Exam 3 - Antidepressants and Antihypertensives Flashcards
How does a tricyclic antidepressant overdose typically present? (3)
(anticholinergic) increased BP that may suddenly decrease, increased HR, increased temperature
What is a characteristic of EKGs in a tricyclic antidepressant overdose?
terminal 40 msec rightward axis deviation in frontal plane (R wave in a VR)
What is the primary treatment and dosing for a tricyclic antidepressant overdose?
hypertonic sodium bicarbonate 1-2 mEq/kg bolus then 150 mEq in 1 L D5W at twice maintenance rate
What are treatments for dysrhythmias in a tricyclic antidepressant overdose? (2)
magnesium, lidocaine
What are treatments for hypotension in a tricyclic antidepressant overdose? (4)
norepinephrine, epinephrine, vasopressin, phenylephrine
What are treatments for seizures in a tricyclic antidepressant overdose? (2)
BZDRAs, barbiturates
What should NOT be used in a tricyclic antidepressant overdose? (2)
phenytoin, flumazenil
What toxidrome does a bupropion overdose present as?
sympathomimetic
What are decontamination options for bupropion overdose? (3)
orogastric lavage, activated charcoal, whole bowel irrigation
What are treatments for bupropion overdose? (3)
supportive care (BZDRAs, antihypertensives), lipid emulsions, ECMO
What are treatments for SSRI overdose? (2)
supportive care, monitoring
Which SSRIs are most likely to cause seizures in an overdose? (2)
citalopram and escitalopram
What are treatments for serotonin syndrome? (4)
supportive care (decreasing core temperature), cyproheptadine, BZDRAs, propranolol
What are the main symptoms of an antihypertensive overdose? (2)
bradycardia, hypotension
What are the selective beta blockers? (4)
bisoprolol, esmolol, atenolol, metoprolol (BEAM)
What are the vasodilating beta blockers? (4)
betaxolol, carvedilol, labetalol, nebivolol
What beta blockers have membrane stabilizing effects? (4)
propranolol, carvedilol, betaxolol, acebutolol
Which beta blocker is most likely to cause Torsade de Pointes? Seizures?
sotalol; propranolol
What are decontamination options for a CCB/BB overdose? (2)
activated charcoal, whole bowel irrigation
What is the primary treatment and dosing for a CCB/BB overdose?
high dose insulin euglycemia therapy (HIET) 1 U/kg bolus then 1-10 U/kg/hr
What are other treatments for a CCB/BB overdose? (9)
isotonic crystalloids, atropine, calcium chloride/gluconate, glucagon, vasopressors (epi/norepi), inotropes (dobutamine, milrinone), cardiac pacing, intralipid, VA-ECMO
What is only a BB overdose treatment that is not a treatment for CCB overdose?
glucagon
What are treatments for all other antihypertensive overdoses? (3)
fluids, atropine, vasopressors
What are treatments and dosing for a clonidine overdose? (2)
naloxone 5-10 mg bolus +/- infusion, supportive care
In what scenario should physostigmine not be administered as an antidote?
anticholinergic toxidrome caused by a TCA
