Overdose Flashcards
Drugs which can cause anticholinergic syndrome
Antihistamines Atropine Cyclic antidepressants Anti-parkinson's drugs Scopolamine
Clinical features of peripheral anticholinergic toxicity
Tachycardia Hyperthermia Mydriasis Dry skin Decreased bowel sounds Urinary retention
Clinical features of central anticholinergic toxicity
Hallucinations
Psychosis
Seizures
Coma
Management of anticholinergic toxidrome
IV benzodiazepines
Physostigmine
Physostigmine contraindications
Reactive airway disease
Cardiovascular disease(bradycardia, heart block)
May precipitate seizures
Effects of sympathomimetics on mental status
Hyperalert
Agitation
Hallucinations
Paranoia
Effect of sympathomimetics on pupils
Mydriasis
Effect of sympathomimetics on vital signs
Hyperthermia, tachycardia, hypertension, widened pulse pressure, tachypnea,
Common manifestations of sympathomimetics
Diarphoresis
Tremors
Hyperreflexia
Seizures
Examples of toxic sympathomimetics
Cocaine
Amphetamines
Theophylline
Caffeine
Effect of hallucinogens on pupils
Mydriasis(usually)
Effects of opioids on mental status
CNS depression
Coma
Effect of opioids on pupils
Miosis
Effect of opioids on vital signs
Bradypnea, apnea characteristic; may develop: hypothermia, bradycardia, hypotension
Hyporeflexia
Pulmonary edema
Clinical manifestations of sedative/hypnotics(benzos, barbiturates)
Hypothermia
Bradycardia
Hypotension
Hyporeflexia
Effects of cholinergic syndrome on mental status
Confusion
Coma
Effect of cholinergics on pupils
Miosis
Effects of cholinergics on vital signs
Bradycardia, hypertension or hypotension, tachypnea or bradypnea
Effects of cholinergics
Salivation, urinary and fecal incontinence, diarrhea, emesis, diaphoresis, lacrimation, GI cramps, bronchoconstriction, muscle fasciculations and weakness, seizures
Examples of cholinergics
Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium
Management of cholinergic crisis
Cessation of any cholinergic agents
Atropine
Gastric lavage inly if a poisoned patient presents within 1 hr of ingestion
Management of sympathomimetic crisis
Supportive
Benzodiazepines
Management of arrhythmias
External cooling if pyrexic
Early features of TCA overdose
Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.
Features of severe TCA overdose
arrhythmias
seizures
metabolic acidosis
coma
ECG changes caused by TCA overdose
sinus tachycardia
widening of QRS
prolongation of QT interval
What is a widening of QRS associated with
Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias
Mx of TCA overdose
IV bicarbonate
Other drugs for arrhythmia
IV lipid emulsion
CVS effects of cocaine overdose
coronary artery spasm → myocardial ischaemia/infarction
both tachycardia and bradycardia may occur
hypertension
QRS widening and QT prolongation
aortic dissection
Neuro effects of cocaine toxicity
seizures
mydriasis
hypertonia
hyperreflexia
Psych effects of cocaine toxicity
agitation
psychosis
hallucinations
Metabolic disturbance in cocaine toxicity
metabolic acidosis
What type of GI complication can occur in cocaine toxicity
Ischaemic colitis
Mx of cocaine toxicity
Benzos
GTN
PCI if MI develops
What might lithium toxicity me precipitated by
Dehydration
Renal failure
Drugs
Drugs which can precipitate lithium toxicity
diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole
Features of lithium toxicity
Coarse tremor(tremor is fine, worse when holding out arms against gravity in therapeutic range) hyperreflexia acute confusion polyuria seizure coma
Mx of lithium toxicity
Fluid rests with saline in mild-moderate
Haemodialysis in severe toxicity
Monitoring in digoxin treatment
digoxin level is not monitored routinely, except in suspected toxicity
if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose
Features of digoxin toxicity
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
Digoxin precipitating factors
Hypokalaemia Increasing age MI Hypothermia Hypothyroidism Hypomag, hypocalc, hypernatraemia, acidosis
Drugs which can precipitate digoxin toxicity
amiodarone quinidine verapamil diltiazem spironolactone
Mx of digoxin toxicity
Digiband
Correct arrhythmias
Monitor potassium
Features of CO poisoning
Headache Nausea and vomiting Vertigo Confusion Subjective weakness
Features of severe CO toxicity
'Pink' skin and mucosal Hyperperxia Arrhythmias Extrapyramidal features Coma
Use of pulse oximetry in CO toxicity
pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin
Therefore, VBG/ABG should be taken
Mx of CO toxicity
100% high-flow oxygen via non-rebreather - Target sats - 100%
Causes of serotonin syndrome
Monoamine oxidase inhibitors SSRIs St John's Wort Ecstasy Amphetamines
Features of serotonin syndrome
Hyperreflexia Myoclonus Rigidity Hyperthermia Sweating Confusion
Mx of serotonin syndrome
IV fluids
Benzodiazepines
Serotonin antagonists in severe cases(chlorpromazine)
Clinical features of ecstasy poisoning
neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
hyperthermia
rhabdomyolysis
Mx of ecstasy poisoning
Supportive
Dantrolene
Features of opioid misuse
rhinorrhoea needle track marks pinpoint pupils drowsiness watering eyes yawning
Complications of opioid misuse
Viral infections secondary to IVDU
Bacterial infection
VTE
Respiratory depression and death
Psychological problems
Social problems
1st line treatment in opioid detox
NICE recommend methadone or buprenorphine as the first-line treatment in opioid detoxification
Symptoms of PCP intoxication
Violence/aggression
Analgesia
Psychosis
Withdrawal symptoms of PCP
Insomnia
Mood disturbance
What is PCP intoxication associated with
Rotary(torsional) nystagmus
Symptoms of MDMA intoxication
Hallucinations
Euphoria
Disinhibition
Altered sense of time
Withdrawal symptoms of MDMA
Anxiety, concentration difficulties, depression
What is MDMA intoxication associated with
Serotonin syndrome
Bruxism
Hyponatraemia
Hallucinogen persisting perception disorder
Symptoms of marijuana intoxication
Calmness
Altered judgement
slow reaction time
Conjunctivial injection
Withdrawal symptoms of marijuana
Decreased appetite
Insomnia
Irritability
Marijuana associations
Psychosis
Paranoia
Cannabinoid hyperemesis syndrome
Alcohol withdrawal 6-24 hrs
GI upset
Tremors
Agitation
Insomnia
Alcohol withdrawal 12-24 hrs
Alcoholic hallucinosis(orientation is intact)
when do alcohol withdrawal seizures occur
6-48 hrs
When does delirium tremens occur
48 hrs after alcohol withdrawal
Type of cardiomyopathy associated with alcohol
Dilated cardiomyopathy
Dry beri beri vs wet beri beri
Dry - symmetrical peripheral neuropathy
Wet - High output heart failure
Opioid associations
Hepatitis Abscesses Right sided endocarditis HIV/AIDS Overdose
Abscess presentation in opioid overdose
Leukocytosis
CRP
Procalcitonin
Cocaine overdose associations
Nasal septum perforation Cocaine induced cardiomyopathy Paranoia Drug induced depression(withdrawal) RTA Rhabdomyolysis
Methamphetamine associations
Meth mouth
