Drug Poisoning Flashcards
Bath salts Active ingredient and basic info
- 4-methylene-dioxypyrovalerone (MDPV)
- Central nervous system stimulant
- Potentially severe and lethal
Treatment for Bath salts
- Mimics that for amphetamines
- Manage airway and control agitation
- Beside serum glucose to rule out hypoglycemia
- Chemical restraint (best) versus physical restraint
- Gastric decontamination
- Core temperature monitoring (can get hyperpyrexic)
Drug treatment of overdose for bath salts
- Agitation control with benzodiazepines
- Treat hypertension with intravenous agents
- Seizure control with benzodiazepines
- No antidote: Symptomatic treatment only at this time
Anticholinergic effect agents
o Antihistamines
o Antiparkinson drugs
o Antipsychotics
o Muscle relaxants
Symptoms of Anticholinergic effect agents
o Delirium, tachycardia, dilated pupils, dry/flushed skin
Treatment for Anticholinergic effect agents
o Muscle relaxants:
Activated charcoal
Benzodiazepines (seizures, anticholinergic agitation/delirium)
Sodium bicarbonate for QRS prolongation
Fluids; dopamine or norepinephrine if vasopressors needed
Sympathomimetic agents
(block reuptake of norepinephrine) o Cocaine o Amphetamines o Decongestants o “Diet aids”
Symptoms of Sympathomimetic agents
o Delusions, paranoia, tachycardia, hypertension, hyperpyrexia, diaphoresis, mydriasis, hyper reflexia
Treatment of Sympathomimetic agents
o Benzodiazepines
o Nitroglycerin
o Lidocaine
o Sodium bicarbonate (for cocaine-related ventricular arrhythmias)
Depressant Drugs
o Opiates/Opioids (codeine, morphine, heroin)
o Barbiturates
o Benzodiazepines
o Ethanol
Symptoms of Depressant Drugs
o Coma, respiratory depression, miosis, hypotension, bradycardia, diminished bowel sounds, hyporeflexia
Treatment of Depressant Drugs
o Opioids
naloxone
o Benzodiazepines
flumazenil (cautiously
What do Opioids do?
• Stimulation of opiate receptors resulting in sedation and respiratory depression
• Kinetics of Opioids
o Peak effect in 2 to 3 hours but
Watch for use of long-acting dosage forms
Opioids slow gastrointestinal transit so possible delayed peak effects
Fentanyl patch effect can persist after patch removal
•
Toxic doses of Opioids
Vary on agent, route, rate of administration
Clinical presentation of
Mild to moderate overdose of Opioids
Lethargy “pinpoint” pupils Blood pressure/pulse rate depressed Bowel sounds diminished Flaccid muscles
Clinical presentation of
Severe overdose of Opioids
Coma
Respiratory depression
Basics of Opiate overdose treatment
- Airway, ventilation assist, oxygen
- Treat: Coma, Hypotension, Seizures
What drug to treat opioid OD
Naloxone
Naloxone
200 to 400 mcg IV (or IM) repeated every 2 to 3 minutes if no response
If opioid overdose, doses of up to 10 to 20 mg have been used
• If no response, no it wasn’t opioid OD try benzodiazepine OD treatment
Naloxone dose could wear off before opioid dose does
Cholinergic like agents
o Organophosphates (Sarin gas) o Exposure to acetylcholinesterase inhibitor
Cholinergic like agents symptoms
o Confusion, CNS depression, weakness, salivation, lacrimation, urinary/fecal incontinence, pulmonary edema, seizures
Cholinergic like agents treatment
o Atropine o Pralidoxime (Protopam)
Pralidoxime (Protopam) MOA
- Reactivates cholinesterase (mainly outside of the CNS) which has been inactivated by phosphorylation due to an organophosphate
- atropine is always required concomitantly to block the effect of accumulated acetylcholine at this site
