12-2 3

Question 1

Methadone and fentanyl OD may need up to ______- of narcan

Answer 1

10 mg

*Naloxone infusions for long-acting opioids

Question 2

Labwork for ASA OD

Answer 2

Elevated ketones
Mixed respiratory alkalosis with metabolic acidosis

Pediatrics - usually only metabolic acidosis

Question 3

In ASA OD, If you intubate the patient

Answer 3

Set high minute ventilation rates
Use a short-acting paralytic

Question 4

Management of severe ASA OD

Answer 4

hemodialysis

If not a candidate for hemodialysis
Sodium bicarbonate to ionize the salicylate

Question 5

Toxidrome mnemonic for Anticholinergics toxicity

Answer 5

Red as a beet, dry as a bone, blind as a bat, mad as a hatter

Key differences between sympathomimetics
Pupils stay open in light
Bowel sounds are absent
No sweating

Common preparations
Cold preparations
Sleep aids
Antihistamines
Jimson weed

Supportive care/ Benzos

Question 6

Do you use dantrolene for neuroepileptic malignant syndrome?

Answer 6

No

Cooling, benzodiazepines, intubation
Do not give dantrolene

Question 7

Rx for Extrapyramidal reactions

Answer 7

Anticholinergic such as diphenhydramine

Question 8

neuroepileptic malignant syndrome sx

Answer 8

Rigidity, hyperthermia, rhabdomyolysis, and death

No clonus
“Lead pipe” rigidity
AMS
Bradyreflexia
Hypertension and diaphoresis

Question 9

Serotonin syndrome

Answer 9

Classic patient: MAOI + tyramine-containing foods

-Clonus, including ocular clonus
-Hyperreflexia
-AMS
-Neuromuscular hyperactivity
-Autonomic overactivation
-Diaphoresis, hypertension hyperthermia
-Muscle rigidity (lower extremities > upper extremities)

Question 10

Serotonin syndrome rx

Answer 10

Rapid cooling if hyperthermia
Benzodiazepines
Cyproheptadine (serotonin-antagonist)

Question 11

NMS rx

Answer 11

Rapid cooling if hyperthermia
Benzodiazepines
Takes 1 wk to resolve

Question 12

Serotonin syndrome generally has ________, NMS does not bc it has rigidity

Answer 12

clonus