Overdoses and toxic syndromes

Question 1

Causes of serotonin syndrome

Answer 1

1. MAOi’s
2. SSRI’s interacting with St John’s wort or Tramadol
3. Ecstasy
4. Amphetamines

Question 2

Features of serotonin syndrome

Answer 2

1. Neuromuscular excitation (Hyperreflexia, myoclonus and rigidity)
2. Autonomic excitation (Hyperthermia/Sweating)
3. Altered mental state (confusion)

Question 3

Management of serotonin syndrome

Answer 3

1. Supportive with IV fluids
2. Can give benzos
3. Severe cases = cyproheptadine and chlorpromazine

Question 4

What are some features of opioid misuse

Answer 4

• Rhinorrhoea
• Needle track marks
• Pinpoint pupils
• Drowsiness
• Watering eyes
• Yawning

Question 5

What are some complications of opioid misuse

Answer 5

1. Viral infection secondary to sharing needles - HIV, Hep B/C
2. Bacterial infection secondary to injection - infective endocarditis, septic arthritis, septicaemia, nec fasc
3. VTE
4. OD can lead to resp depression and death
5. Psych problems e.g. craving
6. Social problems e.g. crime, prostitution, homelessness

Question 6

Emergency management of opioid OD

Answer 6

IM/IV naloxone - has a rapid onset and relatively short duration of onset

Question 7

Harm reduction intervention of opioid use

Answer 7

1. Needle exchange
2. Offer testing for HIV and Hep B/C

Question 8

Management of opioid dependence

Answer 8

These patients are usually managed by specialist drug dependence clinics and patients may be offered maintenance therapy or detox

Detox:
Methadone or Buprenorphine

Question 9

How do we monitor compliance to opioid detox and maintenance

Answer 9

urinalysis
detox takes 4 weeks as an in patient and 12 weeks in the community

Question 10

Features of digoxin toxicity

Answer 10

Generally unwell, lethargy, N&V
ANOREXIA, CONFUSION and YELLOW-GREEN VISION
Arrhythmia’s
Gynaecomastia

Question 11

Precipitating factors or digoxin toxicity

Answer 11

1. HYPOKALAEMIA
2. Increasing age
3. Renal failure!!!
4. MI
5. Electrolyte abnormalities - low Mg/Albumin and high Ca/Na
6. Hypothermia
7. Hypothyroid
8. Drugs

Question 12

Which drugs precipitate digoxin toxicity

Answer 12

1. Amiodarone
2. Verapamil
3. Diltiazem
4. Ciclosporin
5. Drugs causing hypokalaemia - thiazides and loop diuretics

Question 13

Management of digoxin toxicity

Answer 13

Digibind
Correct any arrhythmia
and Monitor the K
(DAK)