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Other OD's 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
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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
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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
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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.

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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

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6
Q

What are features of a beta-blocker OD?

A

bradycardia
hypotension
heart failure
syncope

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7
Q

How is a beta-blocker OD managed?

A

If bradycardic: atropine

in resistant cases, glucagon may be used

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8
Q

Is haemodialysis effective in beta-blocker OD?

A

No

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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.

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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.

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11
Q

What is the therapeutic range for lithium?

A

Very narrow (0.4-1.0 mmol/L)

And long half-life

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12
Q

How is lithium excreted?

A

By kidneys mainly

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13
Q

At what concentrations does lithium concentration usually form?

A

> 1.5 mmol/L

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14
Q

What may precipitate lithium toxicity?

A

Dehydration

Renal failure

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

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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

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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

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17
Q

What are other names for cannabis?

A

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

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18
Q

How is cannabis taken?

A

Usually smoked
Mixed in food or drink

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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

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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

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21
Q

What are Sympathomimetics?

A

Eg. cocaine
Amphetamines

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22
Q

What are features os sympathomimetic OD?

A

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

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23
Q

How is a sympathomimetic OD treated?

A

Benzodiazepine e.g. diazepam

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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
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25
What may exam questions re carbon monoxide poisoning hint at?
badly maintained housing e.g. student houses.
26
What are symptoms of a carbon monoxide OD?
- 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
27
What investigations may be done in carbon monoxide OD and what may they show?
- 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
How is a carbon monoxide OD treated?
- 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
What are street drugs and what are the different categories?
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
What are consequences of street drug use?
- 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
What are depressant drugs? Examples
Alcohol Barbituartates Benzodiazepines
32
Examples of stimulant drugs?
Speed up brain system Caffeine Energy drinks Nicotine Amphetamines Cocaine Bath salts
33
Examples of Hallucinogens?
Brain thinks differently- in all senses Hallucinogen – altered reality - Marijuana (mild) - Mushrooms - LSD - Spice/K2/Synthetic Marijuana
34
Examples of club drugs?
Ecstasy PCP (phencyclidine) GHB (gamma-Hydroxybutyric acid) Ketamine Meth LSD (Lysergic acid diethylamide) Rohypnol (Roofies)
35
Examples of opiate drugs?
Morphine Heroin Oxycontin Percocet Vicodin/hydrocodone
36
What are other names for cocaine?
Crack, coke, white, toot, pebbles, freebase
37
How does cocaine work?
blocks the uptake of dopamine, noradrenaline and serotonin
38
How does cocoaine make people feel?
It makes people feel super-confident, and alert. It reduces hunger pangs. After a big high, there follows a 'come-down', or low.
39
What are adverse effects of cocaine usage?
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
What are features of cocaine toxicity?
Difficulty breathing Loss of urine control Cyanosis Loss of awareness or surroundingsHTN Death
41
How is cocaine toxicant managed?
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
What is LSD?
Synthetic hallucinogen one of the most potent psychoactive compounds
43
What are the effects of LSD?
Heightening or distortion of sensory stimuli and enhancement of feelings and introspection
44
Who are the most frequent LSD users?
Adolescents and young adults
45
How do patients with LSD toxicity present? Symptoms
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
What are signs of LSD intoxication?
Tachycardia HTN Mydriasis Paresthesia Hyperreflexia Pyrexia
47
What manifestations of LSD intoxication can appear quickly?
Manifestations such as tachycardia, hypertension, pupillary dilation, tremor, and hyperpyrexia can occur within minutes following oral administration of 0.5–2 µg/kg.
48
What complications can a massive LSD OD lead to?
Respiratory arrest Coma Hyperthermia Autonomic dysfunction Bleeding disorders
49
What investigations can be done in an LSD intoxication?
Diagnosis based on hx and examination Most drug screens don't pick up LSD
50
How is LSD intoxication managed?
- 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
Are activated charcoal and gastric emptying useful in LSD OD?
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
What are other names for ecstasy?
E, crystal, dolphins, superman, pills, mitsubishis, MDMA, mangy, brownies
53
How is ecstasy taken?
As a pill
54
What does ecstasy do?
- 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
What are harmful effects of ecstasy?
- Often no pure, so effects unpredictable - "comedown" after can make pt feel very low. Can cause depression, anxiety and memory problems
56
What are other names for amphetamines?
Speed, whizz, sulphur, dexies
57
How are amphetamines take?
In powder form
58
What do amphetamines do?
Stimulant - gives more energy Feel upbeat and excited
59
What are harmful effects of amphetamines?
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
What are other names for heroin?
H, Smack, Skag, Gear, Brown
61
How is heroin usually taken?
Dissolved into liquid then injected Can be smoked and snorted
62
What does heroin do?
Used as a very strong painkiller Makes one feel calm, happy, relaxed
63
What are the harmful effects of heroin?
Extremely addictive Infection through needles (hepatitis or HIV)
64
What is the Misuse of Drugs Act 1971
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
What are Class A drugs?
Most harmful Eg. cocaine, heroin, ecstasy, LSD, methadone, magic mushroom Possession: Max 7 years in prison + fine Supply: life imprisonment + fine
66
What are class B drugs?
eg. amphetamines, cannabis, mephedrone, codeine, barbiturates Possession: Max 5 years in prison + fine Supply: 14 years in prison + fine
67
What are Class C drugs?
Eg. anabolic steroids, minor tranquilisers Possession: Max 2 years prison + fine Supply: 14 years prison + fine

Acute and Emergency (17 decks)

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