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Toxic > Antidepressant Toxicology > Flashcards

Antidepressant Toxicology Flashcards

1
Q

What type of drug is doxepin?

A

TCA

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2
Q

What causes the increase risk of seizures with TCA overdose?

A

Decreased Cl flow through the GABA mediated Cl channels

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3
Q

Why can there be intermittent periods of intoxication and recovery with TCA overdoses?

A

Anticholinergic effects on the gut will slow motility/absorption, until effect wears off.

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4
Q

What is the effect of acidosis on TCA intoxication? (2)

A
  • Increases the amount of non-protein bound drug

- Increases Na channel blocking effect

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5
Q

What is the role of dialysis in TCA overdose and why?

A

Not effective, since highly protein bound

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6
Q

Which leads on an EKG will better reflect the changes with TCA overdose? What pattern does is resemble?

A

Limb leads

RBBB

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7
Q

What causes the hypotension with TCA overdose?

A
  • Peripheral alpha blockade

- Decreased ionotropy

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8
Q

Which TCAs in particular predispose to seizures?

A

Amoxepine

Maprotiline

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9
Q

What meds are NOT used to treat seizures 2/2 TCA overdose?

A

Phenytoin (worsens Na channel blockade)

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10
Q

What happens if a cholinergic drug is given to combat the anticholinergic effects of TCAs?

A

Worsens cardiac issues

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11
Q

How does alkalinization work in the treatment of TCA overdose?

A

Increases TCA binding to proteins and frees heart from Na channel blockade

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12
Q

What is the antiarrhythmic of choice for TCA overdose?

A

Lidocaine

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13
Q

How long must patients be monitored for with TCA overdose?

A

24 hours

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14
Q

What are the two hydrazine derivative MAOIs? What is the significance of this?

A
  • Isocarboxazid, Phenelzine

- inhibit Vitamin B6 production, leading to seizures

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15
Q

what is the difference between drug half-life and physiologic effect half-life of MAOIs?

A

Drug half life is short, but the physiologic effects are long

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16
Q

what is the enzyme that the hydrazine derivative MAOIs block to causes seizures? What metabolic change does this cause?

A

Pyridoxine phosphokinase.
Increases glutamate
Decreased GABA

17
Q

What is the MOA of MAOI intoxication?

A

Inactivates neuron stored and neuron released catecholamines

18
Q

What is the role of dialysis in MAOI intoxication and why?

A

No role

High protein binding

19
Q

When is the latent period in MAOI overdose?

A

6-12 hours

20
Q

What, generally, are the s/sx of MAOI overdose?

A

Sympathomimetic

21
Q

What are the three poor prognostic indicators in MAOI overdose?

A
  • hyperthermia
  • hypotension
  • (heart) ventricular arrhythmias
22
Q

What is the antihypertensive of choice for MAOI overdose?

A

Nitroprusside

23
Q

What is the treatment for hyperthermia associated with MAOI overdose?

A

Cooling, benzos

24
Q

When do s/sx appear of the Tyramine reaction with MAOI overdose?

A

minutes to few hours

25
Q

What is the role of activated charcoal with SSRI overdose?

A

None

26
Q

What electrolyte problem can SSRIs cause?

A

SIADH

27
Q

What is more specific to citalopram / escitalopram overdose as compared to other SSRI overdoses?

A

Seizures

28
Q

What EKG changes can occur with wellbutrin overdose?

A

QRSd increase

29
Q

What is the MOA of mirtazapine?

A

alpha-2 antagonist, leading to increased catecholamines in the synaptic cleft

30
Q

What are the s/sx and treatment of mirtazapine overdose?

A
  • AMS, tachycardia

- Good supportive care

31
Q

What is the MOA of Trazodone?

A

5HT2 receptor antagonist

32
Q

What are the s/sx and treatment of trazodone overdose?

A

CNS depression, coma, orthostatic hypotension
Increased QT interval
Supportive care. Correct lytes.

33
Q

What is the MOA and classic side effect of nefazodone?

A

Same as trazodone.

hepatic necrosis

34
Q

What is the MOA of venlafaxine?

A

SNRI

35
Q

What are the s/sx of venlafaxine OD? Treatment?

A

CNS depression, seizures, hyperthermia, hepatotoxic
QRS widening

GSC and bicarb if QRS widens

36
Q

What is the MOA of duloxetine? Treatment for OD?

A

5HT and NE reuptake inhibitor (SNRI)

GSC

37
Q

What is the antidote for serotonin syndrome?

A

cyproheptadine

Toxic (12 decks)

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