PHARMACY PREP.

TOXYCOLOGY
1- Antidote of mercury may include:
a) Dimercaprol
b) EDTA
c) Deferoximine
d) Succimer
e) Naloxone

2- Which of the following is a benzodiazepinics antagonist:

a) Naloxone
b) Physostigmine
c) Flumazenil
d) Naltrexone
e) Penicillamine

3- What would be the best treatment for cyanide poisoning?

a) Antivenin
b) Sodium thiosulfite
c) Acetylcystein
d) Oxygen therapy
e) Sodium bicarbonate

4- Carbon monoxide can be highly toxic because it easily binds to:

I- Hemoglobin
II- Myoglobin
III- Cytochrome oxidase
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct
5- Acetaminophen toxicity most well know complication is:
a) Cardiovascular failure
b) Pulmonary edema
c) CNS lethargy
d) Liver necrosis
e) Sedation
6- Salicylate toxicity treatment include which of the following?
I- Alkalinization of urine with sodium bicarbonate
II- Decontamination with syrup of IPECAC until 30 minutes of overdose
III- CHARCOAL every 6 hours
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

7- Hyperphosphatemia is best treated by:

a) Magnesium hydroxide
b) Calcium carbonate
c) Aluminium hydroxide
d) Sodium Bicarbonate
e) Sodium phosphate

8- Correct statements regarding IPECAC may include:

I- It has an emetic effect when large doses are administrated
II- It has a expectorant effect when small doses (1 to 2mls) is administrated
III- Used in decontamination procedures during toxic treatments
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

9- The organophosphates commonly found in insecticides are thought to act

by witch of the following mechanisms?
a) Combining with acetylcholine
b) Potentiating the action of acetylcholinesterase
c) Forming a very stable complex with acetylcholinesterase
d) Reacting at the cholinergic receptor
e) Preventing the release of acetylcholine from the nerve ending

10- all of the following can be recognized as atropine poisoning, EXCEPT:

a) Dry skin
b) Mydriasis
c) Flushed appearance
d) Diarrhea
e) Delirium

11- Antidote for atropine poisoning may include:

a) Physostigmine
b) Aminophillim
c) Pralidoxine
d) Flumazenil
e) Dimercaprol

12- Poison Ivy can be treated by which of the following agents?

I- Topical antipruritic
II- Antihistaminics
III- Systemic corticosteroids
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

13- A patient is stabilized on heparin as anticoagulant. After one hour of

administration of the drug, he exercised bleeding from his gums, while he
was brushing his teeth. The pharmacist can advise him to take:
a) Ascorbic acid
b) Vitamin K
c) Protamine sulfate
d) Warfarin
e) Quinolone

14- N-acetyl-cysteine may be the antidote of choice for which of the

following agents?
a) Aspirin
b) Warfarin
c) Digoxin
d) Lead
e) Acetaminophen

15- Dimercaprol (BAL) + mercury (Hg) combination characteristics include:

I- Dimercaprol is the best antidote for elemental mercury inhalation
poisoning
II- They form a stable complex excreted renally
III- Penicillamine is an alternative when mercury suffer GIT absorption
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

16- Naloxone is the best antidote for which of the following overdose
agents?
a) Opioid overdose
b) Heavy metal overdose
c) Benzodiazepinics overdose
d) Organophosphate overdose
e) Digitalis overdose

17- Management and characteristics of Digoxin toxicity may include:

I- May cause heart failure, cardiac dysrrhythmias, nausea, anorexia,
vomiting, and confusion
II- Treated by decontamination and supportive therapy
III- Treated with a digoxin specific antidote known as FAB antibodies
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

18- Death due to cyanide poisoning is due to:

a) Cyanide-RBCs complex formation
b) Cyanide-hemoglobin complex formation
c) Cyanide inhibiting of cytochrome oxidase
d) Cyanide increasing hemoglobin levels
e) Coronary vessel oclusion

19- The toxicity of methyl alcohol is due to formation of:

a) Ketones
b) Formaldehyde
c) Free alcohol radicals
d) Ethylene
e) Aldehyde

20- Acetaminophen toxicity is due to:

a) Oxidation stress
b) Active metabolite
c) Free radical chain
d) Reactive metabolite
e) Reduction of metabolite

21- Salicylate toxicity excessive respiration is due to:

I- Excess production of CO2
II- Pulmonary irritation
III- Central stimulation in the brain
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

22- Grayish mouth and loose of teeth are toxic symptoms of:
I- Fe salts poisoning
II- Cu poisoning
III- Lead poisoning
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

23- Vomiting is contra indicated if poisoning is due to:

I- Bleaching
II- Gasoline
III- Light petroleum
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

24- Universal antidote is a mixture of:

I- Activated charcoal
II- Magnesium oxide
III- Tannic acid
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

