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
Gastric Emptying is done by?
Syrup of ipecac
Syrup of ipecac MOA
local irritation of gastric mucosa and stimulation of chemoreceptor trigger zone
Syrup of ipecac ADR
Arrhythmias
Rare cases of fatal myocarditis after excessive doses
Syrup of ipecac effects with other drug
Activated charcoal neutralizes ipecac effect
Adsorbent
Activated charcoal
Activated charcoal MOA
o Adsorbs various toxins in gastrointestinal tract; greatest benefit only up to 60 minutes post ingestion.
–> has lots of surface area, so drugs can get stuck to it
Activated charcoal ADR
o Vomiting from rapid ingestion, constipation, diarrhea
What do you add before 1st dose of Activated charcoal
• Add sorbitol to first dose to reduce chance of vomiting
•
Antidote for antifreeze
Fomepizole (Antizol™)
Antidote for benzodiazepines
Flumazenil (Romazicon™)
Antidote for iron toxicity
Deferoxamine mesylate (Desferal™)
Antidote for digoxin
Digoxin Immune fab (Digibind™)
Antidote for insulin‑induced hypoglycemia
Glucagon
Antidote for acetaminophen toxicity
Acetylcysteine (Acetadote™)
- Mucolytic
Pediatric Poisoning:
- often small amounts of substance are absorbed
- proverbial glass of milk for the child and a pitcher of reassurance for the parent
- Keep the phone number of the poison control center close at hand
