Overdoses, adverse effects Flashcards
What distinguishes beta-blocker toxicity from calcium channel blocker toxicity?
beta-blocker toxicity included hypoglycemia and AMS
What is the mechanism of hypoglycemia seen in beta-blocker toxicity?
inhibition of glycogenolysis and stimulation of gluconeogenesis
What is the treatment for beta-blocker toxicity?
glucagon
-in hypotensive pts the addition of IV calcium can help
What is the MOA behind elevated plasma levels of statins when taken w/ clarithromycin and what can it lead to?
-macrolides are CYP3A4 inhibitors which cause the statin level increases
-can result in muscle toxicity and rhabdo
What electrolyte disorder can be sen with carbamazepine (antiepileptic, antipyschotic)?
hyponatremia
-carbamazepine acts on renal tubules to increase their sensitivity to ADH
What is the interaction between fluconazole and warfarin?
-fluconazole is an inhibitor of cytochrome P450 which metabolizes warfarin
-these drugs interacting lead to warfarin over-anticoagulation
What are the s/s of serotonin syndrome?
-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
What are the classic characteristics of neuroleptic malignant syndrome?
-hyperthermia
-mental status changes
-fever
-muscle rigidity
-autonomic instability
What is the mechanisms of neuroleptic malignant syndrome?
-reaction to dopamine receptor antagonist medications
-or d/t withdrawal of dopaminergic drugs
What is an adverse effect of nitroprusside if given in high doses or for prolonged periods?
lactic acidosis
What medications have been associated w/ SJS?
-amoxicillin/PCNs
-lamotrigine
-carbamazepine
-cephalosporins
-quinolones
-minocycline
-NSAIDs
What is the treatment for organophosphate poinsoning?
-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
What is the MOA of organophosphate poisoning and its s/s?
-increase ACh levels
-anxiety
-szs
-coma
-bradycardia
-pinpoint pupils
-salivation
-lacrimation
-hyperactive bowel sounds
What are s/s of overdose w/ anticholinergic medication?
-dilated pupils
-dry mouth
-urinary retention
-dry skin
What adverse effects can occur if undiluted amniocaproic acid is injected and/or injected at a fast rate?
hypotension
bradycardia
arrhythmia
What are the presenting s/s of calcium channel blocker toxicity?
-hypotension
-bradycardia
-PR prolongation
What is the treatment for Ca channel blocker toxicity?
-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
What is the MOA of naloxone?
pure, competitive opioid antagonist w/ high affinity for the mu-opioid receptor
What is the IV dosing for naloxone in an opioid naive pt? In an opioid dependent pt?
-naive = 0.4mg IV
-dependent = 0.04-0.1mg IV
What is the intranasal, IM, or SQ dosing of naloxone?
1-4mg (the intranasal spray people get is 4mg)
What are the adverse effects of naloxone?
-anxiety/aggression
-nausea/vomiting
-abdominal pain/diarrhea
-rhinorrhea
-diaphoresis
-tachycardia
-noncardiogenic pulmonary edema (0.2-3.6% of pts)
What is the treatment for digitalis OD with bradycardia?
Digitalis specific antibodies
What is the treatment for beta-blocker OD with bradycardia?
Glucagon
What is the inheritance pattern of malignant hyperthermia?
autosomal dominant
What anesthetics can lead to malignant hyperthermia?
-halogenated anesthetic gases (halothane, isoflurane)
-succinylcholine
What are the signs/symptoms of malignant hyperthermia?
-sudden rise in EtCO2
-fever
-muscle rigidity
-myoglobinuria
What is the treatment for malignant hyperthermia?
-immediate discontinuation of offending agent
-dantrolene x 3days
-treat fever
-increased ventilation to reduce EtCO2
What is the adverse effect of dantrolene?
liver failure
