Medications

Question 1

What is the most common drug intoxications

Answer 1

Benzodiazepines

Question 2

Benzodiazepines with longest and shortest biological half-life

Answer 2

Shortest:
Midazolam with 2 hours

Longest:
Clorazepate with 40-100 hours

Question 3

Benzodiazepines easily penetrate to fetus. What can it cause in the fetus?

Answer 3

Floppy infant syndrome (hypotonia, breathing disorder, hypothermia, weak or immature sucking ability)

Fetal withdrawal syndrome (intrauterine growth restriction, diarrhea, vomiting)

Question 4

Benzodiazepines - Methods of Enhanced Elimination

Answer 4

Multiple doses of activated charcoal, hemodialysis and hemoperfusion are ineffective

Question 5

Benzodiazepines - Antidote

Answer 5

Flumazenil

Question 6

At which concentrations of barbiturates will the person die?*

Answer 6

10x the therapeutic dose

Question 7

Barbiturates - Decontamination

Answer 7

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

Question 8

Barbiturates - Methods of Enhanced Elimination

Answer 8

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

Question 9

Nonbenzodiazepine Hypnotics Intoxication Symptoms

Answer 9

Drowsiness
Slurred speach
Ataxia
Disorientation
Narrow pupils
Toxic coma
Apnea (possible but rare, mostly in mixed intoxications)

Question 10

Nonbenzodiazepine Hypnotics Intoxication Treatment

Answer 10

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

Question 11

Why are tricyclic antidepressants very dangerous in overdose?

Answer 11

Because of their cardiotoxicity

Question 12

Tricyclic Antidepressants - Decontamination

Answer 12

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

Question 13

Tricyclic Antidepressants - Methods of Enhanced Elimination

Answer 13

Hemodialysis and hemoperfusion are not effective due to large volume of distribution

Question 14

SSRIs with shortest and longest half-life

Answer 14

Fluvoxamine, 13-22 hours

Fluoxetine, 1-6 days, metabolites up to 16 days

Question 15

SSRIs - Management of Intoxication

Answer 15

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)

Question 16

MAOI - Intoxication Treatment

Answer 16

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

Question 17

Lithium concentration that will cause coma and shock

Answer 17

> 4,0mmol/l

Question 18

Lithium - Intoxication Treatment

Answer 18

Gastric lavage
Sodium chloride
Hemodialysis (severe intoxications)

Question 19

What are the symptoms of neuroleptic intoxication?

Answer 19

• 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

Question 20

Neuroleptic intoxication treatment?

Answer 20

Benzodiazepines for seizures
Norepinephrine for hypotension
Sodium bicarbonate for QT prolongation 
Lidocaine for ventricular tachycardia 
Bromocriptine, amantadine or levodopa for neuroleptic malignant syndrome

Question 21

Digoxin - Intoxication Treatment

Answer 21

Specific antidote: digoxin-specific antibody (in severe intoxications or in cardiac arrest, expensive and rarely available)

Lidocaine
Magnesium sulfate
Cardioversion

Question 22

Beta blockers with shortest and longest half-life

Answer 22

Propranolol 3-5 hours

Nebivolol 22 hours

Question 23

Beta Blockers - Intoxication Spesific Treatment

Answer 23

Glucagon

Insulin

Question 24

CCBs - Intoxication Treatment

Answer 24

Calcium chloride or calcium gluconate
Dopamine
Glucagon
Insulin

Question 25

Paracetamol toxic dose

Answer 25

Toxic dose: over 8 g/day (children: 150-200 mg/kg/day)

Question 26

Paracetamol - Antidote

Answer 26

Acetylcysteine

Question 27

Salicylates - Intoxication Treatment

Answer 27

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

Question 28

Opiod - Intoxication Treatment

Answer 28

Naloxone

Question 29

What are the main cardiotoxic drugs?

Answer 29

Cardiac glycosides
Beta blockers
CCBs