Overdoses, adverse effects

Question 1

What distinguishes beta-blocker toxicity from calcium channel blocker toxicity?

Answer 1

beta-blocker toxicity included hypoglycemia and AMS

Question 2

What is the mechanism of hypoglycemia seen in beta-blocker toxicity?

Answer 2

inhibition of glycogenolysis and stimulation of gluconeogenesis

Question 3

What is the treatment for beta-blocker toxicity?

Answer 3

glucagon
-in hypotensive pts the addition of IV calcium can help

Question 4

What is the MOA behind elevated plasma levels of statins when taken w/ clarithromycin and what can it lead to?

Answer 4

-macrolides are CYP3A4 inhibitors which cause the statin level increases
-can result in muscle toxicity and rhabdo

Question 5

What electrolyte disorder can be sen with carbamazepine (antiepileptic, antipyschotic)?

Answer 5

hyponatremia
-carbamazepine acts on renal tubules to increase their sensitivity to ADH

Question 6

What is the interaction between fluconazole and warfarin?

Answer 6

-fluconazole is an inhibitor of cytochrome P450 which metabolizes warfarin
-these drugs interacting lead to warfarin over-anticoagulation

Question 7

What are the s/s of serotonin syndrome?

Answer 7

-clonus
-hyperreflexia (differentiates this from neuroleptic malignant syndrome)
-hyperthermia
-agitation
-disorientation
-diaphoresis
-tachycardia
-nausea
-vomiting
-tremor
-muscle rigidity
-dilated pupils
-ocular clonus
-dry mucous membrane
-flushed skin
-b/l Babinski sign

Question 8

What are the classic characteristics of neuroleptic malignant syndrome?

Answer 8

-hyperthermia
-mental status changes
-fever
-muscle rigidity
-autonomic instability

Question 9

What is the mechanisms of neuroleptic malignant syndrome?

Answer 9

-reaction to dopamine receptor antagonist medications
-or d/t withdrawal of dopaminergic drugs

Question 10

What is an adverse effect of nitroprusside if given in high doses or for prolonged periods?

Answer 10

lactic acidosis

Question 11

What medications have been associated w/ SJS?

Answer 11

-amoxicillin/PCNs
-lamotrigine
-carbamazepine
-cephalosporins
-quinolones
-minocycline
-NSAIDs

Question 12

What is the treatment for organophosphate poinsoning?

Answer 12

-atropine 2-5mg IV q3-5min until respiratory compromised resolved
-competitive muscarininc receptor antagonist
-pralidoxime (2-PAM) 30mg/kg
-acts on nicotinic receptor
-rapid administration can cause cardiac arrest

Question 13

What is the MOA of organophosphate poisoning and its s/s?

Answer 13

-increase ACh levels
-anxiety
-szs
-coma
-bradycardia
-pinpoint pupils
-salivation
-lacrimation
-hyperactive bowel sounds

Question 14

What are s/s of overdose w/ anticholinergic medication?

Answer 14

-dilated pupils
-dry mouth
-urinary retention
-dry skin

Question 15

What adverse effects can occur if undiluted amniocaproic acid is injected and/or injected at a fast rate?

Answer 15

hypotension
bradycardia
arrhythmia

Question 16

What are the presenting s/s of calcium channel blocker toxicity?

Answer 16

-hypotension
-bradycardia
-PR prolongation

Question 17

What is the treatment for Ca channel blocker toxicity?

Answer 17

-initially fluid resuscitation and atropine
-if not responsive to above give IV Ca gluconate as 0.6mg/kg bolus of 10% solution and 0.6-1.5mg/kg/hr

Question 18

What is the MOA of naloxone?

Answer 18

pure, competitive opioid antagonist w/ high affinity for the mu-opioid receptor

Question 19

What is the IV dosing for naloxone in an opioid naive pt? In an opioid dependent pt?

Answer 19

-naive = 0.4mg IV
-dependent = 0.04-0.1mg IV

Question 20

What is the intranasal, IM, or SQ dosing of naloxone?

Answer 20

1-4mg (the intranasal spray people get is 4mg)

Question 21

What are the adverse effects of naloxone?

Answer 21

-anxiety/aggression
-nausea/vomiting
-abdominal pain/diarrhea
-rhinorrhea
-diaphoresis
-tachycardia
-noncardiogenic pulmonary edema (0.2-3.6% of pts)

Question 22

What is the treatment for digitalis OD with bradycardia?

Answer 22

Digitalis specific antibodies

Question 23

What is the treatment for beta-blocker OD with bradycardia?

Answer 23

Glucagon

Question 24

What is the inheritance pattern of malignant hyperthermia?

Answer 24

autosomal dominant

Question 25

What anesthetics can lead to malignant hyperthermia?

Answer 25

-halogenated anesthetic gases (halothane, isoflurane)
-succinylcholine

Question 26

What are the signs/symptoms of malignant hyperthermia?

Answer 26

-sudden rise in EtCO2
-fever
-muscle rigidity
-myoglobinuria

Question 27

What is the treatment for malignant hyperthermia?

Answer 27

-immediate discontinuation of offending agent
-dantrolene x 3days
-treat fever
-increased ventilation to reduce EtCO2

Question 28

What is the adverse effect of dantrolene?

Answer 28

liver failure