Overdose Flashcards

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1
Q

Anticholinesterase toxicity (e.g. organophosphate)

A

Bradycardia, miosis, salivation

Manage with:
Atropine
Pralidoxime

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2
Q

TCA overdose effects, management

A
  1. Anticholinergic
  2. CNS (e.g. seizures)
  3. Cardio (e.g. prolonged QRS, hypotension) - blocks fast sodium channels and decreases myocardial conduction velocity (like class IA quinidine); QRS >100 ms associated with increased risk for ventricular arrhythmia

Therefore, ABC supportive care and cardiac monitoring
1. Hypotension - treat with isotonic saline boluses, then vasopressors if necessary
2. QRS/arrhythmia - treat with sodium bicarbonate if QRS >100 ms (also improved hypotension) - sodium overcomes blockade while alkalinization makes TCA less active

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3
Q

Conjunctival injection

A

Marijuana

Psychomotor impairment can last up to a day, beyond period of euphoria

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4
Q

Yawning

A

Opioid withdrawal

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5
Q

Nystagmus, ataxia

A

Phencyclidine intoxication

Usually also violent behavior, agitation, didssociation

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6
Q

Alcohol + cocaine coingestion

A

Creates metabolite cocaethylene - prolongs and enhances cocaine sympathomimetic effects

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7
Q

PCP intoxication - pathophysiology, treatment

A
  1. NMDA agonist (excitatory, psychotic)
  2. Dopamine, NE, serotonin receptors
  3. Sigma receptor complex (psychotic, anticholinergic)

Treat with benzos

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8
Q

Benzo overdose treatment

A

Flumazenil - competitive antagonist

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9
Q

Hydroxocobalamin

A

Cyanide poisoning - would expect lactate >10

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10
Q

Fomepizole

A

Ethylene glycol or methanol poisoning - inhibits ADHase

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11
Q

Ethylene glycol or methanol poisoning - treatment

A
  1. Fomepizole
  2. NaCO3
  3. Hemodialysis
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12
Q

Illicit drugs associated with hypertension

A

Cocaine and other stimulants (MDMA/Ecstasy), PCP, marijuana

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13
Q

MDMA leads to what two toxicity profiles?

A

Sympathomimetic toxicity

Serotonin syndrome - includes drug-induced SIADH

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14
Q

Acute iron poisoning - signs

A

Iron directly injures GI mucosa by free radical production and lipid peroxidation, causing:

Abdominal pain, hematemesis, melena, diarrhea, green/black stool from tablets
Shock (multiple causes)
Anion gap metabolic acidosis
Liver necrosis (1-2 days later)

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15
Q

Hydroflouric acid burns - concerns and treatment

A

Hypomagnesemia/hypocalcemia (binding); resulting K release from cells into blood
Cardiac arrhythmia
Direct cardiotoxic effect

Treat with irrigation and calcium gluconate gel/intradermal injection or iv for cardiac arrhythmia

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16
Q

What must be accounted for in methadone overdose?

A

Long half-life - need to admit to hospital for prolonged observation in case naloxone redosing is needed

17
Q

What should be done for alkaline cleaner ingestion in kid?

A

Take off clothes, endoscopy within 24 hr later (but not immediately since injuries may not be immediately present) +/- nasogastric tube (do not place blindly), barium swallow 2-3 weeks later

18
Q

PCP vs meth

A

PCP has nystagmus, lower duration than meth

Both have psychomotor agitation, hallucinations, tachycardia, hypertension

19
Q

Anticholinergic plants

A
  1. Mushrooms
  2. Jimsonweed
  3. Nightshade
20
Q

Explain the biphasic response to nicotine poisoning

A

Early/stimulatory phase (<1 hr) - nicotinic agonism - agitation, nausea/vomiting, HTN, tachycardia, myoclonus, seizures

Late/inhibitory phase (1-4 hr) - overwhelmed nicotinic receptors, functional inhibition - delayed parasympathetic effects, neuromuscular blockade

Variable muscarinic effects (e.g. drooling, wheezing, diarrhea)

21
Q

Salicylate treatment

A
  1. IV sodium bicarbonate - alkalinizes serum and urine to aid in its (anion) excretion)
  2. Hemodialysis - indicated if unable to tolerate large volume of sodium bicarbonate required
22
Q

When is hemodialysis preferred over IV sodium bicarbonate for salicylate treatment?

A

When cannot tolerate large volumes:
ESRD, renal failure
Salicylate-induced pulmonary edema

Also severe ingestions resulting in shock or seizure, refractory acidosis, or clinical worsening despite bicarb

23
Q

Is iron poisoning anion gap metabolic acidosis?

A

Yes - from iron absorption and lactic acid production

24
Q

Acidic vs alkaline ingestion necrosis

A

Acidic - coagulation necrosis - protein denaturation results in eschar, preventing further injury

Alkaline - liquefactive necrosis - cell membrane dissolution allows deeper penetration of tissues and more severe injury

25
Q

Cocaine treatment

A

Benzos, nonselective beta-blockers (e.g. labetalol)