Exam 3 - Opioid, BZDRA, and Salicylate ODs Flashcards
What is the treatment for an opioid toxidrome?
naloxone
What is the dosing for naloxone in a non-opioid dependent patient?
0.4 mg IV
What is the dosing for naloxone in an opioid-dependent patient?
0.04 mg IV titrated to effect
Explain the PK differences for the ROA for naloxone?
IV works quickly but fades quickly, IN works slowly but lasts long, IM needs higher doses than normal
What are the AEs for naloxone? (2)
rhinorrhea, flash pulmonary edema
What are treatments for naloxone-induced pulmonary edema? (4)
nitroglycerin, diuretics, positive pressure ventilation, smaller initial naloxone doses
What is unique to the toxidrome for a loperamide overdose?
severe cardiac arrhythmias
What are treatments for loperamide overdose-related cardiac disturbances? (4)
IV magnesium, sodium bicarbonate, isoproterenol, transcutaneous pacing
What is the treatment and dosing for a sedative-hypnotic toxidrome?
Flumazenil 0.2 mg IV over 15s
What makes benzodiazepine overdoses lethal?
the withdrawal effects, not the overdose itself (though this may still cause respiratory depression)
What are examples of situations that warrant flumazenil use? (2)
procedural (iatrogenic) sedation, unintentional pediatric exposures
What are toxic doses for acute aspirin overdose? (2)
> 150 mg/kg, > 500 mg/kg (life-threatening)
What are toxic doses for chronic aspirin overdose?
less clearly established, greater toxicity at lower doses
In a 70 kg patient, how many tabs of apsirin 81, 325, and Excedrin before toxic?
81 = 247, 325 = 61, Ex = 80
In a 70 kg patient, how much oil of wintergreen before toxic?
20.4 mL
What is the mechanism of toxicity for an aspirin overdose?
metabolic acidosis via uncoupled oxidative phosphorylation
How do salicylate toxidromes typically present? (4)
increased RR, N/V, CNS (hypoglycorrachia, AMS, tinnitus), non-cardiogenic pulmonary edema
What are the early, middle, and late/preterminal laboratory manifestations in salicylate toxidromes?
early = respiratory alkalosis, middle = respiratory alkalosis and metabolic acidosis, late/preterminal = respiratory and metabolic acidosis
What are the electrolyte laboratory manifestations in salicylate toxidromes? (3)
hypo or hyperglycemia, increased fluid and electrolyte losses, increased anion gap
What should not be done in salicylate overdoses?
intubation
What are treatments for a salicylate toxidrome? (3)
0.5-1 g/kg IV dextrose, 150 mEq sodium bicarbonate at twice maintenance rate (urine pH > 7.5), maintain potassium
What are the indications for hemodialysis in salicylate toxidromes? (5)
serum levels > 100 mg/dL (acute) or > 60 mg/dL (chronic), neurologic deterioration (seizures), intractable acidosis (pH < 7.2), renal failure, pulmonary edema
Dialysis for salicylate toxidrome treatment should continue until? (3)
clear improvement in patient, levels < 19 mg/dL, dialysis completed for 4-6 hrs and levels not obtainable
