Tox: Sympathomimetics

Question 1

Examples of drugs that can cause a sympathomimetic toxidrome

Answer 1

1) ADHD meds
2) OTC/herbal preparations: Ephedrine, pseudoephedrine, Ma Huang
3) Illicit drugs: cocaine, meth

Question 2

In addition to increasing norE/epi levels, what additional toxicity results from cocaine

Answer 2

Na+ channel blockade (wide complex dysrhythmias)

Question 3

Sympatho toxidrome

Answer 3

Fight/flight. 
Agitation, hallucinations. 
\+HR, +BP. 
\+temp, +diaphoresis. 
Mydriasis. 
Muscular rigidity.

Question 4

Tx of sympatho toxidrome

Answer 4

1) Supportive: passing/active cooling, aggressive sedation and possible intubation, paralytics to maintain normothermia. IVF.
2) Benzos: for agitation, hypthermia, tachycardia, seizures, muscular rigidity.
3) NaHCO3: for wide complex dysrhythmias.

Question 5

Drug to AVOID in sympthatho tox

Answer 5

BB: due to concern for unopposed alpha-receptor stimulation (and ++BP)

Question 6

Complications of sympathomimetics

Answer 6

Cardiac ischemia, aortic dissection, ruptured AAA, ischemic bowel, ICH, rhabdo, dysrhythmia.