Sympathomimetics OD

Question 1

MoA of sympathomimetics

Answer 1

Inhibition of NE and dopamine reuptake, or increased release of neurotransmitters

Question 2

Examples of sympathomimetics

Answer 2

Cocaine, amphetamines, bath salts, pseudoephedrine, nootropics

Question 3

What receptors do sympathomimetics act on?

Answer 3

Alpha-1, alpha-2, beta-1, beta-2

Question 4

Effects of sympathomimetics on alpha-1 receptors

Answer 4

vasoconstriction, increased peripheral resistance, increased BP, mydriasis, increased closure of internal sphincter of the bladder

Question 5

Effects of sympathomimetics on beta-1 receptors

Answer 5

tachycardia, increased lipolysis, increased myocardial contractility, increased release of renin

Question 6

Sympathomimetic toxidrome: what does it increase?

Answer 6

BP, pulse, RR, temperature, pupil size, bowel sounds, diaphoresis

Question 7

Sympathomimetic toxidrome: what does it do to mental status?

Answer 7

Agitated, hyperalertness

Question 8

Sympathomimetic toxidrome: what else can it do?

Answer 8

Tremors, seizures

Question 9

Cocaine: a typical line is how much?

Answer 9

20-30mg

Question 10

Ingestion of 1g of cocaine is what?

Answer 10

Fatal

Question 11

Effects of cocaine

Answer 11

Euphoria, seizures, dysrhythmias, HTN

Question 12

What else can cocaine do?

Answer 12

Coronary artery spasm MI

Question 13

Effects of cocaine in a coronary artery spasm MI

Answer 13

ST elevation, will see a high troponin value

Question 14

What can cocaine sometimes get laced with?

Answer 14

Levamisole

Question 15

Effects of levamisole

Answer 15

neutropenia, vasculitis, purpura

Question 16

How do people smuggle cocaine across borders?

Answer 16

body packers

Question 17

Management of cocaine OD

Answer 17

BZDs, supportive care

Question 18

MoA of amphetamines

Answer 18

releases catecholamines

Question 19

Clinical manifestations of amphetamines

Answer 19

adrenergic effects (similar to cocaine, just longer lasting)

Agitation, seizures, hyperthermia, HTN, delirium

Question 20

Management of amphetamine OD

Answer 20

BZDs, barbiturates, anti-hypertensives, supportive care

Question 21

Chemically speaking, what happens when you change the backbone structure of epinephrine?

Answer 21

The drug will have profoundly different effects depending on what you do to it

Question 22

Bath salts are what?

Answer 22

Synthetic cathinones

Question 23

Effects of bath salts

Answer 23

agitation, tachycardia, insomnia, paranoia, seizures, violent, unpredictable behavior

Question 24

Management of bath salt OD

Answer 24

supportive care

Question 25

General management for sympathomimetic OD: elimination strategies

Answer 25

AC

Question 26

General management for sympathomimetic OD: BZDs

Answer 26

Use if the patient is agitated, needs to be restrained, can help with HTN May need higher doses

Question 27

General management for sympathomimetic OD: anti-hypertensives

Answer 27

Add on to BZDs if they don't work and the patient is super hypertensive and is in tachycardia

Question 28

General management for sympathomimetic OD: fluids

Answer 28

If the patient is sweaty/has a lot of fluid loss

Question 29

General management for sympathomimetic OD: APS

Answer 29

use if the patient is REALLY agitated

Question 30

Which APS can you use in sympathomimetic OD management?

Answer 30

Haldol, olanzapine

Question 31

General management for sympathomimetic OD: electrolyte management

Answer 31

replace electrolytes as needed

Question 32

General management for sympathomimetic OD: ice baths

Answer 32

if the patient is hyperthermic

Question 33

What else can you use if the patient is hyperthermic?

Answer 33

ice packs, cool fluids, BZDs, antipyretics

Question 34

General management for sympathomimetic OD: when to use sodium bicarb

Answer 34

If the patient is in acidosis, has a wide QRS complex seen on EKG (dysrhythmia)

Question 35

What else can you use for dysrhythmias in sympathomimetic OD?

Answer 35

Lidocaine

Question 36

General management for sympathomimetic OD: airway protection

Answer 36

If the patient is extremely agitated, irate, needs high doses of sedatives

Question 37

General management for sympathomimetic OD: rhabdomyolysis

Answer 37

Give fluids, watch CK values

Question 38

Structure of Wellbutrin is similar to what?

Answer 38

A cathinone (bath salt)

Question 39

Structure of pseudoephedrine is similar to what?

Answer 39

Amphetamine

Question 40

Significance if a patient ODs on Wellbutrin or pseudoephedrine

Answer 40

Because these drugs have similar structures to other sympathomimetics, OD'ing on one of these will result in the patient presenting with similar findings of a sympathomimetic or adrenergic toxidrome