Loading...
Question 1
What is toxicology?
study of harmful effects of physical and chemical agents
Question 2
What is acute toxicity?
Single exposure to a toxic substance, such as a snake bite.
Question 3
What is chronic toxicity?
Multiple exposure to a toxic substance
Question 4
What is delayed-onset toxicity?
Toxicity after an interval following exposure
Question 5
What are toxidromes?
set of symptoms that can be caused by specific drugs or toxins
Question 6
Possible causes of HT and Tachycardia
Amphetamines, cocaine, nicotine and antimuscarinic drugs
Question 7
Possible causes of HypoT and bradychardia
Opioids, Clonidine, sedatives-hypnotics, β-blockers
Question 8
Possible causes of flaccid coma
Opioids sedatives/hypnotics
Question 9
Possible causes of dysarthria, ataxia, nystagmus
Phenytoin, alcohol and sedatives
Question 10
Possible causes of ileus (bowl obstruction)
Antimuscarinics, opioids and sedatives
Question 11
What are the major deleterious effects of chronic lead exposure, especially for children?
Impaired bone formation and developmental issues
Question 12
What are some sources of lead exposure?
Sources include exposure to old paint, industrial pollution, contaminated water, and contaminated dust.
Question 13
What are the early signs of lead exposure?
constipation and a metallic taste in the mouth
Question 14
What is a sign of lead poisoning
Burton’s line
Question 15
What are the CNS effects of lead intoxication?
Headaches, confusion, fatigue, and impaired concentration.
Question 16
How does lead intoxication affect erythrocyte life span?
It shortens the erythrocyte life span
Question 17
What is the treatment for lead intoxication?
Chelation therapy
Question 18
What are the three forms of mercury mentioned in the slide?
Elemental, inorganic salts, and organic salts
Question 19
How is elemental mercury absorbed?
By inhalation, liquid at room temp
Question 20
What are inorganic mercury salts?
Mercuric or mercurous salts absorbed via dermal route
Question 21
What are organic mercury salts
methylmercury lipid soluble form that permeate cell membrane and BBB
Question 22
What are the symptoms of mercury poisoning?
Neurotoxicity, nephrotoxicity, excessive salivation, irritability, and teratogenicity.
Question 23
What are the effects of acute high-level exposure to mercury vapor?
Corrosive inflammation of upper + lower respiratory tract nephrotoxic and neurotoxic effects
Question 24
What is Minamata disease?
Neurological syndrome caused by chronic mercury poisoning, ataxia, muscle weakness, loss of hearing and vision
Question 25
What are the recommended guidelines for minimizing mercury exposure in the dental environment?
• pre-encapsulated amalgam preparations with PPE • recycled and properly dispose of capsules • use Amalgam separator traps
Question 26
What are the sources of fluoride poisoning?
• Water with high fluoride content (>1ppm) • accidental ingestion of fluoride supplements • fluorine-containing insecticides
Question 27
Age group most susceptible to fluoride poisoning
Children (<6 years) from toothpaste or mouthwash ingestion
Question 28
What are the symptoms of acute fluoride toxicity?
GI disturbances Severe cases: renal and cardiac failure, coma
Question 29
What causes chronic toxicity (fluorosis)?
High concentrations in water chronic use of fluoride supplements
Question 30
What are the consequences of severe chronic toxicity (fluorosis)?
Skeletal fluorosis fragile bones → risk of fractures possible joint damage
Question 31
What is the mechanism of action of fluoride in dental fluorosis?
• Amelogenin binds to fluoridated hydroxyapatite • interferes w/ matrix proteinase • fluoride can cause apoptosis of ameloblast
Question 32
What are the acute management steps for dental fluorosis?
IV fluid, calcium, and symptom control.
Question 33
Carbon monoxide poisoning patho
carbon monoxide bind to oxygen-binding sites in Hb forms carboxyhemoglobin leading to ischemic injuries
Question 34
Carbon monoxide poisoning symptoms
headache, dyspnea, tachycardia, fatality
Question 35
What is the recommended daily dosage of acetaminophen?
not exceed 4 g/day
Question 36
What are the four phases of acetaminophen toxicity?
Phase 1: 0 to 24 hours Phase 2: 24 to 72 hours Phase 3: 72 to 96 hours Phase 4: > 4 days to 2 weeks
Question 37
At what level does acetaminophen toxicity develop?
