Chapter 30 Toxicology and Drugs of Abuse
1. Toxicology is the study of the hazardous effects of chemicals, including drugs, on biologic systems.
2. Toxicity is a reflection of how much, how fast, and how long an individual is exposed to a poison.
• Individuals are fast or slow acetylators of isoniazid (slow acetylator have increased neurotoxicity).
• Increased risk of drug-induced torsades de pointes with mutations in ion channels leading to prolonged QT interval
• Interactions between drugs and between drugs and environmental chemicals may occur by both toxicokinetic and toxicodynamic mechanisms
TABLE 30-2 Specific Antidotes for Selected Drugs and Toxins
Antidote | Poison |
---|---|
Drugs That Chelate Metals | |
Calcium disodium edetate (CA2+,2Na+EDTA) | Lead |
Deferoxamine | Iron |
Dimercaprol | Arsenic, gold, mercury, lead |
Penicillamine | Lead, copper, arsenic, gold |
Succimer | Lead; also used for chronic exposure to arsenic and mercury |
Substances That Act Against Specific Drugs or Toxins | |
Acetylcysteine | Acetaminophen |
Amyl nitrite/sodium nitrate | Cyanide |
Atropine | Cholinesterase inhibitor |
Digoxin-specific FAB antibodies | Cardiac glycosides (e.g., digoxin) |
Esmolol | Theophylline, caffeine, metaproterenol |
Ethanol | Methanol or ethylene glycol |
Flumazenil | Benzodiazepine |
Fomepizole | Ethylene glycol, methanol |
Glucagon | Beta blockers |
Naloxone | Opioids |
Oxygen | Carbon monoxide |
Physostigmine | Anticholinergics |
Pralidoxime (2-PAM) | Organophosphates; contraindicated for carbamates |
Pyridoxine | Isoniazid |
Sodium bicarbonate | Cardiac depressants (tricyclic antidepressants, quinidine) |
Sodium thiosulfate | Cyanide |
FAB, fragment antigen binding.
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