Class 4 (02|01|22) Toxicology - Overdose & Poisonings Flashcards
What are toxidromes?
What do they help with?
Is it a perfect science?
a group of clinical signs and symptoms associated with a toxic ingestion or exposure (often with overdosage)
Help with the identification of common signs and symptom pt are presenting with which help HCP determine the class of drugs uses Combination of specific signs and symptoms that reflect drug class effects on particular neuroreceptors
Imperfect because symptoms from multiple toxins can overlap, clouding the clinical picture
Toxidormes Classication
Downers
opioid
Sedative-Hypnotic
Cholinergic
Fast & Furious
Anticholinergic
Sympathomimetic
Downers — OPIOIDS
examples
Morphine, Codine, Tramado, Heroin, Meperidine, Diphenoxylate, Hydromorphone, Fentanyl, Methadone, Propoxyphene, Pentazocine, DXM, Oxycodone, Hydrocodone
Downers — OPIOIDS
pathophysiology
stimulate three receptors in the CNS and PNS
Downers — OPIOIDS
main use
MAIN USE: analgesic properties — inhibits nociceptive information in the nervous system (prevents transmission of pain to the brain
Euphoria — increases dopamine release
Anxiolysis — lower anxiety
Downers — OPIOIDS
s/s
Heart Rate: decrease Resp Rate: decrease Temp: decrease Pupils: pinpoint/constricted Bowel sounds: decrease Skin: normal Mental status: depressed
Downers — OPIOIDS
management
ABCDE approach
Naloxone-: block effect of opioid
Blood Glucose:hypoglycemia can present similarly
GI decontamination: risk for aspiration so a later resort
Downers — OPIOIDS
significant clinical findings
resp rate > 12 is usually the best indicator
Look for tach marks
Downers — SEDATIVE-HYPNOTIC
examples
Anti-anxiety agents, muscle relaxants, antiepileptics and preanesthetic medications -Barbiturates - Benzodiazepines
Downers — SEDATIVE-HYPNOTIC
treatment/managment
ABCDE approach — focusing on the life threatening aspects (cardio, resp depression)
Dialysis in order to clear the toxins
Flumazenil: Benzo - antagonist: blocks the effects of the benzodiazepines
Downers — SEDATIVE-HYPNOTIC
s/s
Heart Rate: decrease Resp Rate: decrease Temp: decrease Pupils: no change Bowel sounds: decrease Skin: normal Mental status: depressed
Downers — SEDATIVE-HYPNOTIC
useages
Choral hydrate: sedation in hospital
Rohypnol: date-rape-drug (gamma hydroxybutyrate)
Downers — SEDATIVE-HYPNOTIC
patho
enhance the effect of the GABA transmitter that blocks impulse nerve cells and brain
Increase GABA/blockage, they can improve mood and anxiety
When taxes in excess, end up with toxidrome: sedative and hypnotic
Downers — SEDATIVE-HYPNOTIC
what present similarly
signs and symptoms of the over dose can look like alcohol usage
What is Flumazenil?
Flumazenil: Benzo - antagonist: blocks the effects of the benzodiazepines (Downers — SEDATIVE-HYPNOTIC)
Antagonsis
Downers — CHOLINERGIC
examples
Organic Phosphorous Compounds: Carbamates, Arecholine, Pilocarpine, Urecholine (Betanechol), Carbachol, Choline, Metacholine, Mushrooms
Downers — CHOLINERGIC
common uses
found in agriculture and chemicals
Included in medications
Downers — CHOLINERGIC
patho
increase levels of acetylcholine at the neuromuscular junction due to the inactivity of the acetylcholine enzyme which would normally break down acetylcholine
Results with increase levels and longer duration at the receptor of acetylcholine
Symptoms arise when the receptors found: smooth muscle of GI, bronchi, heart, salivary & sweat glands, and ciliary body of eye
Downers — CHOLINERGIC
“classic” set of s/s
SLUDGE
Increase salivation and sweating increase lacrimation increase urinary incontinence increase diarrhea increase GI cramps increase emesis
Downers — CHOLINERGIC
s/s
Heart Rate: no change - decrease Resp Rate: no change Temp: no change Pupils: pinpoint/constricted Bowel sounds: increase Skin: diaphoresis Mental status: depressed, confused, seizures
Downers — CHOLINERGIC
treatment/management
- anticholinergic medications: atropine (IV) | diazepam: treat seizures
Fast & Furious — ANTICHOLINERGIC
examplese
Anticholinergics - Atropine, scopolamine, glycopyrrolate benztropine, trihexyphenidyl
Antihistamines - chlorpheniramine, cyproheptadine, doxylamine, hydroxyzine, dimenhydrinate, diphenhydramine, meclizine promethazine
Fast & Furious — ANTICHOLINERGIC
common uses
Tricyclic antidepressants, muscle relaxants, anti-psychotics, antimuscarinic agents for an overactive bladder (Oxybutlnin)
Plants
Fast & Furious — ANTICHOLINERGIC
patho
inhibition of the muscarinic cholingeric neurotransmission: block the acetylcholine from blinding to receptors (blocks parasympathetic nervous system and body will enter fight to flight mode with no regulation)
Reports can be found on the smooth muscle on the Gi tract, bladder, heart, sweat glands, ciliary of eye, salivary glands
Fast & Furious — ANTICHOLINERGIC
s/s
Heart Rate: increase Resp Rate: no change Temp: increase Pupils: dilated Bowel sounds: decrease Skin: normal - dry Mental status: depressed, confused, hallucinations, seizures
Fast & Furious — ANTICHOLINERGIC memorization technique (5)
Mad as a hatter - altered mental status blind as a bat - mydriasis red as a beet - flushed skin hot as a hare - skin dry dry as a bone - dry mucous membranes
Fast & Furious — ANTICHOLINERGIC
significant clinical findings
body cannot sweat so it regulates body temp by becoming hyperthermic
Tachycardia: earliest and most reliable s/s
Fast & Furious — ANTICHOLINERGIC
treatment
ABCDE approach:
Gastric decom. : activated charcoal
Diazepam: calm, treat seizures
Physostigmine salicylate: antidote for anticholingeric toxicity
What is physostigmine salicylate?
Physostigmine salicylate: antidote for anticholingeric toxicity
Fast & Furious — SYMPATHOMIMETIC
examples
where is it found in medication?
Caffeine, cocaine, amphetamines, methamphetamines, ritalin, LSD, Theophylline, MDMA
Medication: E, NE, dopamine