7.5 - 10 g/day and it is exacerbated by alcohol use
Question 38
What is N-acetyl-P-benzoquinolone imine (NAPQI)?
A toxic metabolite of acetaminophen produced by CYP450
Question 39
Mechanism of acetaminophen toxcity
Excess acetaminophen = saturation of metabolic pathway → accumulation of excess NAPQI → liver injury + hepatocyte damage
Question 40
What is the antidote for acetaminophen overdose?
N-acetylcysteine
Question 41
Causes of Salicylates toxicity
1. Aspirin 2. Oil of Wintergreen 3. bismuth subsalicylate
Question 42
What is the maximum daily dose of aspirin?
4 g/day
Question 43
when does Acute Salicylate toxicity develop
few hours after large single overdose (100 mg/dl or around 10 gm)
Question 44
What are the symptoms of salicylism?
Tinnitus, hearing loss, vomiting, vertigo.
Question 45
What is the treatment for salicylate toxicity?
Administration of charcoal urine alkylation by sodium bicarbonate
Question 46
What is Kava kava?
Kava kava is a herbal supplement derived from the roots of Piper methysticum.
Question 47
What are the uses of Kava kava?
recreational drink in some countries herbal supplement to treat anxiety, insomnia, decrease hypertension, pain management, and kidney cleanser
Question 48
What are the adverse effects of Kava kava?
acute liver injury that can lead to fatal complications
Question 49
What is hemodialysis and how does it enhance the elimination of certain medications/toxins?
blood is filtered through a dialyzer to remove waste products and excess fluids elimination of certain medications/toxin by filtering them out of the blood
Question 50
How does urinary alkalization enhance the elimination of salicylates?
• increasing urine pH with IV sod. bicarb • transforms salicylates into an ionized form • ↑ renal excretion and reduces toxicity
Question 51
What is activated charcoal and how does it enhance elimination
highly porous material w/ large surface area adsorbs medications, enhancing their elimination
Question 52
What is a substance use disorder?
Excessive use of illicit substances leading to social, academic, and occupational impairment
Question 53
Time criteria for diagnosis SUD
>2 symptoms in past 12 months
Question 54
What are the 11 diagnostic criteria for Substance Use Disorder (SUD) according to DSM-V?
1. Larger amounts/ longer period 2. Desire to stop 3. Spending a lot of time 4. Cravings 5. Failure to fulfill responsibilities 6. Giving up important activities 7. Recurrent use 8. Continuous use despite physical/psychological problems 9. Continuous use despite relationship problems or work obligations 10. Tolerance 11. Withdrawal symptoms
Question 55
What are the three categories of SUD based on the number of symptoms?
Mild, Moderate, Severe
Question 56
What defines a Mild SUD?
Presence of 2-3 symptoms in the past 12 months
Question 57
What defines a Moderate SUD?
Presence of 4-5 symptoms in the past 12 months
Question 58
What defines a Severe SUD?
Presence of 6 or more symptoms in the past 12 months
Question 59
What percentage of patients diagnosed with SUD received treatment in 2020?
6.5%
Question 60
How many people died from drug overdoses in 2023?
105,000
Question 61
!0 classes of substances
• Alcohol • Tabacco • Caffeine • Cannabis/Marijuana • Heroin • Fentanyl • Opioids • Sedatives, hypnotics • Stimulants • Inhalants
Question 62
Risk factors for SUD
Multifactorial • psychological • biological • socio-cultural • environmental factors
Question 63
Examples of risk factors
psychiatric disorders genetic factors adverse childhood experiences
Question 64
What are the four stages of substance use disorder (SUD) pathophysiology?
Pleasure or reward effect Dependence Tolerance Stopping lead to withdrawal
Question 65
What is the primary component responsible for alcohol's effects?
Ethanol content
Question 66
What is the main site of ethanol absorption in the body?
Proximal portion of the small intestine (duodenum/jejunum)
Question 67
What is the first metabolite produced from ethanol in the liver?
Acetaldehyde
Question 68
What enzyme is responsible for the metabolism of ethanol in the liver?
Alcohol dehydrogenase
Question 69
What is the impact of ethanol on the brain?
