Exam 3 - Opioid, BZDRA, and Salicylate ODs

Question 1

What is the treatment for an opioid toxidrome?

Answer 1

naloxone

Question 2

What is the dosing for naloxone in a non-opioid dependent patient?

Answer 2

0.4 mg IV

Question 3

What is the dosing for naloxone in an opioid-dependent patient?

Answer 3

0.04 mg IV titrated to effect

Question 4

Explain the PK differences for the ROA for naloxone?

Answer 4

IV works quickly but fades quickly, IN works slowly but lasts long, IM needs higher doses than normal

Question 5

What are the AEs for naloxone? (2)

Answer 5

rhinorrhea, flash pulmonary edema

Question 6

What are treatments for naloxone-induced pulmonary edema? (4)

Answer 6

nitroglycerin, diuretics, positive pressure ventilation, smaller initial naloxone doses

Question 7

What is unique to the toxidrome for a loperamide overdose?

Answer 7

severe cardiac arrhythmias

Question 8

What are treatments for loperamide overdose-related cardiac disturbances? (4)

Answer 8

IV magnesium, sodium bicarbonate, isoproterenol, transcutaneous pacing

Question 9

What is the treatment and dosing for a sedative-hypnotic toxidrome?

Answer 9

Flumazenil 0.2 mg IV over 15s

Question 10

What makes benzodiazepine overdoses lethal?

Answer 10

the withdrawal effects, not the overdose itself (though this may still cause respiratory depression)

Question 11

What are examples of situations that warrant flumazenil use? (2)

Answer 11

procedural (iatrogenic) sedation, unintentional pediatric exposures

Question 12

What are toxic doses for acute aspirin overdose? (2)

Answer 12

> 150 mg/kg, > 500 mg/kg (life-threatening)

Question 13

What are toxic doses for chronic aspirin overdose?

Answer 13

less clearly established, greater toxicity at lower doses

Question 14

In a 70 kg patient, how many tabs of apsirin 81, 325, and Excedrin before toxic?

Answer 14

81 = 247, 325 = 61, Ex = 80

Question 15

In a 70 kg patient, how much oil of wintergreen before toxic?

Answer 15

20.4 mL

Question 16

What is the mechanism of toxicity for an aspirin overdose?

Answer 16

metabolic acidosis via uncoupled oxidative phosphorylation

Question 17

How do salicylate toxidromes typically present? (4)

Answer 17

increased RR, N/V, CNS (hypoglycorrachia, AMS, tinnitus), non-cardiogenic pulmonary edema

Question 18

What are the early, middle, and late/preterminal laboratory manifestations in salicylate toxidromes?

Answer 18

early = respiratory alkalosis, middle = respiratory alkalosis and metabolic acidosis, late/preterminal = respiratory and metabolic acidosis

Question 19

What are the electrolyte laboratory manifestations in salicylate toxidromes? (3)

Answer 19

hypo or hyperglycemia, increased fluid and electrolyte losses, increased anion gap

Question 20

What should not be done in salicylate overdoses?

Answer 20

intubation

Question 21

What are treatments for a salicylate toxidrome? (3)

Answer 21

0.5-1 g/kg IV dextrose, 150 mEq sodium bicarbonate at twice maintenance rate (urine pH > 7.5), maintain potassium

Question 22

What are the indications for hemodialysis in salicylate toxidromes? (5)

Answer 22

serum levels > 100 mg/dL (acute) or > 60 mg/dL (chronic), neurologic deterioration (seizures), intractable acidosis (pH < 7.2), renal failure, pulmonary edema

Question 23

Dialysis for salicylate toxidrome treatment should continue until? (3)

Answer 23

clear improvement in patient, levels < 19 mg/dL, dialysis completed for 4-6 hrs and levels not obtainable