Poisoning from medicines and drugs

Question 1

Naloxone is not indicated in the treatment of poisoning associated with

Answer 1

an altered level of consciousness unless opiate poisoning is strongly suspected.

Question 2

treatment

Answer 2

• Measure the blood glucose concentration if the patient has diabetes or an altered level of consciousness, and treat accordingly.
• Administer naloxone if opiate poisoning is suspected and the patient has a significantly impaired level of consciousness, or significantly impaired breathing:
  a) 0.1-0.4 mg of naloxone IV every five minutes for an adult, or
  b) 0.8 mg of naloxone IM every ten minutes for an adult.
  c) See the paediatric drug dose tables for a child.
• Administer 0.9% sodium chloride IV if the patient has signs of hypovolaemia or poor perfusion:
  a) 1 litre IV for an adult.
  b) 20 ml/kg IV for a child.
  c) Repeat as required.
• Administer 0.9% sodium chloride IV if cyclic antidepressant poisoning is suspected and the patient has tachycardia, QRS prolongation or an altered level of consciousness:
  a) 2-3 litres IV for an adult.
  b) 40-60 ml/kg IV for a child.
• If 8.4% sodium bicarbonate is immediately available or can be delivered to the scene within ten minutes, in addition to 0.9% sodium chloride, administer:
  a) 100 ml IV over 5-10 minutes for an adult.
  b) 2 ml/kg IV over 5-10 minutes for a child.

Question 3

Naloxone administration may be associated with

Answer 3

seizures, hypertension, pulmonary oedema or severe agitation.

Question 4

Significant paracetamol poisoning may cause

Answer 4

acute liver failure, but this is treatable provided treatment occurs early.

Question 5

A patient with significant paracetamol poisoning is commonly

Answer 5

asymptomatic in the first 6-12 hours and then usually develops nausea, vomiting and non- specific abdominal pain.

Question 6

Part of the toxicity from cyclic antidepressants comes from

Answer 6

the drug binding to sodium channels within the heart and this may be reduced by the administration of a large dose of sodium ions. This is the reason for an IV bolus of 0.9% sodium chloride.

Question 7

Signs and symptoms of serotonin syndrome

Answer 7

tachycardia, tachypnoea, hypertension, sweating, hyperthermia, tremor, rigidity, confusion, agitation and seizures. If severe, the patient will be unconscious with severe shock.

Question 8

Glucagon is sometimes suggested as part of the treatment for bradycardia caused by beta-blockers because

Answer 8

t stimulates cardiac cells via a mechanism that is independent of the beta receptor. However, glucagon has no role in the out-of-hospital setting because it rarely provides a sustained heart rate rise in addition to adrenaline and requires much higher doses than carried by ambulance personnel.

Question 9

Gamma hydroxybutyrate (GHB) may cause the patient to be

Answer 9

deeply unconscious with a poor airway, poor breathing and intermittent apnoea Commonly the patient requires assisted ventilation and improves rapidly after 20-30 minutes. The patient may take longer to improve if another sedative (for example alcohol) has also been ingested.

Question 10

Ecstasy may cause

Answer 10

an altered level of consciousness, seizures and hyperthermia.

Question 11

Ketamine may cause

Answer 11

hallucinations or an altered level of consciousness.

Question 12

Amphetamines and methamphetamines may cause

Answer 12

severe hypertension,
tachycardia and disturbed behaviour. The latter may be severe and may be
associated with violence or attempted suicide.

Question 13

Cathinones (for example mephedrone) are amphetamine-like. They may
cause

Answer 13

hypertension, tachycardia, hallucinations, paranoia, panic attacks
and disturbed behaviour. The latter may be severe.

Question 14

Cannabis and cannabinoids may cause

Answer 14

mental dissociation, anxiety,
tachycardia, palpitations, chest pain, nausea and vomiting.

Question 15

Cocaine may cause

Answer 15

severe hypertension, tachycardia, intracranial haemorrhage, coronary artery spasm and myocardial ischaemi

Question 16

Organophosphates inhibit the activity of

Answer 16

the enzyme cholinesterase. This causes acetylcholine (ACh) to build up at neural and neuromuscular junction

Question 17

The build-up of ACh causes:

Answer 17

ū Salivation.
ū Lacrimation.
ū Defaecation and vomiting.
ū Urination.
ū Bradycardia.
ū Bronchoconstriction and bronchial secretions.
ū Muscle twitching and muscle weakness.

Question 18

Cyanide impairs

Answer 18

oxygen utilisation at a mitochondrial level. The oxygen levels within blood and tissues are normal, but oxygen cannot be used by cells.

Question 19

Patients with cyanide poisoning have non-specific signs and symptoms:

Answer 19

ū Anxiety, nausea and headache.
ū Tachycardia.
ū Tachypnoea.
ū Falling level of consciousness (when severe).
ū Cardiac arrest (when very severe).