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Pesticide Poisoning

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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

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