Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute and Emergency > Other OD's > Flashcards

Other OD's Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

How do benzodiazepines work?

A
  • Enhance effect of the neurotransmitter gamma-aminobutyric acid (GABA)
  • Resulting in sedative, anxiolytic, anticonvulsant and muscle relaxant effects.
  • These properties of benzodiazepines make them a particularly dangerous drug to take in overdose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are clinical features of benzodiazepine OD?

A
  • Reduced level of consciousness (including coma): if severe this can result in loss of airway tone and reflexes leading to hypoxia if left untreated.
  • Respiratory depression: low RR can –> hypoxia and inadequate tissue perfusion.
  • Hypotension
  • Bradycardia
  • Rhabdomyolysis
  • Hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What else can cause the patient’s OD?

A

Dual pathology, which may relate to the pt’s OD

  • Trauma secondary to falls (e.g. head injury)
  • Aspiration pneumonia secondary to a reduced level of conciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are benzodiazepine OD’s managed?

A

Flumazenil

The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil.

It is generally only used with severe or iatrogenic overdoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the classic presentation of a benzodiazepine OD?

A

CNS depression with normal or near-normal vital signs.

Many patients will still be arousable and even provide a reliable history.

Sx:
- Slurred speech
- Ataxia
- Atered mental status
- Agitation
- Euphoria
- Blurred vision
- Slate-grey cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are features of a beta-blocker OD?

A

bradycardia
hypotension
heart failure
syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is a beta-blocker OD managed?

A

If bradycardic: atropine

in resistant cases, glucagon may be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is haemodialysis effective in beta-blocker OD?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What may also be present in beta-blocker OD and how is this managed?

A

Hypocalcaemia may also be present, and should be corrected with calcium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is lithium used for?

A

Mood stabilising drug used most commonly prophylactically in bipolar disorder but also as an adjunct in refractory depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the therapeutic range for lithium?

A

Very narrow (0.4-1.0 mmol/L)

And long half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is lithium excreted?

A

By kidneys mainly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

At what concentrations does lithium concentration usually form?

A

> 1.5 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What may precipitate lithium toxicity?

A

Dehydration

Renal failure

Drugs:
- Diuretics (especially thiazides)
- ACEi/ARB
- NSAIDs
- Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are features of lithium toxicity?

A

coarse tremor (a fine tremor is seen in therapeutic levels)

hyperreflexia

acute confusion

polyuria

seizure

coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is Lithium toxicity managed?

A

Mild-moderate:
- May respond to volume resuscitation with normal saline

Severe:
- Haemodialysis may be needed

Sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are other names for cannabis?

A

Hash, hashish, weed, pot, ganja, dope, skunk, grass, puff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is cannabis taken?

A

Usually smoked
Mixed in food or drink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the desired effects of cannabis?

A

Make pt feel happy and relaxed
Can change the way pt hears or sees things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are symptoms of a cannabis OD?

A

Dry cough
Increased appetite
Social withdrawal and paranoia
Altered perception of time

Makes pts more likely to develop shizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are Sympathomimetics?

A

Eg. cocaine
Amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are features os sympathomimetic OD?

A

Tachycardia, mydriasis, euphoria, formication- insects crawling, agitation, tremor, dilated pupils, tachycardia, arrhythmias, convulsions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is a sympathomimetic OD treated?

A

Benzodiazepine e.g. diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the pathophysiology of carbon monoxide toxicity?

A
  • Carbon monoxide binds readily to haemoglobin, forming carboxyhaemoglobin → reduced oxygen-carrying capacity
  • In carbon monoxide poisoning the oxygen saturation of haemoglobin decreases leading to an early plateau in the oxygen dissociation curve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What may exam questions re carbon monoxide poisoning hint at?

A

badly maintained housing e.g. student houses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are symptoms of a carbon monoxide OD?

A
  • Headache: 90% of cases
  • N + V: 50%
  • Vertigo: 50%
  • Confusion: 30%
  • Subjective weakness: 20%

Severe toxicity:
- ‘pink’ skin and mucosae
- Hyperpyrexia
- Arrhythmias
- Extrapyramidal features
- Coma
- Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What investigations may be done in carbon monoxide OD and what may they show?

