Psychiatry - SE & overdose Flashcards
What is the treatment for paracetemol overdose?
N-acetylcystine drip for 24 hours
Which drugs would you use for rapid tranquilization?
benzodiazepines
haloperidol
must do a capacity assessment
What are the symptoms of TCA overdose?
CCCAs - coma, convulsions, cardiac arrhythmias, anti-cholinergic symptoms
What is the treatment of a TCA overdose?
ABCDE
Activated charcoal in 1st hour
Sodium bicarbonate
benzodiazepine
What are the symptoms of lithium overdose?
dystharia, nausea and vomiting, coarse tremor, dizziness, hyperreflexes, convulsions, renal failure
Clumsy, confused, coughing
Nystagmus, slurred speech, dysdiadokinesia
Untreated - seizures, coma, renal failure
What is the treatment of lithium overdose?
stop lithium and diuretics
monitor electrolytes and renal function
Severe cases - ventilate, haemodyalisis, treat seizures
What is an acute dystonic reactions?
Antipsychotic medications cause excess of Ach due to drop in dopamine
What are the symptoms of acute dystonic reactions?
Dystonia (muscle contractions), extrapyramidal SE
agitated, eyes and face ‘stuck’, flexed neck, increased resp rate, stridor
What is the treatment of acute dystonic reactions?
ABCDE resuscitation benztropine (used to treat dystonia) benzodiazepines, antihistamines procyclidine IM - anticholinergic
What is serotonin syndrome?
excessive stimulation of CNS and peripheral serotonin receptors
Name 3 symptoms of serotonin syndrome
CAN - cognitive changes, autonomic changes (hyperthermia), neuromuscular changes (tremor)
How would you treat serotonin syndrome?
supportive
What is neuroleptic malignant syndrome?
D2 blockade often due to antipsychotics
Name 3 symptoms of neuroleptic malignant syndrome?
hyperthermia, altered mental state, muscular rigidity, tremor, tachycardia, dry mucosa, increased cap refill time, lead pipe rigidity
What tests would you do for neuroleptic malignant syndrome?
creatinine kinase - indicates muscle damage
What is the treatment for neuroleptic malignant syndrome?
fluids
stop meds
dopaminegic drugs e.g. bromocriptine mesylate
bicarb loading to prevent renal failure
What are some complications of neuroleptic malignant syndrome?
renal failure, DIC, DVT, MI, PE, aspirate pneumonia, cardiorespiratory failure, seizure, sepsis
What is the diagnostic criteria for serotonin syndrome?
Hunter’s criteria:
autonomic toxicity +
change in mental state +
neuromuscular affect
What are some complications of serotonin syndrome?
seizures, DIC, renal failure, rhabdomulosis
What are some blood tests you would do follow paracetamol overdose?
FBC, U&E, LFT, clotting, ABG
What are some SE of lithium and what tests do you need to do before prescribing?
TFT, KFT
hypothyroidism. nephropathy
cerebellar syndrome, myasthenia gravis, muscle weakness, nystagmus, peripheral neuropathy
