Exam 3 - Antidepressants and Antihypertensives

Question 1

How does a tricyclic antidepressant overdose typically present? (3)

Answer 1

(anticholinergic) increased BP that may suddenly decrease, increased HR, increased temperature

Question 2

What is a characteristic of EKGs in a tricyclic antidepressant overdose?

Answer 2

terminal 40 msec rightward axis deviation in frontal plane (R wave in a VR)

Question 3

What is the primary treatment and dosing for a tricyclic antidepressant overdose?

Answer 3

hypertonic sodium bicarbonate 1-2 mEq/kg bolus then 150 mEq in 1 L D5W at twice maintenance rate

Question 4

What are treatments for dysrhythmias in a tricyclic antidepressant overdose? (2)

Answer 4

magnesium, lidocaine

Question 5

What are treatments for hypotension in a tricyclic antidepressant overdose? (4)

Answer 5

norepinephrine, epinephrine, vasopressin, phenylephrine

Question 6

What are treatments for seizures in a tricyclic antidepressant overdose? (2)

Answer 6

BZDRAs, barbiturates

Question 7

What should NOT be used in a tricyclic antidepressant overdose? (2)

Answer 7

phenytoin, flumazenil

Question 8

What toxidrome does a bupropion overdose present as?

Answer 8

sympathomimetic

Question 9

What are decontamination options for bupropion overdose? (3)

Answer 9

orogastric lavage, activated charcoal, whole bowel irrigation

Question 10

What are treatments for bupropion overdose? (3)

Answer 10

supportive care (BZDRAs, antihypertensives), lipid emulsions, ECMO

Question 11

What are treatments for SSRI overdose? (2)

Answer 11

supportive care, monitoring

Question 12

Which SSRIs are most likely to cause seizures in an overdose? (2)

Answer 12

citalopram and escitalopram

Question 13

What are treatments for serotonin syndrome? (4)

Answer 13

supportive care (decreasing core temperature), cyproheptadine, BZDRAs, propranolol

Question 14

What are the main symptoms of an antihypertensive overdose? (2)

Answer 14

bradycardia, hypotension

Question 15

What are the selective beta blockers? (4)

Answer 15

bisoprolol, esmolol, atenolol, metoprolol (BEAM)

Question 16

What are the vasodilating beta blockers? (4)

Answer 16

betaxolol, carvedilol, labetalol, nebivolol

Question 17

What beta blockers have membrane stabilizing effects? (4)

Answer 17

propranolol, carvedilol, betaxolol, acebutolol

Question 18

Which beta blocker is most likely to cause Torsade de Pointes? Seizures?

Answer 18

sotalol; propranolol

Question 19

What are decontamination options for a CCB/BB overdose? (2)

Answer 19

activated charcoal, whole bowel irrigation

Question 20

What is the primary treatment and dosing for a CCB/BB overdose?

Answer 20

high dose insulin euglycemia therapy (HIET) 1 U/kg bolus then 1-10 U/kg/hr

Question 21

What are other treatments for a CCB/BB overdose? (9)

Answer 21

isotonic crystalloids, atropine, calcium chloride/gluconate, glucagon, vasopressors (epi/norepi), inotropes (dobutamine, milrinone), cardiac pacing, intralipid, VA-ECMO

Question 22

What is only a BB overdose treatment that is not a treatment for CCB overdose?

Answer 22

glucagon

Question 23

What are treatments for all other antihypertensive overdoses? (3)

Answer 23

fluids, atropine, vasopressors

Question 24

What are treatments and dosing for a clonidine overdose? (2)

Answer 24

naloxone 5-10 mg bolus +/- infusion, supportive care

Question 25

In what scenario should physostigmine not be administered as an antidote?

Answer 25

anticholinergic toxidrome caused by a TCA