Lecture 26 - Toxidromes

Question 1

Sympathomimetic (stimulation of sympathetic nervous system) toxidromes are caused by stimulation of Alpha and Beta ______ receptors. Drugs that act this way include ____, _____, and Phencyclidine. Think FIght or FLight response.

Answer 1

Adrenergic

Cocaine

Methamphetamine

Question 2

Amphetamines act by effectively increasing the concentration of bioactive ______ at the synapse –> those that go on to bind Alpha1 adrenergic receptors cause activation of _______ C –> leads to increase in intracellular _____ –> contraction of vascular smooth muscle, skeletal muscle, GI tract, and Radial muscle (pupil dilation).

Those that go on to act on Beta1 receptors will increase _____ rate and contractility. Beta2 agonists cause relaxation of _____ and act on the GI tract.

Answer 2

Amines

Phospholipase C

Ca++

Heart rate

Bronchioles

Question 3

______ are the safest sedative drugs to treat Sympathomimetic toxidromes bc they have very few drug-drug interactions.

What is the issue with using Beta-blockers in these patients?

Answer 3

Benzodiazepines

Risk of unopposed alpha-effect (Alpha-adrenergic crisis)

Question 4

Anticholinergic toxidrome (blockade at Muscarinic receptors) patients present almost identically to sympathomimetic toxidrome patients, except for two differences. What are they?

Answer 4

The former don’t sweat; they’re dry, and they have HYPOactive bowel sounds compared to Sympathomimetic toxidrome patients.

Question 5

The following are mnemonics for Anticholinergic toxidrome symptoms:

"Mad as a Hatter"
"Red as a beet"
"Hot as Hades"
"Blind as a bat"
"Dry as a bone"

What symptoms do they indicate?

Answer 5

Delerium

Flushing

Hyperthermia

Mydriasis

Anhidrosis

Question 6

Benzodiazepines are used as treatment for Anticholinergic toxidrome, but _______, an AChE inhibitor, may also be considered.

Answer 6

Physostigmine

Question 7

Organophosphate pesticides cause _______ toxidrome. The organophosphates are AChE inhibitors, so they affect both nicotinic and muscarinic ACh receptors.

Answer 7

Cholinergic toxidrome

Question 8

“DUMBBELS” describes the muscarinic effects of Cholinergic toxidrome. What do the letters stand for?

Answer 8

Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Salivation

Question 9

Cholinergic toxidrome can be treated with high doses of _______ (an anticholinergic) or ______, a cholinesterase reactivator. Though the latter must be given before Acetylcholinesterase “______.”

Answer 9

Atropine

Pralidoxime (2Pam)

Aging

Question 10

Look for ______ (goosebumps) in Opioid withdrawal.

Answer 10

Piloerection