| four | | the ____________ for OP toxicity is atropine pralidoxime |
| anticoagulants | | 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 |
| carbamates | | 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 |
| atropine | | this group of OP has a cyanide or a halogen (except fluorine); cyanophasphates: tabun |
| cons | | pralidoxime kinetics for __________ individuals are Vd 2.8-8.8 l/kg, t1/2 3.44 hrs, Cl 0.57 L/kg/hr |
| pros | | this class of rodenticides includes warfarin and superwarfarins |
| coags | | the ________ of pesticides include increased crop yeilds, better food quality, and decrease in insect-borne disease |
| diagnosis | | 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 |
| poisoned | | these include insecticides (organophosphates, carbamates, organochlorines, pyrethrines, and nicotine), rodenticides, and herbicides |
| three | | this group of OP are the fluorophosphates; X = Fluorine; volatile and highly toxic; ex: sarin |
| antidote | | 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 |
| benzodiazepines | | 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 |
| seizures | | the __________ pathway in the vitamin K cycle is measured by PPT and INR; measures warfarin activity |
| organophosphates | | 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 |
| vitamink | | pralidoxime kinetics for __________ individuals are Vd 0.8 L/kg and T1/2 is 75 min |
| one | | this class of pesticides is lipophilic but rapidly metabolized, cause Na channel blockade, and is synthetic; cause neurotoxicity |
| aging | | 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 |
| pralidoxime | | this is used in treatment of anticoags; replaces clotting factors, risks of blood products, only for bleeding or high risk of bleed |
| INR | | 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 |
| organochlorines | | this class of pesticides has 4 groups; X indicates properties of specific agents and attaches AChE and leaves thereby binding the OP to enzyme |
| two | | the ______ of pesticides include development into chemical weapons, bioaccumulation, and persistence in environment |
| significant | | 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 |
| neuropathy | | pralidoxime has its most _____________ effect at N sites, which improves muscle strength, but also is very effective at M sites |
| vacor | | this goup of OP is the largest group; majority are dimethoxy or diethoxy; mostly insecticides: malathion and parathion |
| intermittent | | toxicity of this class of rodenticides is treated with vitamin K and fresh frozen plasma |
| symptoms | | 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 |
| freshfrozenplasma | | the ____________ pathway in vitamin K synthesis measures haparin activity |
| superwarfarins | | 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 |
| pesticides | | 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 |
| superwarfarins | | 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 |
| GABAa | | this indicates properties of specific agents and attaches AChE and leaves thereby binding the OP to enzyme |
| continuousinfusion | | this also means excess oral secretions; OP tx of this includes oxygenate and atropine |
| pyrethrinspyrethroids | | this class of pesticides makes a permenent covalent bond with AChE and involves aging |
| chronic | | 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 |
| pyrethroids | | 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 |
| nicotinic | | this is a rodenticide; it antagonizes glycine, which is an inhibitory NT; see muscle spasms, seizures,opisthotonos, risus sardonicus; need to differentiate from tetanus |
| skin | | these cause elevation of PT/INR and bleeding; most effective in a large single ingestion and multiple small ingestions |
| intubation | | __________ of organochlorides involves history, chlorinated hydrocarbons radiopaque, and gastric chromotography for confirmation |
| healthy | | 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 |
| extrinsic | | these are measured in 24-48 hours in a small, single ingestion or baseline for an intentional ingestion |
| antimuscarinic | | 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 |
| anticoagulant | | if pt undergoing this procedure, use nondepolarizing NM blockers b/c depolarizing ones may prolong paralysis |
| strychnine | | this accounts for varying throboplastin reagents among labs |
| restore | | 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 |
| organophosphatescarbamates | | these are used to treat seizures because they don't cause as much respiratory depression as barbiturates |
| organochlorine | | to ________ inhibition from strychnine, you treat w/minimal stimulii, BDZs, barbiturates, and paralysis and intubation |
| intrinsic | | 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 |
| organophosphates | | 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 |
| DDT | | the summary of this class of pesticides is neurotoxicity, lipophilicity, seizures, BDZs |
| bronchorrea | | lindane and cyclodienes are well absorbed through the ________, most are P450 inducers, and are lipophilic |
| intermediate | | diphenhydramine and glycopyrrolate both have this type of effect so they will help w/OP treatment but not reverse it |
| supportive | | factors 2, 7, 9, and 10 are dependent upon ________ ___ in order to be synthesized; warfarin prevents regeneration of these clotting factors |
| muscarinic | | this is the permanent binding of OP to AChE; has 3 stages; pralidoxime won't be effective after stage 3 occurs |
| pyrethrins | | these anticoagulants are more lipid soluble, saturate microsonal enzymes at low levels, and have a longer duration of action |
| leavinggroup | | treatment of these due to organochlorines include benzodiazepines and barbiturates |
