ONE PILL CAN KILL

Question 1

Sulfonylureas

Answer 1

Examples - glipizide - Glyburide

Mechanism - Inhibit ATP-dependent K+ channels on pancreatic beta cells
S&S
- Asymptomatic to overt coma{glipizide}
- refractory hypoglycemia {glyburide}
TREATMENT
– Weight-based dextrose bolusa

Question 2

Calcium Channel Blockers

Answer 2

Examples - amlodipine - diltiazem

Mechanism - Block Ca2+ entry through voltage gated L-type cellular membrane Ca2+ channels…leading to arterial smooth muscle relaxation and inhibition AV/SA nodal…depolarization and decreased contractility
S&S
- Bradycardia {amlodipine}
- Hypotension
- Dizziness
- Seizures
- gi symptoms{diltiazem}
- Hyperglycemia
- Lactic acidosis
TREATMENT
– IVF, atropine (usually ineffective), calcium chloride, vasopressors{amlodi
– High dose insulin (diltia

Question 3

Toxic Alcohols

Answer 3

Examples - Isopropanol - methanol - ethylene - glycol

Mechanism -Metabolized to acetone - - -Oxidized in the liver to formaldehyde and formic acid - - -Oxidized to glycoaldehyde and glycolic acid, which is eventually metabolized to oxalic acid
S&S
- Respiratory depression, hypotension, hemorrhagic gastritis, osmol gap without anion gap acidosis{ISO
- Abdominal pain, obtundation, visual loss/snowfield vision….Delayed onset osmolar gap and AGMAe.{METHA
- AMS, ataxia, hallucinations, tachycardia, tachypnea, hypertension, CHFf, ARDSg, circulatory collapse, tetany, QT prolongatio{ETH,GLYC

TREATMENTS
- – Hemodialysis may greatly enhance serum elimination{ISO

• – Fomepizoleh – Hemodialysis for visual impairment, profound acidosis, renal failure, or levels >50mg/dL—folate supplementation {METHA
• – Ethylene Glycol: Thiamine and pyridoxine supplementation

Question 4

Central A Agonist

Answer 4

Example- Clonidine
Mechanism- Central α2 receptor agonist
S&S
Opioid-like toxidrome,—-bradycardia, hypotension, apnea

TREATMENT
– Naloxone
– Treat refractory bradycardia with atropine
– Treat hypotension with IVF and dopamine

Question 5

TRICYCLIC ANTI-DEPRESSANTS(TCAs)

Answer 5

Example -Amitriptyline, nortriptyline, imipramine

Mechanism - Centrally mediated inhibition of biogenic amines, inhibition of H1 histamine and M1 muscarinic receptors, blockage of fast voltage-gated sodium channels on cardiac myocytes
S&S
—–Anticholinergic toxidrome, cardiovascular collapse, widened QRS with terminal R wave in aVR, seizure, coma
TREATMENT
– AC as soon as possible
– Sodium bicarbonate IV bolus

Question 6

Salicylate

Answer 6

Examples – Aspirin, wintergreen oil
Mechanism– Stimulation of medullary respiratory center, uncoupling of oxidative phosphorylation, metabolic acidosis, increased pulmonary vascular permeability, inhibition of gluconeogenesis
S&S
– Lethargy, diaphoresis, coma, seizure, cardiovascular collapse, vomiting, tachypnea, diaphoresis, hypoglycemia, metabolic acidosis

TREATMENT
- AC if early after ingestion
- Alkalinize urine with sodium bicarbonate
- Maintain glucose

Question 7

Opioids

Answer 7

Examples - Methadone, Oxycodone, Fentanyl
Mechanism - Interact with µ, κ, and δ opioid receptors throughout the CNS, PNS and GI tract
S&S
– Dizziness, euphoria, depressed reflexes, AMS, lethargy, coma, dry mucus membranes, nausea and vomiting, bronchospasm, bradycardia, bradypnea, miosis

TREATMENT
– Naloxone 1-2mg if respiratory depression present
– AC if within 1 hr of delayed-absorption of sustained release product

Question 8

Anti Malarials

Answer 8

Examples - chloroquine,
hydroxy- chloroquine
Mechanism - Blocks DNA and RNA synthesis
SNS
– Hypotension, hypokalemia, QRS prolongation, seizures, coma, cardiac dysrhythmias, headache, nausea and vomiting

TREATMENT
- AC for asymptomatic recent ingestions
– Sodium bicarbonate IV bolus

Question 9

Beta Blockers

Answer 9

Example - labetalol , metoprolol, propranolol
Mechanism - Inhibition of β1 receptors on heart à bradycardia…Blockage of GNGl à hypoglycemia
..CNS depression
S&S
– Bradycardia, hypotension, reflex tachycardia, hypoglycemia (prominent in pediatrics)
Propranolol is highly lipid soluble (crosses BBBm) and has Na+ channel blocking effects and may lead to dysrhythmias (Torsade de Pointes)

TREATMENT
– Treat initial hypotension with IVF bolus.
– If hypotension continues, use glucagonn.
– If hypotension continues use vasopressors and high dose insulin therapy
– may consider lipid emulsion for refractory cases
– Atropine for bradycardia
– AC for recent, substantial ingestion
– Sodium bicarb for arrythmia
– Benzodiazepines for seizures