PPW 3 Medications Flashcards
Which benzodiazepine have the highest and the lowest half-life?
Shortest half-life–>Midazolam (2hrs)
Longest half-life–>Clorazepate (40-100hrs)
Side effects of benzodiazepines in pregnancy?
Floppy infant syndrome and fetal withdrawal syndrome
What should be given in benzodiazepine poisoning?
Activated charcoal during the first hour after benzodiazepine ingestion and flumazenil
In which patients is flumazenil contraindicated?
History of seizures, widening of QRS complex, and many mixed intoxications
What should be given in barbiturate poisoning?
Activated charcoal during the first hour after barbiturate ingestion
What should be given in TCA poisoning?
Activated charcoal during the first hour after TCA ingestion
What are the characteristic symptoms of acute lithium intoxication?
Nausea, vomiting, and diarrhea
-No neurological symptoms, because lithium penetrates BBB slowly
What are the causes of chronic lithium intoxication and what are the most severe symptoms?
Causes:
-Iatrogenic intoxication (too high doses during psychiatric treatment)
-Drug interactions (thiazide diuretics, ibuprofen, diclofenac, tetracyclines, and phenytoin)
-Co-morbidities (Renal failure, diabetes, Addisons disease)
-Decreased lithium renal clearance in elderly
-Hyponatremia
Severe symptoms:
-Cardiovascular and CNS effects
Treatment of lithium intoxication?
Activated charcoal is ineffective
-Give sodium chloride and consider hemodialysis
What are the symptoms of neuroleptic intoxication?
- CNS symptoms (Drowsiness, mitosis, hypothermia, seizures, and coma)
- Extrapyramidal symptoms (Dystonia, dyskinesias, akathisia, and Parkinsonism)
- Cardiovascular (hypotension, sinus tachycardia, QT prolongation and tornados de pointes)
- Others: Salivation, agranulocytosis, hyperglycemia, rhabdomyolysis, priapism and neuroleptic malignant syndrome
Neuroleptic intoxication treatment?
Benzodiazepines for seizures Norepinephrine for hypotension Sodium bicarbonate for QT prolongation Lidocaine for ventricular tachycardia Bromocriptine, amantadine or levodopa for neuroleptic malignant syndrome
Carbamazepine intoxication symptoms?
CNS symptoms, cardiovascular symptoms, respiratory symptoms (apnea, respiratory failure, aspiration pneumonia) and other symptoms (mydriasis, dry skin/mucous membranes, rhabdomyolysis and acute kidney failure)
Valproate intoxication symptoms?
CNS effects, cerebral edema, respiratory failure, sinus bradycardia, hypotension, hyporeflexia and miosis
What are the main cardiotoxic drugs?
Cardiac glycosides, beta blockers and CCBs
Treatment of digoxin toxicity?
- Correct hypokalemia
- Atropine for AV bocks and bradycardia
- Phenytoin, lidocaine or magnesium sulfate for tachycardia
- Give digoxin-specific antibody
