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YR5 Psychiatry > Drug Overdose > Flashcards

Drug Overdose Flashcards

1
Q

What are 2 symptoms of paracetamol overdose?

A

N+V
Asymptomatic

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2
Q

Give 2 groups at increased risk of paracetamol overdose

A

Those on enzyme inducers e.g. Rifampicin, Phenytoin, Carbamazepine, St Johns Wort

Malnourished/ not eaten for a few days

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3
Q

What is the management of paracetamol overdose?

A

Activated charcoal if <1h
N acetylcysteine infusion delivered over 1h
Liver transplantation

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4
Q

What are the 4 indications for N-acetylcysteine in paracetamol OD?

A

plasma conc. on/ above a single tx line joining points of 100 mg/L at 4h

Staggered OD or doubt over time of ingestion, regardless of plasma concentration

Pt presenting 8-24h after ingestion of an acute OD of >150 mg/kg, even if plasma conc not yet available

patients who present >24h if they are clearly jaundiced or have hepatic tenderness/ ALT is above upper limit of normal

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5
Q

What adverse effects may be seen when infusing N-Acetylcysteine for paracetamol OD?

How should this be managed?

A

Anaphylactoid reaction (non IgE mediated mast cell release)

Stop the infusion, then restart at a slower rate.

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6
Q

What are 5 symptoms of salicylate overdose with mild toxicity?

A

N+V

Epigastric pain

Tinnitus + deafness

Dizziness

Lethargy

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7
Q

What are 3 symptoms of salicylate overdose with moderate toxicity?

A

Sweating

Fever

Dyspnoea: Hyperventilation (centrally stimulates respiration)

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8
Q

What are 3 symptoms of salicylate overdose with severe toxicity?

A

Confusion

Convulsions

Coma

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9
Q

What acid base picture is found in salicylate overdose?

A

mixed respiratory alkalosis + metabolic acidosis

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10
Q

Give 4 signs of salicylate overdose on examination

A

Warm peripheries + bounding pulse
Tachypnoea + hyperventilation
Cardiac arrhythmia
Acute pulmonary oedema

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11
Q

What bedside investigations should be performed in salicylate overdose?

A

Basic obs: tachycardia + taachypnoea

ECG: monitor for arrhythmia

CBG: exclude hypoglycaemia/ ketoacidosis

ABG: Acid base balance

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12
Q

What bloods should be taken in salicylate overdose?

A

Salicylate conc. >,2h after ingestion + repeat every 2h

Paracetamol conc.: identify mixed OD

FBC

U+Es: Electrolyte disturbances

LFTs: Hepatic dysfunction

Coagulation: INR + PT may be increased in hepatic dysfunction

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13
Q

What peak salicylate levels define mild, moderate and severe salicylate toxicity?

A

Mild: <300 mg/L
Moderate: 300 to 700 mg/L
Severe: >700 mg/L

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14
Q

Describe initial management of salicylate overdose

A

A-E
Activated charcoal if <1h
IV NaCl
K+ replacement
IV sodium bicarbonate (urinary alkalisation, enhances excretion in urine)

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15
Q

Give 2 indications for haemodialysis in salicylate overdose

A

Serum conc > 700mg/L
Tx resistant Metabolic acidosis

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16
Q

Give 4 complications of salicylate overdose

A

Acute respiratory distress syndrome
Seizures
Drug-induced hepatitis
Cardiac arrest (prolongation of QT)

17
Q

What are 3 symptoms/ signs of opioid overdose?

A

Bradypnoea (resp. depression)

Pinpoint pupils (miosis)

Drowsiness/ Coma (altered mental status)

18
Q

Give 4 measurable signs of opioid overdose?

A

Bradycardia
Hypotension
Hypothermia
Constipation (reduced BS)

19
Q

What is used for management of opioid overdose?

A

IV/ IM Naloxone
(Rapid onset, relatively short duration of action, may need to repeat/ infusion)

20
Q

What are 8 symptoms of benzodiazepine overdose?

A

Reduced level of consciousness (inc. coma)

Resp. depression: can result in hypoxia +
inadequate tissue perfusion.

Ataxia + dysarthria

Nystagmus

Hypotension

Bradycardia

Rhabdomyolysis

Hypothermia

21
Q

What can coma lead to in Benzodiazepine overdose?

A

Loss of airway tone + reflexes leading to hypoxia

22
Q

Describe management of Benzodiazepine overdose

A

A-E assessment
Maintain airway
Supportive e.g. fluids
Activated charcoal if <1h since ingestion if awake
+/- Flumazenil

23
Q

When is flumazenil use indicated in a benzodiazepine overdose?

A
  1. CNS depression so severe requires ventilation
  2. Confidence only benzos have been taken (e.g. no possibility of a mixed OD)
  3. Patient is not known to be benzo dependent
24
Q

Why must 3 conditions be met for flumazenil to be used in benzodiazepine overdose?

A

Use outside these conditions risks precipitating seizures
(e.g. if a patient has also taken TCAs)

v difficult to treat due to the GABA antagonism caused by Flumazenil.

25
Q

Give 4 symptoms of TCA overdose

A

Dry mouth
Hot, dry skin
Confusion + hallucinations
Palpitations

26
Q

What are symptoms of TCA overdose mediated by?

A

anticholinergic toxicity + the result of sodium channel blockade

27
Q

Give 4 severe effects of TCA overdose

A

arrhythmia
cardiovascular collapse
convulsions
coma.

28
Q

Describe management of TCA overdose

A

Activated charcoal if <1h since ingestion.

Sodium bicarbonate: in arrhythmia + acidosis to prevent progression to ventricular arrhythmias

29
Q

What are the key investigations in TCA overdose? What will be seen?

A

ECG: QRS widening or QTc prolongation

ABG: acidosis.

30
Q

Which antiarrhythmetics should be avoided in TCA overdose?

A

Class 1a (e.g. Quinidine) + 1c (e.g. Flecainide) as they prolong depolarisation.

Class III (e.g. amiodarone) as they prolong the QT interval.

31
Q

What are 4 symptoms of lithium overdose?

A

N+V
Abdo pain
Diarrhoea
Coarse Tremor

32
Q

Describe management of lithium overdose

A

Mild-mod: volume resus with normal saline

Haemodialysis: if severe toxicity

Sodium bicarbonate: increases alkalinity of urine thus promotes lithium excretion. Sometimes used but limited evidence to support

33
Q

Describe management of Warfarin overdose

A

Vitamin K1

34
Q

What drug is used for heparin overdose?

A

Protamine sulphate

35
Q

What drugs are used in beta blocker overdose?

A

If Bradycardic: atropine
In resistant cases glucagon may be used

YR5 Psychiatry (33 decks)

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