Carbamazepine

Question 1

Dose Related Risk Assessment

Answer 1

20-50 mg/Kg= mild-mod CNS & anticholinergic
> 50 mg/kg=
- fluctuating mental status
-intermittent agitation & coma in 12 hrs
-cardiotox (Na channel block) & Hypotension

Question 2

Pregnancy

Answer 2

teratogenic in 1st trimester

Question 3

Toddler

Answer 3

> 20mg/ kg- observe
1x 400 mg tablet observe 8 hrs
blood test 1 hr post ingestion & 0 level= no ingestion

Question 4

Clinical Features mild to Mod CNS

Answer 4

nystagmus
Dysarthria
Ataxia
delirium
ophthalmoplegia
myoclonus
mydriasis

Question 5

Clinical: anticholinergic

Answer 5

Urinary retention
Tachycardia
Dry mouth

Question 6

Clinical: Coma

Answer 6

delayed 8-12 hrs
agitation
fluctuating LOC
Sz

Question 7

Clinical Cardiac: Na channel block

Answer 7

conduction abnormal
arrhythmia - VF/ VT/ Asystole
hypotension

Question 8

Serum Levels & clinical

Answer 8

8-12 mg/L= therapeutic
>12 mg/L= nystagmus/ ataxia
> 20mg/L= CNS & anticholinergic
> 40 mg/L= coma/ sz/ cardiac conduction abn

Question 9

ECG

Answer 9

Na Channel block

Question 10

Management

Answer 10

Life threats
- coma/ sz
- arrhythmia
Resus
A/B
C: NaBicarb
D: Sz- Benzo
Supportive

Question 11

Decontamination

Answer 11

AC IF:
<50mg/kg or larger CR tabl & early present
CNS toxicity- then AC when intubated

Question 12

Enhanced Elimination

Answer 12

MDAC
Hemodialysis: IF:
- prolonged coma
- rising serum levels after 48 hrs
- hemodynamic instablity