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Overdose Flashcards

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1
Q

Drugs which can cause anticholinergic syndrome

A 
Antihistamines 
Atropine 
Cyclic antidepressants 
Anti-parkinson's drugs 
Scopolamine
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2
Q

Clinical features of peripheral anticholinergic toxicity

A 
Tachycardia 
Hyperthermia 
Mydriasis 
Dry skin 
Decreased bowel sounds 
Urinary retention
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3
Q

Clinical features of central anticholinergic toxicity

A

Hallucinations
Psychosis
Seizures
Coma

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4
Q

Management of anticholinergic toxidrome

A

IV benzodiazepines

Physostigmine

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5
Q

Physostigmine contraindications

A

Reactive airway disease
Cardiovascular disease(bradycardia, heart block)
May precipitate seizures

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6
Q

Effects of sympathomimetics on mental status

A

Hyperalert
Agitation
Hallucinations
Paranoia

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7
Q

Effect of sympathomimetics on pupils

A

Mydriasis

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8
Q

Effect of sympathomimetics on vital signs

A

Hyperthermia, tachycardia, hypertension, widened pulse pressure, tachypnea,

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9
Q

Common manifestations of sympathomimetics

A

Diarphoresis
Tremors
Hyperreflexia
Seizures

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10
Q

Examples of toxic sympathomimetics

A

Cocaine
Amphetamines
Theophylline
Caffeine

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11
Q

Effect of hallucinogens on pupils

A

Mydriasis(usually)

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12
Q

Effects of opioids on mental status

A

CNS depression

Coma

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13
Q

Effect of opioids on pupils

A

Miosis

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14
Q

Effect of opioids on vital signs

A

Bradypnea, apnea characteristic; may develop: hypothermia, bradycardia, hypotension

Hyporeflexia
Pulmonary edema

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15
Q

Clinical manifestations of sedative/hypnotics(benzos, barbiturates)

A

Hypothermia
Bradycardia
Hypotension
Hyporeflexia

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16
Q

Effects of cholinergic syndrome on mental status

A

Confusion

Coma

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17
Q

Effect of cholinergics on pupils

A

Miosis

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18
Q

Effects of cholinergics on vital signs

A

Bradycardia, hypertension or hypotension, tachypnea or bradypnea

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19
Q

Effects of cholinergics

A

Salivation, urinary and fecal incontinence, diarrhea, emesis, diaphoresis, lacrimation, GI cramps, bronchoconstriction, muscle fasciculations and weakness, seizures

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20
Q

Examples of cholinergics

A

Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium

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21
Q

Management of cholinergic crisis

A

Cessation of any cholinergic agents

Atropine

Gastric lavage inly if a poisoned patient presents within 1 hr of ingestion

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22
Q

Management of sympathomimetic crisis

A

Supportive
Benzodiazepines
Management of arrhythmias
External cooling if pyrexic

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23
Q

Early features of TCA overdose

A

Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

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24
Q

Features of severe TCA overdose

A

arrhythmias
seizures
metabolic acidosis
coma

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25
Q

ECG changes caused by TCA overdose

A

sinus tachycardia
widening of QRS
prolongation of QT interval

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26
Q

What is a widening of QRS associated with

A

Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias

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27
Q

Mx of TCA overdose

A

IV bicarbonate
Other drugs for arrhythmia
IV lipid emulsion

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28
Q

CVS effects of cocaine overdose

A

coronary artery spasm → myocardial ischaemia/infarction
both tachycardia and bradycardia may occur
hypertension
QRS widening and QT prolongation
aortic dissection

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29
Q

Neuro effects of cocaine toxicity

A

seizures
mydriasis
hypertonia
hyperreflexia

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30
Q

Psych effects of cocaine toxicity

A

agitation
psychosis
hallucinations

31
Q

Metabolic disturbance in cocaine toxicity

A

metabolic acidosis

32
Q

What type of GI complication can occur in cocaine toxicity

A

Ischaemic colitis

33
Q

Mx of cocaine toxicity

A

Benzos
GTN
PCI if MI develops

34
Q

What might lithium toxicity me precipitated by

A

Dehydration
Renal failure
Drugs

35
Q

Drugs which can precipitate lithium toxicity

A

diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole

36
Q

Features of lithium toxicity

A 
Coarse tremor(tremor is fine, worse when holding out arms against gravity in therapeutic range)
hyperreflexia
acute confusion
polyuria
seizure
coma
37
Q