25- Amphetamines overdose is best treated with administration of:

a) Salicylates
b) Benzodiazepinics
c) Barbiturates
d) Naloxone
e) B and C are right.
26- True statements regarding the treatment of hyperkalemia:
I- If change in ECG is detected give Ca to counteract the excess of K on the
heart
II- Bicarbonate and insulin administration can shift K from extra to
intracellular
III- Enema of kafexolate (exchange resin) or dialysis helps to remove excess
of K from the body
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

27- Cardiovascular drug that overdose can cause cyanide intoxication

include:
a) Nitrates
b) Nitroglycerin
c) Nitroprusside
d) Isosorbide
e) Isosorbide dinitrate

28- Lead poisoning can be treated by:

I- BAL-Dimercaprol
II- EDTA-Edentate
III- Penicillamine
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

29- Specific antidote for iron preparations overdose include:

a) Dimercaprol
b) Deferoxamine
c) Penicillamine
d) Naloxone
e) Sucimmer

30- Atropine, an anticholinergic drug is used as antidote in the poisoning

treatment of:
a) Organophosphates
b) Heavy metal
c) Salicylates
d) Tricyclic antidepressants
e) Iron

31- Treatment of tricyclic antidepressants overdose is done by all the

following procedures, EXCEPT:
a) Control the seizures and cardiotoxicity
b) Administration of benzodiazepinics or phenytoin to control seizures
c) Activated charcoal can be used
d) MAO antidepressants can helps to overcome the patient’s seizure
e) Control acidosis with administration of sodium bicarbonate

32- Specific antidote used for poisoning caused by snake and black spider
bits
a) Deferoxamine
b) Ancrod
c) Antivenin
d) Psysostigmine
e) Naloxone

33- Best treatment for carbon monoxide intoxication:

a) Alkalinization of urine
b) Oxygen therapy
c) Supportive therapy
d) Acidification of urine
e) Gastric lavage

34- Which of the following is the isoniazide antidote?

a) Vitamin A
b) Bitamin B6
c) Vitamin B12
d) Folic acid
e) Vitamin E

35- Which of the following is considered the warfarin antidote?

a) Vitamin K
b) Heparin
c) Protamine
d) Filgrastin
e) Vitamin E

36- The major first step in the initial management of ANY intoxication and
poisoning is the supportive care treatment that involve:
a) Detoxification
b) Decontamination
c) Hydration
d) Evaluation and support of vital function (Airway, Breath and Circulation-
ABC)
e) Toxicology laboratory tests

37- General management in treating patients with depressed mental status

include:
I- Treat hypoglycemia with 50mls of dextrose 50%
II- Administration of thiamine 100mg IV push
III- Administration of naloxone
a) I only
b) III only
c) I and II only
d) II and III only
e) All are correct

38- Decontamination procedures may include:

a) Gastric lavage
b) Emesis
c) Administration of activated charcoal
d) Administration of adsorbent agents
e) All are correct

39- Intravenous calcium administration is used in which of the following

situations?
a) Verapamil overdoses
b) Cocaine overdose
c) Verapamil overdose and hyperkalemia
d) Hyperkalemia
e) Nifedipeno overdose
 CORRECT ANSWERS
TOXICOLOGY

1- A
Comments: Antidote of elemental mercury inhalation is dimercaprol and
inorganic salt mercury gastrointestinal absorption the antidote may be
dimercaprol and penicillamine as well.

2- C
Comments: Flumazenil is a benzodiazepinic antagonist therefore used as
antidote in benzodiazepinic overdoses.

3- B
Comments: Treatment for cyanide poisoning may be done by sodium
thiosulfite, amyl and sodium nitrile as well.

4- E
Comments: Carbon monoxide can be highly toxic due to its ability to rapidly
bind to hemoglobin, myoglobin and cytochrome oxidase. Essential
components for the vital functions in human body.

5- D
Comments: The main and more serious implication concerning
acetaminophen toxicity is liver necrosis

6- E
Comments: Salicylate toxicity treatment can first be done by control of the
vital functions following administration of sodium bicarbonate to alkalinize
the urine and correct the acidosis, decontamination with syrup of IPECAC
until 30 minutes of overdose and CHARCOAL every 6 hours may be
considered. In case of failure of these methods, hemodialysis should be
considered.

7- C
Comments: Aluminum hydroxide causes hypophosphatemia as side effect
therefore may be used in the treatment of hyperphosphatemia.

8- E
Comments: IPECAC is a gastric decontaminant agent used in the treatment
of overdoses and poisonings of many different agents. It acts by inducing
vomiting and is best used within 60 minutes of agent ingestion. It also has an
expectorant effect when used in very low doses.

9- C
Comments: Organophosphates are substances commonly found in
insecticides in very toxic to humans due to formation of a very stable
complex with acetylcholinesterase

10- D
Comments: Constipation is a common side effect of atropine poisoning,
therefore we should not consider diarrhea as atropine symptoms of overdose.

