Drug Overdose Flashcards
Dysrhythmia
Wide complex
Sodium bicarb
IV
Torsade de pointes
Magnesium sulfate
Seizure
Benzos first line:
Lorazepam IV/IM preferred
Midazolam IV/IM, drip
Barbituates or Propofol to sedate
Hypoglycemia
Oral load
Amp of D50
Glucagon IM
Females
HCG test (pregnancy)
Activated Charcoal
decreases AUC of macromolecules
Use 1 hr after ingestion of toxin
Cathartics = induce diarrhea
Sorbitol, Mag citrate
diarrhea within a few hours
Cause volume depletion and elec abnormalities
How to alkalize the urine
Sodium bicarb
Titrate to serum pH of 7.45-7.55 and urine pH of 7.5-8.5
Replace K+ though!
Hemodialysis for drugs with these properties
Low Vd, Low molecular weight, and poor serum protein binding
the ones that can’t be used for charcoal
ex. Methanol, ethylene glycol, salicylates, lithium, theophylline.
CVVHF if high Vd
Opioid overdose
Activated charcoal
IV fluids if hypotens
Whole bowel flush for ER formulations or body packers
Naloxone
Naloxone
Competes with a displaces opioids at receptor sites.
IV/IM/nasal
AEs: opiod withdrawal, AGGRESSIVE
Tylenol overdose
Causes liver failure instead of killing you…
Charcoal if within 1 hr
N-acetylcystine
N-acetylcysteine
binds to NAPQI to decrease liver toxicity
Repletes glutathione stores
APAP levels
must draw 4 hours after ingestion or more. 150+–> treat.
Rumack-Matthew line will progress to liver failure to treat a little below that line
Ali Oliyei says if you suspect APAP OD, treat with NAC no matter the levels
Salicyclate OD mechanism
Disturbs carb metabolism, ketones form-->lactate-->metabolic acidosis Fever, volume loss, nausea/vomit Acute lung injury and resp stimulant Anion gap Entry into CNS->edema->death
Salicylate overdose
Charcoal w/o sorbitol w/in 1 hr
IV fluids unless pulm edema
Sodium Bicarb
Dialysis
Calcium Channel Blocker OD mechanism
DHPs (-pines): hypotens and reflex tachy
Non-DHP: brady and decreased contractility
Decrease insulin release
Metabolic acidosis
CCB OD treatment
Charcoal asymptomatic can be observed IV fluids for hypotens IV Calcium to improve contract and BP Norepi or Epi Lipid drip for coding patients because CCBs are lipophilic Pacemaker? Sodium bicarb if acidotic
What is HIET
Hyperinsulinemia/Euglycemia Therapy
High dose insulin–>inotropic effect to resolve cardio shock
+Dextrose infusion
monitor Mag, K, Phos
Serotonin syndrome caused by
SSRIs
Antidepressents
MAOis
Linezolid
Serotonin syndrome treatment
Charcoal Benzos for agitation 5-HT antagonist (Cyproheptadine, Olanzapine, Chlorpromazine) Vecuronium or cistracuronium DO NOT GIVE SUCCINYLCHOLINE HTN with nitroprusside or esmolol
TCAs
Amitriptyline, doxepin, Desipramine, Nortriptyline
Very lipophilic and high conc in CNS and cardiac
Benzos for seizure
Sodium Bicarb for arrhythmias (a lot)
