Материал: 2016_Kaplan_USMLE_Step_1_Lecture_Notes_Pharmacology

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Chapter 1 λ Toxicology

Table XI-1-5. Purified Nutritional Supplements

Name		Pharmacology		Side Effects
Dehydroepiandrosterone	Androgen precursor advocated		Females:
(DHEA)	for treatment of AIDS (↑ CD4 in		androgenization
		females), Alzheimer disease	and concern
		and “aging,” diabetes,		regarding CV
		hypercholesterolemia, and SLE	disease and breast
		(↓ in symptoms and “flare-	cancer
		ups” in females)	Males:
			Males:
			feminization in
			young and concern
			in elderly regarding
			BPH and cancer
Melatonin	Serotonin metabolite used for		Drowsiness,
	“jet-lag” and sleep disorders		sedation,
			headache.
			Contraindicated
			in pregnancy, in
			women trying to
			conceive (↓ LH),
				and in nursing
				mothers
				(↓ prolactin)

Chapter Summary

λTable XI-1-1 lists the common toxic syndromes with their signs and symptoms and potential modes of intervention and/or antidotes.

λTable XI-1-2 lists the common heavy metal poisons with their most common sources, signs, and symptoms and potential modes of intervention and/or antidotes.

λTable XI-1-3 lists antidotes and the type of poisoning against which they act.

λTable XI-1-4 lists the characteristics of selected herbals, and Table XI-1-5 lists the relevant purified nutritional supplements.

319

Toxicology Practice Questions

1.Chronic ingestion of lead-based paint chips will result in which of the following?

A.Garlic breath

B.Changes in skin pigmentation

C.Accumulation of δ-aminolevulinate and inhibition of heme synthesis

D.Auditory and visual loss

E.Interstitial pneumonitis and neurological effects

2.A 3-year-old child was brought to the ER following the ingestion of several pills. The child is suffering from severe gastrointestinal discomfort and has thrown up twice, each time producing a bloody vomitus. Questioning of the mother reveals the child got into the mother’s old prenatal vitamins. What antidote should be given?

A.Dimercaprol

B.Deferoxamine

C.EDTA

D.Penicillamine

E.Succimer

Answers

1.Answer: C. Chronic poisoning with lead will result in a multitude of

effects including inhibition of heme synthesis and accumulation of δ-aminolevulinate in the plasma. Arsenic poisoning is associated with garlic breath and changes in skin pigmentation. Organic mercury causes auditory and visual loss and loosening of the teeth, while inhaled mercury vapor can cause interstitial pneumonitis and neurological effects.

2.Answer: B. The child is suffering from iron poisoning. Deferoxamine chelates iron and is the antidote in iron poisoning. The other choices are all metal chelators with utility in other types of heavy metal poisoning. Dimercaprol is useful for a variety of metals including lead, arsenic, and mercury. EDTA is a back-up in lead poisoning. Penicillamine is useful in copper poisoning, and succimer is preferred for lead poisoning in kids.

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Index

Abciximab characteristics/uses, 266 clinical uses, 310 platelet activation, 265

Absorption, 3, 6–7 antacid impact, 225 bioavailability, 6, 7, 10 first-pass effect, 7

of quinidine, antacid impact on, 106 plasma level curves, 6

Abuse, 71. See Drugs of abuse Acarbose

characteristics/uses, 275 modes of action, 275

Accommodation mechanisms, 43 Acebutolol, characteristics/uses, 62, 107 Acetaldehyde toxicity, 138 Acetaminophen

antidote for, 31 characteristics/uses, 233 cytochrome P450 isozymes, 10 for migraine headaches, 228 metabolism, 11

Acetazolamide

as carbonic anhydrase inhibitor, 84 modes of action/effects, 88

Acetylation, 11

Acetylcholine (ACh), 40. See also Cholinergic pharmacology cholinergic properties, 47

drugs mimicking. See Cholinomimetics receptors for, 23, 24

Acetylcholinesterase (AChE), 45, 46 inhibition. See AChE inhibitors

Acetyl CoA, 46 Acetylcysteine, as antidote, 317 Acetylsalicylic acid (ASA)

characteristics/uses, 231–232 common toxic syndromes, 315 for migraine headaches, 228

AChE inhibitors, 45–46 drug lists, 48, 71

poisoning with, 48–49, 316, 317 toxicity, 48–49

Acidification of urine, 5

Acidosis

alcohols and, 137 diuretics causing, 88

Action potential, cardiac fast-response fibers, 101, 101–102 slow-response fibers, 103, 103–104

Action potential duration (ADP), and effective refractory period, 104

Activated charcoal, as antidote, 317 Active metabolites, 9

Active transport, 5

Acute mountain sickness, drugs for treating, 84 Acyclovir

characteristics/uses, 200 mechanism of action, 200

Adalimumab, clinical uses of, 235, 310 Adenosine, characteristics/uses, 108–109 Adenosine triphosphate (ATP), 24 Adenyl cyclase, 24

Adrenal steroids, characteristics/uses, 279, 283 Adrenergic pharmacology

adrenergic receptor activators, 57, 58–61, 71 adrenergic receptor antagonists, 61–64, 71 catecholamine synthesis/action/degradation, 55

Adrenergic receptor activators, 55, 57 direct-acting, 58, 58–61, 71

drug list, 71 indirect-acting, 61, 71 mechanisms used by, 58 mixed, 71 mixed-acting, 59–61 α1 agonists, 43

α2 agonists, 57, 71

βagonists, 59, 71 Adrenergic receptor antagonists

drug list, 71

indirect-acting, 71

α1 antagonists, 71 α2 antagonists,, 71 α antagonists, 61–62

βreceptor antagonists, 62, 62–63, 71, 94 Adrenergic stimulation, 44

Adrenoceptors, 24 sensitivity, 57

Adrenocorticotropin hormone (ACTH), 287 Adrensl steroids, drug list, 291

323

Источник: https://studfile.net/preview/16445239/

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