Depressants: - CNS depression - alcohol - benzos - opioids - barbiturates - hypnotics (ambien) Stimulants: - CNS stimulation - cocaine - methamphetamines - cannabis ASA Tylenol Antidepressants

supportive care: - activated charcoal (if given w/in 2 hours of ingestion) - intubation - HD (to filter from body) - rewarming - hydration - vasopressors

Poisoning and Drug Overdose Flashcards by Kaitlin Hobbs

Primary Drug Behind Overdose

narcotics (heroine, oxycodone, dilaudid, morphine)

mixes of drugs in street drugs

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Drug Types

Depressants:

CNS depression
alcohol
benzos
opioids
barbiturates
hypnotics (ambien)

Stimulants:

CNS stimulation
cocaine
methamphetamines
cannabis

ASA
Tylenol
Antidepressants

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Signs of Depressant Overdose

blue lips or nails
dizziness and confusion
can’t be woken up
choking, gurgling, or snoring sounds (d/t inability to protect airway)
slow, weak, or no breathing
drowsiness or difficulty staying awake

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Opioids

street forms: heroine, fentanyl carfentanyl (more potent form of fentanyl)

oral or Rx opioids: dilaudid, morphine, etc.

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Opioids: Reversal Agent

nalaxone (Narcan)

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Opioid Overdose: Nursing Consideration

intubate if person cannot protect their airway
try to reverse opioid OD
is family involved? personal hx?
protect self (call hospital security to come search bags if needed)
short term: stabilize pt
long term: think about discharge items like rehab
may have long term respiratory issues (aspiration pneumonia is common SE for someone who isn’t able to protect airway for long periods)
methadone
clonidine

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Opioids: Withdrawal

fatigue
cravings
disorientation
abdominal pain
n/v
sweating
tachycardia
yawning

*body is going through process of receptors detoxing - body has developed dependency on opioids so process of withdrawal can be long and painful

cravings may never go away

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Benzodiazepines

lorazepam
diazepam
alprazolam
clonazepam
temazepam

used to decrease anxiety

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Benzodiazepines: Reversal Agent

Flumazenil

SE = seizures, SVT, dysrthythmias

sometimes SE risks don’t outweigh the benefits

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Benzodiazepine: OD

can range from mild sedation to stupor or coma

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Benzodiazepine: Nursing Considerations

supportive care:

intubation
BiPAP or CPAP

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Barbiturates

CNS effects: drowsiness and sleepiness

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Barbiturates: OD Sx

respiratory depression
decreased LOC
poor coordination/ “drunken” behaviors

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Barbiturates: OD Tx

supportive care:

activated charcoal (if given w/in 2 hours of ingestion)
intubation
HD (to filter from body)
rewarming
hydration
vasopressors

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Alcohol Poisoning: Sx

apnea
decreased RR
hypothermia
coma
vomiting
seizures
confusion

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Alcohol Poisoning: Tx

supportive care:

fluids/electrolytes
glucose replacement
stomach pumping
intubation (in extreme cases)

Alcohol: Withdrawal

one of most important questions to ask: when was their last drink

initial symptoms begin 4-6 hours after last drink

withdrawal for alcoholics will occur w/in 48-72 hours of last drink

Q1hr CIWAS (scale used for assessing level of withdrawal)

Tx: benzos, sometimes barbiturates

Delirium Tremens

Alcohol poisoning and alcohol withdrawal can progress to DT in heavy users (form of withdrawal)

includes but not limited to:

tactile/auditory disturbances and hallucinations
tremors/shivering
seizures
irregular HR
sweating
severe anxiety (feelings of doom)

Tx: benzos and barbiturates

Zolpidem (Ambien): OD

CNS changes: dizziness, visions changes, hallucination, tremors/shaking

CNS depression: respiratory depression, bradycardia, coma

when mixed w/ alcohol or benzos, effects are heightened

Signs of Stimulant Overdose

Psychological Distress:

anxiety
paranoia
confusion
panicking
hallucinations
extremely agitated
psychosis

Physical Distress:

chest pain
stroke
racing pulse
SOB
overheated
sweating
shaking
seizing
vomiting
paralyzed
in and out of consciousness
lung/liver/kidney damage

*schizophrenia w/ cannabis

Nicotine

use causes: tachycardia, HTN

long term: cardiac and respiratory effects, and lung cancer

cessation programs locally and nationally

Cocaine

typically snorted but can be IV

concern w/ cocaine:

HTN
tachycardia
hemorrhagic stroke
chest pain
seizures
hyperthermia
anxiety
agitation

Cocaine: Detox

takes 3 days

hallucinations
auditory disturbance
severe cravings (that will persist for the rest of life)

Tx: supportive care (tx BP and calm pt)

nitroprusside or labetalol for HTN
benzos to calm pt

Methamphetamines

ecstasy
molly
meth

can cause:

psychosis
seizures
HTN
hemorrhagic strokes
mood swings
violent behavior

*methamphetamines used to treat ADHD

Methamphetamines: OD Tx

- haldol - beta blockers - labetalol - charcoal (if substance was ingested w/in 2 hours of admin)

Methamphetamines: Withdrawal

occurs about 24 hours after last use sx: - agitation - HTN - seizures - cravings

Cannabis

can be stimulant or depressant based on strain can cause panic attacks (elevated HR and BP) no antidotes -supportive care: manage environment, can give med to lower BP if needed effect wears off typically after 6 hours

Aspirin (ASA): OD

nephrotoxic so need to tx OD right away sx: hyperventilation, vomiting, dehydration, coma, convulsion ABG would show: respiratory alkalosis initially d/t hyperventilation then progress to metabolic acidosis as body metabolizes aspirin

ASA: OD Tx

supportive care: - intubation (if needed) - gastric lavage w/ activated charcoal if w/in 2 hours of ingestion - HD/CRRT to support kidneys - urine alkalinization w/ sodium bicarb (IV sodium bicarb makes entire body alkalized)

Acetaminophen: OD

- hepatotoxic (RUQ pain) - rapid and severe liver failure can ensue - liver failure>encephalopathy and hypoglycemia sx: - vomiting - airway protection if not protecting it on their own

Acetaminophen: Reversal Agent

acetylcysteine (sulfur based drug) -start w/ loading dose, then q4 we know it's working when we see decrease in liver function test

Antidepressants: TCAs Sx

low doses: - anticholinergic - agitation - cardiac effects high doses: - CNS depression - cardiac effects (prolonged QT, prolonged QRS w/ ventricular disturbances - dangerous rhythms)

Antidepressants: OD Tx

no antidote supportive care: - HD to filter out - meds to tx sx (charcoal, gastric lavage, serum alkalinization (sodium bicarb given), respiratory support) do not induce vomiting b/c don't want to damage airway, have them reabsorb any, or aspirate

Iron: OD

- vomiting/diarrhea w/ blood - fever - lethargy - hyperglycemia - seizure - coma - gastric lavage - chelation therapy

Iron OD: Reversal Agent

Desferal

Cleaning Agents

acids/alkalis bleach battery acid lye hydrofluoric acid

Cleaning Agents: Ingestion Sx

- excessive salivation - dysphagia - epigastric pain - burns of the mouth/esophagus/stomach

Cleaning Agents: Ingestion Tx

-immediately dilute w/ water, milk, steroids tissue damage may be permanent, may require skin grafts do not induce vomiting, it will burn on the way out too (worsening burn) supportive tx