Medications Flashcards
What is the most common drug intoxications
Benzodiazepines
Benzodiazepines with longest and shortest biological half-life
Shortest:
Midazolam with 2 hours
Longest:
Clorazepate with 40-100 hours
Benzodiazepines easily penetrate to fetus. What can it cause in the fetus?
Floppy infant syndrome (hypotonia, breathing disorder, hypothermia, weak or immature sucking ability)
Fetal withdrawal syndrome (intrauterine growth restriction, diarrhea, vomiting)
Benzodiazepines - Methods of Enhanced Elimination
Multiple doses of activated charcoal, hemodialysis and hemoperfusion are ineffective
Benzodiazepines - Antidote
Flumazenil
At which concentrations of barbiturates will the person die?*
10x the therapeutic dose
Barbiturates - Decontamination
Gastric lavage during the first hour after ingestion
Activated charcoal (1 g/kg of body weight) should be administered during the first hour after ingestion
Endoscopic lavage may be considered
Barbiturates - Methods of Enhanced Elimination
Forced alkaline diuresis (sodium bicarbonate i.v. to urine pH 7-8) increases renal elimination and protects against rhabdomyolysis
Hemodialysis and hemoperfusion may be beneficial in severe intoxications but rarely are neccesary
Nonbenzodiazepine Hypnotics Intoxication Symptoms
Drowsiness Slurred speach Ataxia Disorientation Narrow pupils Toxic coma Apnea (possible but rare, mostly in mixed intoxications)
Nonbenzodiazepine Hypnotics Intoxication Treatment
Secure airways, breathing and circulation (ABC)
Symptomatic – mostly fluids i.v.
Flumazenil i.v. (BDA antidote) should be effective but rarely is neccessary
Methods of enhanced elimination are not used
Why are tricyclic antidepressants very dangerous in overdose?
Because of their cardiotoxicity
Tricyclic Antidepressants - Decontamination
Gastric lavage during the first hour after ingestion
Activated charcoal (1 g/kg of body weight) should be administered during the first hour after ingestion
Tricyclic Antidepressants - Methods of Enhanced Elimination
Hemodialysis and hemoperfusion are not effective due to large volume of distribution
SSRIs with shortest and longest half-life
Fluvoxamine, 13-22 hours
Fluoxetine, 1-6 days, metabolites up to 16 days
SSRIs - Management of Intoxication
Diagnostics: ECG, routine biochemical tests
Gastric lavage and activated charcoal (1 g/kg) only in the first hour after ingestion
ECG and BP monitoring
Symptomatic treatment (crystalloids i.v., benzodiazepines i.v. if agitation or seizures)
MAOI - Intoxication Treatment
Crystalloids i.v.
Benzodiazepines for agitation or seizures (sometimes barbiturates or muscle relaxants are neccessary)
Vasopressants (dopamine, norepinephrine) for severe hypotension
Atropine, dobutamin and sometimes temporary endocardial pacing for bradycardia
Physical cooling or dantrolene for hyperthermia
Urinary alcalisation for rhabdomyolysis
Lithium concentration that will cause coma and shock
> 4,0mmol/l
Lithium - Intoxication Treatment
Gastric lavage
Sodium chloride
Hemodialysis (severe intoxications)
What are the symptoms of neuroleptic intoxication?
- CNS symptoms (Drowsiness, mitosis, hypothermia, seizures, and coma)
- Extrapyramidal symptoms (Dystonia, dyskinesias, akathisia, and Parkinsonism)
- Cardiovascular (hypotension, sinus tachycardia, QT prolongation and tornados de pointes)
- Others: Salivation, agranulocytosis, hyperglycemia, rhabdomyolysis, priapism and neuroleptic malignant syndrome
Neuroleptic intoxication treatment?
Benzodiazepines for seizures Norepinephrine for hypotension Sodium bicarbonate for QT prolongation Lidocaine for ventricular tachycardia Bromocriptine, amantadine or levodopa for neuroleptic malignant syndrome
Digoxin - Intoxication Treatment
Specific antidote: digoxin-specific antibody (in severe intoxications or in cardiac arrest, expensive and rarely available)
Lidocaine
Magnesium sulfate
Cardioversion
Beta blockers with shortest and longest half-life
Propranolol 3-5 hours
Nebivolol 22 hours
Beta Blockers - Intoxication Spesific Treatment
Glucagon
Insulin
CCBs - Intoxication Treatment
Calcium chloride or calcium gluconate
Dopamine
Glucagon
Insulin
Paracetamol toxic dose
Toxic dose: over 8 g/day (children: 150-200 mg/kg/day)
Paracetamol - Antidote
Acetylcysteine
Salicylates - Intoxication Treatment
Disturbances of consciousness → high concentration dextrose (neuroglycopenia may occur even with normal glycemia) Seizures → diazepam i.v. Brain edema → mannitol i.v. Coagulopathy → Vitamin K Fluid overload → Furosemide
Opiod - Intoxication Treatment
Naloxone
What are the main cardiotoxic drugs?
Cardiac glycosides
Beta blockers
CCBs