Ethanol initially has a rewarding and relaxing effect then decreases cognitive function and movement coordination
Question 70
How does ethanol affect the brain's neurotransmitter systems?
GABA agonist glutamate antagonist
Question 71
Ethanol's effect on neurotransmitters
• activates opioid receptors • release of endorphins • triggers release of dopamine and serotonin
Question 72
Ethanol effect on medulla
decrease respiratory rate and reduce consciousness
Question 73
At what level does alcohol intoxication typically develop?
BAC: 0.16-0.3 % slurred speech, vomiting, amnesia
Question 74
What is the BAC level that leads to respiratory suppression and death?
> 0.31 %
Question 75
What are the long-term complications of chronic alcoholism?
Psychiatric:
dependence and withdrawal symptoms
Physical:
• arrhythmia, cardiomyopathy • inflammation of liver • pancreatitis • cancers
Excessive large doses:
• cardiac and respiratory depression •unconsciousness •death
Question 76
What are the symptoms of alcohol withdrawal?
Anxiety, depression, irritability, fatigue, tremors, difficulty sleeping, vomiting, and seizures.
Question 77
What is delirium tremens and what are its symptoms?
severe complication of alcohol withdrawal high fever, intense agitation, visual hallucinations, and tactile hallucinations
Question 78
Alcohol cessation strategies
Non-pharm: CBT Pharm: disulfiram and naltrexone
Question 79
What is the mechanism of action of Disulfiram in alcohol cessation?
inhibits alcohol metabolism
inhibiting acetaldehyde dehydrogenase → build-up of acetaldehyde + hangover
Question 80
What is the effect of prescribing opioids in patients receiving Naltrexone?
Prescribing opioids in patients receiving Naltrexone will diminish opioid activity.
Question 81
What are the side effects of disulfiram?
nausea, flushing, vomiting, headache, and unpleasant effects
Question 82
What are the symptoms of ethanol intoxication in young children?
Severe to fatal hypoglycemia leading to hypoglycemic seizures and death.
Question 83
What are the symptoms of ethanol intoxication in adolescents?
Slurred speech, incoordination, unsteady gait, memory impairment, and CNS depression. Hypoglycemia may occur.
Question 84
What is the management of ethanol intoxication?
Airway, breathing, oxygen, dextrose (hypoglycemia), and fluids.
Question 85
What is methanol and what are its effects?
carcinogenic and toxic alcohol causes retinal injury, seizures, and blindness
Question 86
What is the mechanism of methanol intoxication and what is the antidote?
oxidized to formic acid, lead to permanent blindness Antidote: Fomepizole inhibits methanol oxidation to formic acid
Question 87
What is Nicotine Use Disorder?
continued use of nicotine despite negative consequences
Question 88
What are two health risks associated with smoking?
Myocardial infarction and stroke.
Question 89
What are the effects of formaldehyde on the body?
Causes endothelial cell damage and various inflammatory reactions
Question 90
What is nicotine?
Primary component of tobacco that drives tobacco addiction
Question 91
What is the primary route of absorption for nicotine?
Inhalation from lung alveoli
Question 92
What are the effects of nicotine on neurotransmitters in the CNS?
Nicotine triggers the release of glutamate and dopamine.
Question 93
Effects of low doses of nicotine
some euphoria and arousal improves attention, learning, problem solving, and reaction time
Question 94
High doses of nicotine
CNS/medullary paralysis
Question 95
List the physiological effects of nicotine in the PNS.
↑ BP, HR, cardiac contractility smooth muscle contraction causes vasoconstriction increases metabolism rate of medications
Question 96
What are the withdrawal symptoms of nicotine?
Cravings, irritability, restlessness, difficulty concentrating, anxiety, excessive hunger, and sleep disturbance.
Question 97
How long after quitting do withdrawal symptoms typically start?
Within a few hours from the last cigarette.
Question 98
When are withdrawal symptoms the strongest?
2-3 days after quitting
Question 99
Forms of nicotine replacement therapy
Patch, gum, lozenge, nasal spray
Question 100
Medications that act on nicotinic receptors?
Bupropion, Varenicline
Question 101
MOA of Bupropion
Dopamine-norepinephrine reuptake inhibitor
Question 102
What is the MOA of Varenicline?
Nicotine receptor partial agonist