11- A
Comments: Physostigmine is considered as the best antidote for atropine
poisoning and for antihistaminic overdose as well.
12- E
Comments: Poison Ivy can be treated by topical antipruritic, oral
antihistaminic and systemic corticosteroids in case of severe poisoning.

13- C
Comments: Protamine sulfate is the recommended antidote for heparin

14- E
Comments: N-acetyl-cysteine is the specific antidote for acetaminophen
overdose or poisoning.

15- E
Comments: Antidote of elemental mercury inhalation is dimercaprol and
inorganic salt mercury gastrointestinal absorption the antidote may be
dimercaprol and penicillamine as well.

16- A
Comments: Naloxone is a pure opioid antagonist used in opioids overdose.

17- E
Comments: Digoxin toxicity may cause heart failure, cardiac dysrrhythmias,
nausea, anorexia, vomiting, and confusion. The first step in the treatment of
overdoses should include decontamination and supportive therapy. Digoxin
has a specific antidote known as FAB antibodies (Digibind).

18- B
Comments: Death due to cyanide poisoning is primarily due to cyanide-
hemoglobin complex formation.

19- B
Comments: The toxicity of methyl alcohol is mainly due to formation of
formaldehyde.

20- D
Comments: Acetaminophen toxicity is mainly due to reactive metabolite.

21- A
Comments: 21- Salicylate toxicity excessive respiration is due to excess
production of CO2.

22- B
Comments: Lead poisoning is mainly characterized by grayish mouth and
loose of teeth. The best antidote for lead poisoning includes dimercaprol,
edentate, penicillamine and succimer.

23- E
Comments: Vomiting induction normally done by administration of IPECA
is contra indicated if poisoning is due to bleaching, gasoline, light petroleum
and/or any other corrosive substance.

24- E
Comments: Universal antidote is a mixture of activated charcoal, magnesium
oxide and tannic acid.

25- E
Comments: The main concerning in amphetamines overdose is the control of
the seizures that can be done by either benzodiazepinic or barbiturate agents.

26- E
Comments: Hyperkalemia should be immediately treated if change in ECG
is detected; give Ca to counteract the excess of K on the heart and other
treatments may be considered such as bicarbonate and insulin administration
that can shift K from extra to intracellular. Alternative treatment of
hyperkalemia include enema of kafexolate (exchange resin) or dialysis that
helps to remove excess of K from the body.

27- C
Comments: Nitroprusside is a direct vasodilator agent widely used in
cardiovascular complications. It over dosage may lead to cyanide
intoxication because its end metabolism product is cyanide.

28- E
Comments: The best antidote for lead poisoning includes dimercaprol,
edentate, penicillamine and succimer.

29- B
Comments: Deferoxamine is the only specific antidote used as antidote for
iron preparations overdose or poisoning.

30- A
Comments: Atropine is considered to be the best antidote in the treatment of
organophosphates poisoning

31- D
Comments: MAO antidepressants administration in tricyclic antidepressant
overdoses would intensify the overdose of the patient and would increase the
chances of the patients in develop a syndrome called “serotoninergic
syndrome”.

32- C
Comments: Antivenin is the antidote of choice in poisoning due to bits of
snake and black spider.

33- B
Comments: Oxygen therapy is the most appropriate method to treat carbon
monoxide intoxication avoiding it to bind to hemoglobin.

34- B
Comments: Vitamin B6 also known as pyridoxine is considered the best
antidote in isoniazide overdoses.

35- A
Comments: Vitamin K is considered the specific antidote for warfarin
overdose.

36- D
Comments: Evaluation and support of vital function such as airway, breath
and circulation should be considered as the major first step in the initial
management of any intoxication and poisoning.

37- E
Comments: Patient with depressed mental status and unknown drug
overdose should be general treated by control of hypoglycemia with 50mls
of dextrose 50%, administration of thiamine 100mg IV push and
administration of naloxone
38- E
Comments: Decontamination procedures involve removal of the ingesting
agent with gastric lavage, emesis by IPECA administration, and adsorbent
agents administration-charcoal.

39- C
Comments: Verapamil overdose associated with hyperkalemia may be
treated by intravenous calcium administration

BIBLIOGRAPHIC REFERENCE

1- COMPREHENSIVE PHARMACY REVIEW – Lippincott William &

Wilkins – Fourth edition

2- CPS-COMPENDIUM OF PHARMACEUTICALS AND SPECIALITIES

- Canadian Pharmacist Association – 2001 edition.

3- MEDICAL DICTIONARY – Dorland’s illustrated – 27th edition.

4- PHARMACY PREP – Lectures series & study guide for Evaluating

Examination-TIPS - 2003/2004

5- THERAPUTIC CHOICES – Canadian Pharmacist Association -Third

edition

6- USP DI – Drug Information for the Health Care Professional–15th edition

– Volume I.