Question Of The Day

Consumption of stew containing which mollusk has been associated with development of cardiac glycoside toxicity? Ingestion of stew containing Helix Pomatia (the burgundy snail) has been associated with secondary exposure to cardiac glycosides from Nerium Oleander.  According to the cited reference, after consumption of the…

During the 2022 Winter Olympics, a Russian figure skater allegedly tested positive for trimetazidine. What may be the proposed benefit of this drug to improve performance? In a recent randomized trial at high altitude in healthy volunteers, trimetazidine resulted in decreased fatigue and reversed cardiorespiratory…

What is the most common type of reaction after human exposure to pyrethrins? Allergic reactions. Topical exposure to pyrethrins are associated with dermatitis and rare cases of asthma exacerbations and anaphylaxis are reported. Contributor: Rachel Schult, PharmD, DABAT, University of Rochester Medical Center Proudfoot AT….

What enzyme inhibitor prevents the insecticidal activity of chlorfenapyr? Piperonyl butoxide. Activity of chlorfenapyr is related to CYP enzyme metabolism resulting in the generation of a free pyrrole which uncouples oxidative phosphorylation. In humans, it is associated with delayed symptom onset and a high case…

What is the antidote for treating/preventing local paresthesias from topical pyrethroid exposure? Topical vitamin E oil. D,L-a-tocopherol was shown to selectively inhibit pyrethroid-modified Na+-channels. Contributor: Rachel Schult, PharmD, DABAT, University of Rochester Medical Center Song JH, et al. Selective block of tetramethrin-modified sodium channels by…

Certain rapid antigen tests kits for COVID-19 contain a reagent that could be toxic if ingested. What is the toxic reagent? What kits contain this reagent? Sodium azide (NaN3) is a colorless, odorless, and tasteless reagent in a solution dropped onto the test device. Kits…

What is the most common symptom after dermal exposure to pyrethroids? Local paresthesias. Pyrethroids undergo local absorption through the skin and symptoms are related to direct effects on Na+-channels in cutaneous sensory nerves. Contributor: Rachel Schult, PharmD, DABAT, University of Rochester Medical Center Holland MG….

How does piperonyl butoxide enhance the toxicity of pyrethrin/pyrethroid insecticides? CYP enzyme inhibition in insects. Pyrethrins and pyrethroids are 10-300x more potent after the addition of piperonyl butoxide which is used to ensure insect lethality after application. Contributor: Rachel Schult, PharmD, DABAT, University of Rochester…

A patient has unexplained abnormal liver enzymes. You suspect drug induced liver injury (DILI). Further inquiry yields a history of migraine headaches for which the patient takes an herbal product. What could be the cause of DILI in this patient? Butterbur extract from Petasites hybridus….

How is the chelator DTPA administered for treatment of internal contamination with radioactive plutonium, americium, or curium? DTPA, or diethylenetriamine pentaacetate, is supplied as Ca-DTPA or Zn-DTPA. Administration is intravenous, or via inhalation by nebulization, depending on many variables such as route of contamination. Existing…