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Critical Care > Poisoning and Drug Overdose > Flashcards

Poisoning and Drug Overdose Flashcards

1
Q

Primary Drug Behind Overdose

A

narcotics (heroine, oxycodone, dilaudid, morphine)

mixes of drugs in street drugs

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2
Q

Drug Types

A

Depressants:

  • CNS depression
  • alcohol
  • benzos
  • opioids
  • barbiturates
  • hypnotics (ambien)

Stimulants:

  • CNS stimulation
  • cocaine
  • methamphetamines
  • cannabis

ASA
Tylenol
Antidepressants

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3
Q

Signs of Depressant Overdose

A
  • 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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4
Q

Opioids

A

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

oral or Rx opioids: dilaudid, morphine, etc.

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5
Q

Opioids: Reversal Agent

A

nalaxone (Narcan)

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6
Q

Opioid Overdose: Nursing Consideration

A
  • 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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7
Q

Opioids: Withdrawal

A
  • 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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8
Q

Benzodiazepines

A 
lorazepam
diazepam
alprazolam
clonazepam
temazepam

used to decrease anxiety

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9
Q

Benzodiazepines: Reversal Agent

A

Flumazenil

SE = seizures, SVT, dysrthythmias

sometimes SE risks don’t outweigh the benefits

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10
Q

Benzodiazepine: OD

A

can range from mild sedation to stupor or coma

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11
Q

Benzodiazepine: Nursing Considerations

A

supportive care:

  • intubation
  • BiPAP or CPAP
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12
Q

Barbiturates

A

CNS effects: drowsiness and sleepiness

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13
Q

Barbiturates: OD Sx

A

respiratory depression
decreased LOC
poor coordination/ “drunken” behaviors

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14
Q

Barbiturates: OD Tx

A

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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15
Q

Alcohol Poisoning: Sx

A 
apnea
decreased RR
hypothermia
coma
vomiting
seizures
confusion
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16
Q

Alcohol Poisoning: Tx

A

supportive care:

  • fluids/electrolytes
  • glucose replacement
  • stomach pumping
  • intubation (in extreme cases)
17
Q

Alcohol: Withdrawal

A

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

18
Q

Delirium Tremens

A

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

19
Q

Zolpidem (Ambien): OD

A

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

CNS depression: respiratory depression, bradycardia, coma

when mixed w/ alcohol or benzos, effects are heightened

20
Q

Signs of Stimulant Overdose

A

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

21
Q

Nicotine

A

use causes: tachycardia, HTN

long term: cardiac and respiratory effects, and lung cancer

cessation programs locally and nationally

22
Q

Cocaine

A

typically snorted but can be IV

concern w/ cocaine:

  • HTN
  • tachycardia
  • hemorrhagic stroke
  • chest pain
  • seizures
  • hyperthermia
  • anxiety
  • agitation
23
Q

Cocaine: Detox

A

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
24
Q

Methamphetamines

A

ecstasy
molly
meth

can cause:

  • psychosis
  • seizures
  • HTN
  • hemorrhagic strokes
  • mood swings
  • violent behavior

*methamphetamines used to treat ADHD

25
Q

Methamphetamines: OD Tx

A
  • haldol
  • beta blockers
  • labetalol
  • charcoal (if substance was ingested w/in 2 hours of admin)
26
Q

Methamphetamines: Withdrawal

A

occurs about 24 hours after last use

sx:

  • agitation
  • HTN
  • seizures
  • cravings
27
Q

Cannabis

A

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

28
Q

Aspirin (ASA): OD

A

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

29
Q

ASA: OD Tx

A

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)
30
Q

Acetaminophen: OD

A
  • 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
31
Q

Acetaminophen: Reversal Agent

A

acetylcysteine (sulfur based drug)

-start w/ loading dose, then q4

we know it’s working when we see decrease in liver function test

32
Q

Antidepressants: TCAs Sx

A

low doses:

  • anticholinergic
  • agitation
  • cardiac effects

high doses:

  • CNS depression
  • cardiac effects (prolonged QT, prolonged QRS w/ ventricular disturbances - dangerous rhythms)
33
Q

Antidepressants: OD Tx

A

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

34
Q

Iron: OD

A
  • vomiting/diarrhea w/ blood
  • fever
  • lethargy
  • hyperglycemia
  • seizure
  • coma
  • gastric lavage
  • chelation therapy
35
Q

Iron OD: Reversal Agent

A

Desferal

36
Q

Cleaning Agents

A

acids/alkalis

bleach
battery acid
lye
hydrofluoric acid

37
Q

Cleaning Agents: Ingestion Sx

A
  • excessive salivation
  • dysphagia
  • epigastric pain
  • burns of the mouth/esophagus/stomach
38
Q

Cleaning Agents: Ingestion Tx

A

-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

Critical Care (14 decks)

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