by delayed closing of Na+ channels and prevents opening of K+ channels; repeated APs occur; tremors and exaggerated startle relflexes are sxs 40. lindane and cyclodienes are well absorbed through the ________, most are P450 inducers, and are lipophilic 41. the summary of this class of pesticides is neurotoxicity, lipophilicity, seizures, BDZs & barbs, environmental effects 42. toxicity of this class of rodenticides is treated with vitamin K and fresh frozen plasma 43. this rodenticide has been off=market since 1979; interrupts ox phos and intermediary metabolism; destroys pancreatic B cells --> IDDM (orthostasis, autonomic and peripheral neuropathy), and is tx'd with niancinamide and insulin for hyperglycemia 44. are very similar to OPs; tey are deriviatives of carbamic acid; used to treat myasthenia gravis and to reverse chemical paralysis; bind to ser residue on AChE like OPs but bond isn't as stron and AChE reactivated in 24 hrs; no aging; atropine txs this toxicity 45. __________ of organochlorides involves history, chlorinated hydrocarbons radiopaque, and gastric chromotography for confirmation 46. this type of receptor is located in the CNS (brain), end orgons innervated via PS nerve endings, and postganglionic S innervated sweat glands; not ion mediated but G protein mediated; DUMBBELS is acronym for toxicity 47. this accounts for varying throboplastin reagents among labs 48. pralidoxime kinetics for __________ individuals are Vd 0.8 L/kg and T1/2 is 75 min 49. cyclodienes, toxaphen, and Lindane are antagonists at this receptor; they block the Cl- channel and bind to picrotoxin site; they also sensitize myocardium; see tremors, seizures, and dysrhythmias 51. diphenhydramine and glycopyrrolate both have this type of effect so they will help w/OP treatment but not reverse it 52. this class of pesticides is lipophilic but rapidly metabolized, cause Na+ channel blockade, and is natural; cause allergic reactions in patients who have ragweed and pollen allergies 53. to ________ inhibition from strychnine, you treat w/minimal stimulii, BDZs, barbiturates, and paralysis and intubation 54. these are measured in 24-48 hours in a small, single ingestion or baseline for an intentional ingestion

Down 1. carbamate toxicity has the same sx as OPs except: altered mental status and depresion of RBC ChE not as prolonged; usually resove w/in 24-48 hrs; plasma elimination T1/2 is 1-2 hrs 2. this type of receptor is located in the CNS (spinal cord), the postganglionic autonomic neurons (S and PS), and skeletal neuromuscular junction; are Na+ channel mediated; sx of toxicity include muscle fasiculations, cramps, weakness, paralysis, tachycardia, and high BP 3. this class of pesticides is lipophilic but rapidly metabolized, cause Na+ channel blockade, and is synthetic; cause neurotoxicity 4. these two classes of pesticides, _________________ and _____________, block AChE, cause bradycardia/bronchspasm/bronchorrhea, treated with atropine and pralidoxime, delayed effects noted in OP, and decontamination and prevention 6. the ____________ pathway in vitamin K synthesis measures haparin activity 8. these are used to treat seizures because they don't cause as much respiratory depression as barbiturates 10. the ____________ for OP toxicity is atropine + pralidoxime 11. pralidoxime is dosed 1-2 g in 100 ml NS IV over 15-30 min for adults and 20-40 mg/kg IV over 30 min in peds for this type of dosing; repeat in 1 hr if no improvement in muscle weakness then repeat q8h prn; faster rates of adminassociated w/cardiac arrest 12. this goup of OP is the largest group; majority are dimethoxy or diethoxy; mostly insecticides: malathion and parathion 13. these anticoagulants are more lipid soluble, saturate microsonal enzymes at low levels, and have a longer duration of action 17. this class of pesticides has 4 groups; X indicates properties of specific agents and attaches AChE and leaves thereby binding the OP to enzyme 19. this class of pesticides makes a permenent covalent bond with AChE and involves aging 21. this type of exposure to chlordecone, which has a very long persistence, involves neurotoxicity (tremors, startle response), Kepone shakes (whole body shakes), and reproductive toxicity 23. treatment of these due to organochlorines include benzodiazepines and barbiturates 25. factors 2, 7, 9, and 10 are dependent upon ________ ___ in order to be synthesized; warfarin prevents regeneration of these clotting factors 27. if pt undergoing this procedure, use nondepolarizing NM blockers b/c depolarizing ones may prolong paralysis 31. these cause elevation of PT/INR and bleeding; most effective in a large single ingestion and multiple small ingestions 32. this is a rodenticide; it antagonizes glycine, which is an inhibitory NT; see muscle spasms, seizures,opisthotonos, risus sardonicus; need to differentiate from tetanus 34. this group of pesticides has different PKs but have the same toxicities; has 4 categories: hexachlorocyclohexae (Lindane), dichlorodiphenylthichloroethane (DDT), cyclodienes (aldrin), and mirex and chlordecone 35. this class of rodenticides includes warfarin and superwarfarins 36. this also means excess oral secretions; OP tx of this includes oxygenate and atropine 38. the __________ pathway in the vitamin K cycle is measured by PPT and INR; measures warfarin activity 39. pralidoxime has its most _____________ effect at N sites, which improves muscle strength, but also is very effective at M sites 50. this is the permanent binding of OP to AChE; has 3 stages; pralidoxime won't be effective after stage 3 occurs