Poisoning and Drug Overdose Flashcards
Primary Drug Behind Overdose
narcotics (heroine, oxycodone, dilaudid, morphine)
mixes of drugs in street drugs
Drug Types
Depressants:
- CNS depression
- alcohol
- benzos
- opioids
- barbiturates
- hypnotics (ambien)
Stimulants:
- CNS stimulation
- cocaine
- methamphetamines
- cannabis
ASA
Tylenol
Antidepressants
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
Opioids
street forms: heroine, fentanyl carfentanyl (more potent form of fentanyl)
oral or Rx opioids: dilaudid, morphine, etc.
Opioids: Reversal Agent
nalaxone (Narcan)
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
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
Benzodiazepines
lorazepam diazepam alprazolam clonazepam temazepam
used to decrease anxiety
Benzodiazepines: Reversal Agent
Flumazenil
SE = seizures, SVT, dysrthythmias
sometimes SE risks don’t outweigh the benefits
Benzodiazepine: OD
can range from mild sedation to stupor or coma
Benzodiazepine: Nursing Considerations
supportive care:
- intubation
- BiPAP or CPAP
Barbiturates
CNS effects: drowsiness and sleepiness
Barbiturates: OD Sx
respiratory depression
decreased LOC
poor coordination/ “drunken” behaviors
Barbiturates: OD Tx
supportive care:
- activated charcoal (if given w/in 2 hours of ingestion)
- intubation
- HD (to filter from body)
- rewarming
- hydration
- vasopressors
Alcohol Poisoning: Sx
apnea decreased RR hypothermia coma vomiting seizures confusion
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