Mx of lithium toxicity

A

Fluid rests with saline in mild-moderate

Haemodialysis in severe toxicity

38
Q

Monitoring in digoxin treatment

A

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

39
Q

Features of digoxin toxicity

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

40
Q

Digoxin precipitating factors

A 
Hypokalaemia 
Increasing age 
MI 
Hypothermia 
Hypothyroidism 
Hypomag, hypocalc, hypernatraemia, acidosis
41
Q

Drugs which can precipitate digoxin toxicity

A 
amiodarone 
quinidine 
verapamil 
diltiazem 
spironolactone
42
Q

Mx of digoxin toxicity

A

Digiband
Correct arrhythmias
Monitor potassium

43
Q

Features of CO poisoning

A 
Headache 
Nausea and vomiting 
Vertigo 
Confusion 
Subjective weakness
44
Q

Features of severe CO toxicity

A 
'Pink' skin and mucosal 
Hyperperxia 
Arrhythmias 
Extrapyramidal features 
Coma
45
Q

Use of pulse oximetry in CO toxicity

A

pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin

Therefore, VBG/ABG should be taken

46
Q

Mx of CO toxicity

A

100% high-flow oxygen via non-rebreather - Target sats - 100%

47
Q

Causes of serotonin syndrome

A 
Monoamine oxidase inhibitors 
SSRIs
St John's Wort 
Ecstasy 
Amphetamines
48
Q

Features of serotonin syndrome

A 
Hyperreflexia 
Myoclonus 
Rigidity 
Hyperthermia 
Sweating 
Confusion
49
Q

Mx of serotonin syndrome

A

IV fluids
Benzodiazepines
Serotonin antagonists in severe cases(chlorpromazine)

50
Q

Clinical features of ecstasy poisoning

A

neurological: agitation, anxiety, confusion, ataxia
cardiovascular: tachycardia, hypertension
hyponatraemia
hyperthermia
rhabdomyolysis

51
Q

Mx of ecstasy poisoning

A

Supportive

Dantrolene

52
Q

Features of opioid misuse

A 
rhinorrhoea
needle track marks
pinpoint pupils
drowsiness
watering eyes
yawning
53
Q

Complications of opioid misuse

A

Viral infections secondary to IVDU

Bacterial infection

VTE

Respiratory depression and death

Psychological problems

Social problems

54
Q

1st line treatment in opioid detox

A

NICE recommend methadone or buprenorphine as the first-line treatment in opioid detoxification

55
Q

Symptoms of PCP intoxication

A

Violence/aggression
Analgesia
Psychosis

56
Q

Withdrawal symptoms of PCP

A

Insomnia

Mood disturbance

57
Q

What is PCP intoxication associated with

A

Rotary(torsional) nystagmus

58
Q

Symptoms of MDMA intoxication

A

Hallucinations
Euphoria
Disinhibition
Altered sense of time

59
Q

Withdrawal symptoms of MDMA

A

Anxiety, concentration difficulties, depression

60
Q

What is MDMA intoxication associated with

A

Serotonin syndrome
Bruxism
Hyponatraemia
Hallucinogen persisting perception disorder

61
Q

Symptoms of marijuana intoxication

A

Calmness
Altered judgement
slow reaction time
Conjunctivial injection

62
Q

Withdrawal symptoms of marijuana

A

Decreased appetite
Insomnia
Irritability

63
Q

Marijuana associations

A

Psychosis
Paranoia
Cannabinoid hyperemesis syndrome

64
Q

Alcohol withdrawal 6-24 hrs

A

GI upset
Tremors
Agitation
Insomnia

65
Q

Alcohol withdrawal 12-24 hrs

A

Alcoholic hallucinosis(orientation is intact)

66
Q

when do alcohol withdrawal seizures occur

A

6-48 hrs

67
Q

When does delirium tremens occur

A

48 hrs after alcohol withdrawal

68
Q

Type of cardiomyopathy associated with alcohol

A

Dilated cardiomyopathy

69
Q

Dry beri beri vs wet beri beri

A

Dry - symmetrical peripheral neuropathy

Wet - High output heart failure

70
Q

Opioid associations

A 
Hepatitis 
Abscesses 
Right sided endocarditis 
HIV/AIDS
Overdose
71
Q

Abscess presentation in opioid overdose

A

Leukocytosis
CRP
Procalcitonin

72
Q

Cocaine overdose associations

A 
Nasal septum perforation 
Cocaine induced cardiomyopathy 
Paranoia 
Drug induced depression(withdrawal) 
RTA
Rhabdomyolysis
73
Q

Methamphetamine associations

A

Meth mouth

Psych (9 decks)

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