A
  • Pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin — Therefore do VBG or ABG

Typical carboxyhaemoglobin levels
< 3% non-smokers
< 10% smokers
10 - 30% symptomatic: headache, vomiting
> 30% severe toxicity

ECG is a useful supplementary investgation to look for cardiac ischaemia

28
Q

How is a carbon monoxide OD treated?

A
  • Assess in ED

100% high-flow oxygen via a non-rebreather mask
- Decreases half-life of carboxyhemoglobin (COHb)
- Administer ASAP and continue for at least 6 hrs
- Target sats 100%
- Tx continued until all sx resolved, rather than monitoring CO levels

Hyperbaric oxygen
- Evidence base is limited
- Long-term outcome may be bette than just oxygen in severe cases
- For severe cases (eg. levels > 25%) discuss with specialist

Other indications for hyperbaric oxygen:
- LOC at any point
- Neurological signs other than headache
- Myocardial ischaemia or arrhythmia
- Pregnancy

29
Q

What are street drugs and what are the different categories?

A

Chemical substances taken for enjoyment, or leisure purposes, rather than for medical reasons

  • Psychoactive drugs- Affects Brain
  • Illegal Drugs- prohibited for use or production
  • Controlled drugs- Drug regulated for Medical use.
30
Q

What are consequences of street drug use?

A
  • Infections - HIV, hepatitis passed on by needle use
  • Addiction
  • Cost - expensive, obtaining money can lead to crime
  • Social problems - relationships, jobs
  • Mental problems - bizarre behaviour, depression, anxiety
  • Overdose - v ill or die
  • Impure drugs
  • Unwanted sexual intercourse under the influence
31
Q

What are depressant drugs? Examples

A

Alcohol
Barbituartates
Benzodiazepines

32
Q

Examples of stimulant drugs?

A

Speed up brain system

Caffeine
Energy drinks
Nicotine
Amphetamines
Cocaine
Bath salts

33
Q

Examples of Hallucinogens?

A

Brain thinks differently- in all senses
Hallucinogen – altered reality

  • Marijuana (mild)
  • Mushrooms
  • LSD
  • Spice/K2/Synthetic Marijuana
34
Q

Examples of club drugs?

A

Ecstasy
PCP (phencyclidine)
GHB (gamma-Hydroxybutyric acid)
Ketamine
Meth
LSD (Lysergic acid diethylamide)
Rohypnol (Roofies)

35
Q

Examples of opiate drugs?

A

Morphine
Heroin
Oxycontin
Percocet
Vicodin/hydrocodone

36
Q

What are other names for cocaine?

A

Crack, coke, white, toot, pebbles, freebase

37
Q

How does cocaine work?

A

blocks the uptake of dopamine, noradrenaline and serotonin

38
Q

How does cocoaine make people feel?

A

It makes people feel super-confident, and alert.

It reduces hunger pangs.

After a big high, there follows a ‘come-down’, or low.

39
Q

What are adverse effects of cocaine usage?

A

Cardiovascular:
- coronary artery spasm → myocardial ischaemia / infarction
- Tachycardia and bradycardia
- HTN
- QRS widening and QT prolongation
- Aortic dissection

Neurological:
- Seizures
- Mydriasis
- Hypertonia
- Hyperreflexia

Psychiatric:
- Agitation
- Psychosis
- Hallucinations

Others:
- Ischaemic colitis - consider if pt complain of abdominal pain or rectal bleeding
- Hyperthermia
- Metabolic acidosis
- Rhabdomyolysis

40
Q

What are features of cocaine toxicity?

A

Difficulty breathing
Loss of urine control
Cyanosis
Loss of awareness or surroundingsHTN
Death

41
Q

How is cocaine toxicant managed?

A

1st line:
- Benzodiazepines

Chest pain:
- Benzodiazepines + glyceryl trinitrate
- If MI develops then PCI

Hypertension:
- Benzodiazepines + sodium nitroprusside

The use of beta-blockers in cocaine-induced cardiovascular problems is debated
- AHA issued statement in 2008 warning against use (due to the risk of unopposed alpha-mediated coronary vasospasm)
- If reasonable alternative is given in exam, choose it

42
Q

What is LSD?

A

Synthetic hallucinogen

one of the most potent psychoactive compounds

43
Q

What are the effects of LSD?

A

Heightening or distortion of sensory stimuli and enhancement of feelings and introspection

44
Q

Who are the most frequent LSD users?

