Psychotropics and Anticonvulsants Flashcards
Lithium
Mechanism of Action
(3)
- decrease noradrenaline release
- increase serotonin synthesis
- decrease postsynaptic receptor sensitivity
Lithium
What raises levels?
(6)
- low sodium levels
- excessive sweating
- diarrhoea
- diuretics
- fever
- strenuous exercise
Lithium
What lowers levels?
(3)
- high sodium levels
- high potassium levels
- theophylline
Lithium Toxicity
Neural Symptoms
(8)
- nystagmus
- ALOC
- delirium
- lethargy
- tremors
- ataxia
- seizures
- coma
Lithium Toxicity
Cardiac Symptoms
(2)
- tachycardia
- hypotension (severe levels)
Lithium Toxicity
ECG Findings
(4)
- PR widening
- QRS widening
- QT widening
- flat/inverted T waves
Lithium Toxicity
Peripheral Symptoms
(9)
- weakness
- hyperreflexia
- increased tone
- myoclonic jerks
- hyperthermia
- gastric irritation
- nausea
- vomiting
- renal toxicity
Antipyschotics
Primary Action
(2)
- dopamine receptor antagonist
- effective when >60% dopamine receptors blocked
Antipsychotic Toxicity
Neural Symptoms
(11)
- agitated delirium
- dysphasia
- mutism
- oculogyric crisis
- trismus
- ALOC
- lethargy
- stupor
- seizures
- respiratory depression
- coma
Antipsychotic Toxicity
Extrapyramidal Syndromes
(4)
- acute dystonia
- akasthesia
- parkinsonism
- tardive dyskinesia
Antipsychotic Toxicity
Cardiac Symptoms
- tachycardia
- QT prolongation
- labile blood pressure
- orthostasis
- hypotension
Antipsychotic Toxicity
Peripheral Symptoms
- abnormal neuromuscular activity
- hyporeflexia
- lead pipe muscle rigidity
- hyperthermia
- diaphoresis
- flushing
- urinary retention
Neuroleptic Malignant Syndrome
Symptoms
- mydriasis
- diaphoresis
- agitation
- tachycardia
- hypertensive
- increased bowel sounds/diarrhea
- clonos (lower extremities)
- tremor (lower extremities)
- hyperreflexia (lower extremities)
Anticonvulsant Toxicity
Neural Symptoms
- nystagmus
- dizziness
- ataxia
- ALOC
- lethargy
- stupor
- seizures
- respiratory depression
- coma
Anticonvulsant Toxicity
Cardiac Symptoms
(2)
- VT (refractory)
- VF (refractory)
Anticonvulsant Toxicity
ECG Findings
(3)
- QRS widening
- R axis deviation
- QT prolongation
Anticonvulsant Toxicity
Peripheral Symptoms
(3)
- tremor
- myoclonus
- hyperthermia
Anticonvulsant Toxicity
Treatment Plan
(6)
- safety, QPS back up and/or sedation
- early airway management, vomit/secretion likely
- consider oxygen
- consider IV access for fluids
- cool down pts with hyperthermia
- seizures, may be unresponsive to midazolam
Anticonvulsant Toxicity
Specific Considerations
Risk Assessment
clarify drug class for back up and clinical progression
Anticonvulsant Toxicity
Specific Considerations
Lithium
prehospital treatment is mostly supportive
Anticonvulsant Toxicity
Specific Considerations
Sodium Blockade
sodium bicarbonate 8.4% if QRS >160ms
Anticonvulsant Toxicity
Specific Considerations
Hyperthermia
aggressive cooling regardless of aetiology
Anticonvulsant Toxicity
Specific Considerations
Hypotension
fluids, reassessing every 250-500mLs
Anticonvulsant Toxicity
Specific Considerations
Seizures
midazolam to be given even for anticonvulsants