A

Adolescents and young adults

45
Q

How do patients with LSD toxicity present?
Symptoms

A

Following acute panic reactions (“bad trips”), massive ingestions or unintentional ingestions

Psychoactive sx:
- Variable subjective experiences
- Impaired judgements, can –> injury
- Amplification of current mood which –> euphoria or dysphoria
- Agitation, appearing withdrawn - especially in inexperienced users
- Drug-induced psychosis

Somatic sx:
- Nausea
- Headache
- Palpitations
- Dry mouth
- Drowsiness
- Tremors

46
Q

What are signs of LSD intoxication?

A

Tachycardia
HTN
Mydriasis
Paresthesia
Hyperreflexia
Pyrexia

47
Q

What manifestations of LSD intoxication can appear quickly?

A

Manifestations such as tachycardia, hypertension, pupillary dilation, tremor, and hyperpyrexia can occur within minutes following oral administration of 0.5–2 µg/kg.

48
Q

What complications can a massive LSD OD lead to?

A

Respiratory arrest
Coma
Hyperthermia
Autonomic dysfunction
Bleeding disorders

49
Q

What investigations can be done in an LSD intoxication?

A

Diagnosis based on hx and examination

Most drug screens don’t pick up LSD

50
Q

How is LSD intoxication managed?

A
  • Dependent on specific behavioural manifestation elicited by the drug

Agitation (from ‘bad trip):
- Supportive reassurance in a calm, stress-free environment
- Benzodiazepines, if above ineffective

LSD-induced psychosis
- May need antipsychotics

Massive ingestions of LSD:
- Supportive care (respiratory support and ET intubation if needed)
- HTN, tachycardia, hyperthermia treated symptomatically
- Hypotension: fluids and then vasopressors if needed

51
Q

Are activated charcoal and gastric emptying useful in LSD OD?

A

Because LSD is rapidly absorbed through the GIT activated charcoal administration and gastric emptying are of little clinical value by the time a patient presents to the emergency department.

52
Q

What are other names for ecstasy?

A

E, crystal, dolphins, superman, pills, mitsubishis, MDMA, mangy, brownies

53
Q

How is ecstasy taken?

A

As a pill

54
Q

What does ecstasy do?

A
  • Feel high and happy, full of energy
  • Colors and sounds more intense
  • Feelings of love and affection towards ppl around you
  • Effect lasts several hours
55
Q

What are harmful effects of ecstasy?

A
  • Often no pure, so effects unpredictable
  • “comedown” after can make pt feel very low. Can cause depression, anxiety and memory problems
56
Q

What are other names for amphetamines?

A

Speed, whizz, sulphur, dexies

57
Q

How are amphetamines take?

A

In powder form

58
Q

What do amphetamines do?

A

Stimulant - gives more energy

Feel upbeat and excited

59
Q

What are harmful effects of amphetamines?

A

Overactive, jittery, anxious

Can cause a severe mental condition where people lose contact with reality and see or hear things that aren’t there (psychosis)

60
Q

What are other names for heroin?

A

H, Smack, Skag, Gear, Brown

61
Q

How is heroin usually taken?

A

Dissolved into liquid then injected

Can be smoked and snorted

62
Q

What does heroin do?

A

Used as a very strong painkiller

Makes one feel calm, happy, relaxed

63
Q

What are the harmful effects of heroin?

A

Extremely addictive

Infection through needles (hepatitis or HIV)

64
Q

What is the Misuse of Drugs Act 1971

A

To prevent use of harmful drugs

Three classes - A, B, C

Offences:
- Possession of drugs
- Supply of drugs.
- Possession with intent to supply another person
- Offering to supply another person with drugs
- Manufacture of drugs.
- Export or import of drugs.
- Allowing your property to be used for the use, supply or production of drugs

65
Q

What are Class A drugs?

A

Most harmful

Eg. cocaine, heroin, ecstasy, LSD, methadone, magic mushroom

Possession: Max 7 years in prison + fine

Supply: life imprisonment + fine

66
Q

What are class B drugs?

A

eg. amphetamines, cannabis, mephedrone, codeine, barbiturates

Possession: Max 5 years in prison + fine

Supply: 14 years in prison + fine

67
Q

What are Class C drugs?

A

Eg. anabolic steroids, minor tranquilisers

Possession: Max 2 years prison + fine

Supply: 14 years prison + fine

Acute and Emergency (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions