Toxicologic Emergencies ptII; Specific emergencies Flashcards
1
Q
Toxic Alcohol Poisoning
In addition to ethanol, three other alcohols can cause severe poisoning and can be found in many common household products.
What are they?
A
Methanol
Isopropanol
Ethylene glycol
2
Q
What is Methanol?
Where is it found?
What does it cause?
A
(wood alcohol) is found in windshield wiper fluid, canned fuel (sterno), and solvents such as paint removers
Causes formic acid accumulation
3
Q
What is Isopropanol?
Where is it found?
What does it cause?
A
a major component of rubbing alcohol, disinfectants, cleansers, and nail polish removers
Causes ketones in the urine
4
Q
What is Ethylene glycol?
Where is it found?
What does it cause?
A
an odorless substance contained in antifreeze, detergents, paints, polishes, and coolants. Its sweet taste and fluorescent color are particularly appealing to paediatric patients and pets
Causes urine to fluoresce under Wood’s lamp
affects anion gap and osmolar gap
5
Q
Name 4 ways Toxic alcohol ingestion may occur, and 3 ways that it can be absorbed.
A
Toxic alcohol ingestion can be unintentional, recreational, or suicidal, or it may occur in desperate alcoholics who cannot obtain ethanol. Besides oral ingestion, toxic alcohols may be inhaled or topically absorbed.
6
Q
How does alcohol occur in the body?
A
Toxicity occurs in the liver after the enzymatic conversion of the alcohol to its toxic metabolites.
7
Q
What are The toxic metabolites of ethylene glycol, methanol, and isopropanol?
A
The toxic metabolites-glycolaldehyde (ethylene glycol), formaldehyde and formic acid (methanol), and acetone (isopropanol) - produce widespread damage and metabolic dysfunction.
8
Q
What is another name for isopropanol?
A
acetone
9
Q
Methanol intoxication causes pronounced metabolic acidosis due to Methanol intoxication causes pronounced metabolic acidosis due to what?
A
formic acid accumulation
10
Q
Ethylene glycol toxicity produces what?
A
anion gap metabolic acidosis and a large sum osmolar gap.
11
Q
Isopropanol poisoning does what?
A
elevates the serum acetone level and causes ketones to appear in the blood and urine.
12
Q
S/S The initial symptoms of toxic alcohol poisoning include what? (4)
A
CNS and respiratory depression, with nausea and vomiting after ingestion
13
Q
Methanol toxicity may also result in ____ and ____
A
blindness and coma
14
Q
Isopropanol toxicity causes ____ breath odor, ____ distress, vomiting, ____tension, and ____glycemia
A
acetone
epigastric
hypotension
hyperglycemia
15
Q
Ethylene glycol toxicity produces these seven S/S
A
seizures, ataxia, coma, nystagmus, cardiac conduction disturbances, and dysrhythmias.
16
Q
Profound ____, ____ failure, and ____ edema are major causes of death from toxic alcohol poisoning
A
acidosis
renal
pulmonary
17
Q
What are 4 lab tests you should order for Toxic Alcohol Poisoning and what are the reasons?
A
ABG to detect metabolic acidosis, a common finding in toxic alcohol ingestion
Serum acetone and urine ketone levels, which are characteristically affected in isopropanol poisoning
Blood glucose level because hyperglycemia may occur
Urinalysis to detect oxalate or hippurate crystals (associated with ethylene glycol)
18
Q
Toxic Alcohol Poisoning; Management
what are four procedures you should know?
this is one of them
A
Gastric Lavage
intubation, to maximize pulmonary excretion.
hemodialysis to remove metabolites and reverse acidosis in methanol and ethylene glycol toxicity.
19
Q
Before hemodialysis in a patient with significant methanol and ethylene glycol overdose, expect to administer the antidote, ____ (____). This antidote is NOT indicated for ____ toxicity.
A
fomepizole (Antizol)
isopropanol
20
Q
Toxic Alcohol Poisoning
How does Administration of Fomepizole work?
A
it inhibits alcohol dehydrogenase and blocks formation of toxic metabolites
21
Q
Toxic Alcohol Poisoning
Hemodialysis may be used until ____ resolves and the serum level of ____ ____ol or ____ol is undetectable.
You should Monitor for ____ ____ during the procedure.
A
acidosis
ethylene glycol
methanol
cerebral edema
22
Q
Toxic Alcohol Poisoning
For ethylene glycol, administration of what is indicated?
A
IV calcium or symptomatic hypocalcemia
23
Q
For methanol, administration of ____ ____ is indicated.
A
folinic acid
24
Q
____ and ____ (____ inhibitors) are major active ingredients in insecticides and pesticides, such as ant sprays, flea sprays, and insect sprays, powders, and liquids.
A
Organophosphates and carbamates (cholinesterase inhibitors)
25
Pesticide Toxicity
Pathophysiology - ____ aggressively bind to ____ molecules, inhibiting their effects and leaving acetylcholine unopposed in the neural synapses. As a result, the patient exhibits nicotinic, muscarinic and CNS system effects.
organophosphates
| cholinesterase
26
Organophosphate-cholinesterase bonds do not reverse spontaneously. After __ to __ hours of continuous binding, the cholinesterase molecules are ____. The complete regeneration of cholinesterase can take how long?
24
48
destroyed
weeks or months
27
Organophosphate Poisoning
| Commonly causes Muscarinic effects, such as...(9)
bradycardia, miosis, lacrimation, salivation, increased respiratory secretions (which may mimic pulmonary edema), bronchospasm, urination, emesis, and diarrhea.
28
SLUDGE - what does it stand for?
salivation, lacrimation, urination, defecation, gastrointestinal, and excitation
29
DUMBELS - what does it stand for?
defecation, urination, miosis, bronchospasm, or bronchorrhea, emesis, lacrimation, and salivation
30
MUDDLES - what does it stand for?
miosis, urination, defecation, diaphoresis, lacrimation, excitation, and salivation
31
Organophosphate poisoning may result in respiratory failure from
(4)
Pulmonary edema
Bronchospasm
Bronchorrhea
Respiratory muscle paralysis
32
Pesticide Toxicity
____ do not easily cross into the CNS, and their effects may be related to pulmonary toxicity rather than CNS toxicity, although muscarinic symptoms may occur and the effects may be evident for a shorter period of time.
Carbamates
33
What are Muscarinic symptoms?
by organ system include the following: Cardiovascular - Bradycardia, hypotension.
Respiratory - Rhinorrhea, bronchorrhea, bronchospasm, cough, severe respiratory distress.
Gastrointestinal - Hypersalivation, nausea and vomiting, abdominal pain, diarrhea, fecal incontinence.
34
Dx of both Organophosphates and Carbamates
May be confirmed by measuring the plasma ____ level, red blood cell ____ level, or both.
Other lab tests include (7)
pseudocholinesterase
cholinesterase
electrolyte, BUN, creatinine, and glucose levels; ABG analysis, 12 lead EKG, and chest radiography to detect aspiration or pulmonary edema.
35
What are Carbamates and what are they used for?
They are used as sprays or baits to kill insects by affecting their brains and nervous systems. They are used on crops and in the home to kill cockroaches, ants, fleas, crickets, aphids, scale, whitefly, lace bugs and mealy bugs. Some carbamates control mosquitoes.
36
True or false
when treating a patient who has Carbamate poisoning, staff may be poisoned through coming in contact with the patients bodily fluids or skin.
true
37
With a patient who has ingested Carbamates, what should you anticipate?
If ingested, anticipate the administration of activated charcoal
38
Carbamate poisoning
For a patient with a severely depressed MS and respiratory distress due to secretions or muscle weakness, what should you do?
What should you NOT do?
assist with intubation and administer 100% oxygen
Do not use succinylcholine (Anectine) during intubation. It is contraindicated because of its effect on pseudocholinesterase
39
Pesticide Toxicity/Carbamate poisoning
Administer ____ IV to counteract the ____ effects of organophosphate poisoning. Continue until respiratory secretions have been cleared and bronchospasms and bronchoconstriction have stopped.
Atropine
| cholinergic
40
Pesticide Toxicity/Carbamate poisoning
| Prepare the patient for many days of treatment because why?
recovery requires the synthesis of new cholinesterase
41
Pesticide Toxicity/Carbamate poisoning
Be aware that tachycardia does not contraindicate atropine administration
Know that Atropine does not treat neuromuscular dysfunctions (nicotinic effects), such as muscle fasciculations and weakness.
42
Pesticide Toxicity/Carbamate poisoning
Administer ____ immediately after initiating atropine therapy to decrease or inhibit the effects of organophosphates on nicotinic receptors.
pralidoxime
43
The use of ____ in carbamate poisoning is controversial. ____ should only be used when the poisoning is severe (as defined for organophosphates), and the provider cannot differentiate the two.
oximes
44
Pesticide Toxicity/Carbamate poisoning
| Seizure management should include ____. Avoid using ____ (____) for seizures induced by organophosphates.
Benzodiazepines
| phenytoin (Dilantin)
45
Pesticide Toxicity; ____
Used in head lice treatments
Toxic poisoning very uncommon
Pyrethroids
46
Heavy Metal Toxicity
| Absorption usually through ____ and ____, dermal exposure is possible.
inhalation and ingestion
47
With the exception of ____ and ____, heavy metals have no benefit to humans, are not metabolized, and are accumulated in tissues.
iron and lithium carbonate
48
Lead exposure can occur as a result of (5)
paints, dust in older buildings, lead contaminated soil, plumbing, batteries
49
S/S of lead poisoning include (8)
lethargy, hemolytic anemia, gastro symptoms such as anorexia, abdominal pain, and vomiting, toxic hepatitis, encephalopathy with seizures, coma
50
Chronic lead toxicity includes (9)
behavior changes, ataxia, motor neuropathy, anorexia, intellectual impairment, anemia, hemolysis, interstitial fibrosis, reversible tubular dysfunction
51
Mercury ;exposure can happen through (5)
fish consumption, thermometers, fluorescent lamps, batteries, some paints
52
Acute Mercury Toxicity includes (5)
renal failure, gastro manifestations, Mucous membrane irritation, noncardiac pulmonary edema, chemical pneumonitis
53
Chronic mercury toxicity includes S/S such as (6)
tremor, neuropsychiatric manifestations, irritability, memory loss, acrodynia in pediatric patients, dark blue or black line along the gum line.
54
Arsenic exposure can occur through what?
| 5
contaminated air or ground water, soil, food, paint, fungicide
55
Acute arsenic toxicity includes S/S such as (5)
garlic breath, tremors, seizures, severe gastro manifestations, hemolysis
56
Chronic Arsenic exposure can cause S/S such as (4)
peripheral neuropathy, anemia, malaise, anorexia
57
Cadmium exposure can occur from (4)
industrial production of batteries, electroplating, soldering and welding , smoking
58
Treatment for Heavy metal toxicity can include this type of therapy and also what?
Chelation Therapy - used to eliminate heavy metal from the body. The agent binds to the metals and helps with its excretion
Treatment may involve hemodialysis
59
Iron Toxicity Has a direct corrosive effect on the ____ ____, leading to perforation, hemorrhage, and necrosis. After it is absorbed iron does what?
What lab value should you look out for?
gastrointestinal mucosa
initiates cellular toxicity by interfering with aerobic metabolism, causing lactic acidosis and producing free radical injury
60
Iron Toxicity
| May result in ____ formation which may require surgical removal
bezoar
61
Iron Toxicity
| 6 hours phase __; ____ phase, corrosive effects cause (3)
1
gastro
abdominal pain, diarrhea, and vomiting which may be bloody
62
Iron Toxicity
| 6 to 24 hours; ____ phase, what are the S/S?
latent
| resolution of gastro symptoms, tachycardia, acidosis, depressed mental status
63
Iron Toxicity
12 to 24 hours phase 3,____ phase, what are the S/S?
(7)
systemic
return of gastro symptoms, acidosis, leukocytosis, coagulopathy, renal failure, lethargy or coma, cardiovascular collapse
64
Iron Toxicity
2 to 5 days, phase 4, ____ phase, what are the S/S?
(2)
hepatic phase, Fulminant liver failure, coagulopathy
65
Iron Toxicity
| 3 to __ weeks, phase __, ____ phase;
6
5
Obstructive
66
Iron Toxicity
Lab findings will include
Serum iron level of __ to __ mcg/dl in mild to moderate toxicity or __ in hepatotoxicity
Metabolic acidosis with increased ____ ____
Elevated WBC count, hyperglycemia
350 to 500 mcg/dl
500
anion gap
67
Hydrocarbon Toxicity
| Low viscosity hydrocarbons; exist in
in gasoline, kerosene, charcoal lighter fluid, and furniture polish
68
Hydrocarbon Toxicity
| High viscosity hydrocarbons include (3), but are less likely to be absorbed through what?
motor oil, mineral oil, and lubricants, less likely to be aspirated
69
Hydrocarbon Toxicity
| Plant hydrocarbons occur in (3)
paint thinner, turpentine, and pine oil
70
Halogenated, or chlorinated hydrocarbons appear in what? (3)
methylene chloride (paint stripper), trichloroethylene (degreaser), and carbon tetrachloride (dry cleaning fluid).
71
Aromatic hydrocarbons are found in ____ and ____.
toluene and benzene
72
Hydrocarbon Toxicity
Pulmonary aspiration
what are the S/S
persistent coughing or wheezing after emesis or direct exposure
73
Hydrocarbon Toxicity
| Systemic absorption can result from what three routes?
can result from ingestion, inhalation, or dermal contact.
74
Hydrocarbon Toxicity
| Hepatic failure, ____ failure, or ____ can occur days or weeks after exposure.
renal
| hemolysis
75
Halogenated and aromatic forms can cause these two cardiac conditions
dysrhythmias or complete heart block.
76
Pine oil and turpentine can cause ____ when inhaled or ingested
drowsiness
77
Methylene chloride is metabolized to ____ ____ which can cause impaired neurologic function, lethargy, and coma
carbon monoxide
78
Hydrocarbon Toxicity
Management
ET tube before ____ ____ to prevent aspiration.
a____ c____
Continuous monitoring, spo2, for systemic toxicity
Careful with IV fluids for risk of ____ ____.
Do Not administer ____ or ____.
gastric lavage
Activated charcoal
pulmonary edema
steroids or prophylactic ABx
79
Acids and alkalis
| Acids - found in what? (5)
car batteries, toilet bowel cleaners, vinegar, solder flux, rust removers
80
Toxic acids Have a pH less than __
3
81
Toxic acids Produce coagulation ____, ____, and ____ formation after contact with mucous membranes.
necrosis
blistering
eschar
82
Common acids include (6)
acetic acids, hydrochloric acid, nitric acid, sulfuric acid, phosphoric acid, and hydrofluoric acid
83
```
Alkalis
Found in (8)
```
oven cleaners, drain cleaners, batteries, cleaners and strippers, cement, car air bags, swimming pool products, hair relaxers, bleach
84
Common alkalis include (4)
sodium hydroxide, potassium hydroxide, sodium hypochlorite, and sodium metasilicate
85
Alkalis have a pH of more than __
11
86
Alkalis
They can cause ____ necrosis (fat saponification and collagen destruction) immediately on contact with tissue. An ingested ____ can adhere to the esophagus and cause corrosive effects as metal salts leak and the electrical current is discharged. An alkali splash in the eye can cause what?
liquefaction
Button
corneal erosion and anterior chamber damage.
87
What can be said of the prognosis of Food poisoning?
Most cases are self limiting and resolve quickly but some can result in death
88
Food poisoning
____ species and ____ ____ can cause hemorrhagic colitis that leads to hemolytic uremic syndrome, renal failure, and death
Shigella
| Escherichia coli
89
Food poisoning
| ____ can cause meningitis and sepsis as well as severe uterine infection in pregnancy.
Listeriosis
90
Food poisoning
____ ____ syndrome can result from Campylobacter infection. Usually the patient has signs and symptoms of gastroenteritis with or without fever
Gullian barre
91
Food poisoning Dx by what?
Treatment
The main objective is what?
Should antidiarrheals be used? Why or why not?
stool or blood Cx
adequate rehydration and electrolyte supplementation with oral or IV fluids.
Use of antidiarrheals is contraindicated for any type of infective diarrhea
92
Food poisoning
| ABx when causative bacteria is identified. Until then administer ____ as ordered
trimethoprim/sulfamethoxazole (bactrim) as ordered
93
Of bacterial food poisoning, these three treatments are of no benefit
gastric lavage, emesis induction, and activated charcoal administration
94
Food poisoning
If one of these two types, report to health authorities in your state and the CDC
Consider bioterrorism if large number of people
botulism or e coli
95
Name that toxicity
Rapidly absorbed from the gut and broken down by the liver, forming a toxic metabolite. In therapeutic doses endogenous hepatic enzymes rapidly detoxify this intermediary product. However, toxic doses deplete these enzymes which is followed by damage to the liver and kidneys as this metabolite accumulates.
Acetaminophen toxicity
96
Acetaminophen toxicity
An acute pediatric dose occurs with a single dose of greater than __ to __ mg/kg. Chronic overdose occurs with __ to __ mg/kg/day for __ to __ days
150 to 200
60 to 150
2 to 8
97
Acetaminophen toxicity
| Adults acute OD occurs with a single ingestion of __ g or more
7.5
98
Acetaminophen toxicity
Stage 1; ____ 0 to __ hour
The patient may be asymptomatic or may experience ____, ____, or mild gastric upset including NV nd anorexia
preinjury
24
Lethargy
diaphoresis
99
Acetaminophen toxicity
Stage 2 ____ injury
what are the S/S
Hints; pain in what quadrant? Urine output? Abnormal labs.
liver
| RUQ pain, hepatomegaly, oliguria, abnormal LFTs, prolonged PTT, increasing bilirubin levels
100
Acetaminophen toxicity
Stage 3 ____ liver injury
Pt may display jaundice, acutely ill appearance, hypoglycemia, massive hepatic dysfunction, liver enzymes more than __x normal
Toxicity can progress to (3)
maximum
100
hepatic failure, encephalopathy, and death
101
Acetaminophen toxicity
Stage 4 Recovery
If the pt survives stage 3, enters recovery stage, which is characterized by what?
the slow resolution of hepatic dysfunction
102
```
Acetaminophen toxicity Treatment
____ ____ if ingested within 1 hour. (antidote) is nearly __% hepatoprotective when administered within __ hours of ingestion, and still beneficial within __ hours
Can it (antidote) be used in pregnant patients? What is the route of administration? What should you do after administration?
```
Activated charcoal
Mucomyst (N-acetylcysteine)
100, 8, 24.
Yes. Acetaminophen crosses the placenta and can cause fetal liver toxicity. Can be given orally or by IV
After treatment obtain specimens for repeat LFTs, antidote failure may require liver transplantation
103
Salicylate Toxicologic Emergencies
| what is the most common cause?
aspirin
104
What are some causes of Salicylate Toxicity other than aspirin?
(5)
Oil of wintergreen (methyl salicylate) is a highly toxic, liquid form of salicylate that is used in products such as BENGAY
Bismuth subsalicylate is an ingredient in Pepto-Bismol
Other salicylate-containing products include Exedrin, Ecotrin, and Alka-Seltzer
105
Salicylate Toxicologic Emergencies
| Decreased use in pediatrics due to concerns of ____ syndrome
Reye’s
106
Salicylate Toxicologic Emergencies S/S include:
Stimulation of the respiratory center in the brainstem causing ____ ____. Decrease ATP production which leads to ____ ____, which decreases ____ ____ and increases CNS toxicity. Decreased platelet function can lead to ____. In large doses concretions or ____ may occur due to slow release and absorbed over time eroding the gut
respiratory alkalosis
metabolic acidosis, renal elimination
petechiae
bezoars
107
Salicylate Toxicologic Emergencies
Treatment
____ ____, repeat q 2 hours until serum salicylate levels start to decrease.
If the patient present within __ hour of ingesting ___ mg/kg consider gastric lavage
Activated charcoal
1
500
108
Salicylate Toxicologic Emergencies
Treatments
For a patient with significant metabolic acidosis, administer 50ml of ____ ____ by IV
sodium bicarb
109
Salicylate Toxicologic Emergencies
Treatments
Alkalinize the urine to increase renal excretion by adding __meq of ____ ____ to each liter of IV fluid and infuse at __-__ml/hr. If needed, add ___ to prevent losses from alkaline diuresis
100meq of NaHCO3
2-300
K
110
Salicylate Toxicologic Emergencies
Treatment
What intervention would you take to prevent hyperventilation?
intubation
111
Salicylate Toxicologic Emergencies Treatment
Hemodialysis if the level exceeds __ mg/dl or more, or chronic toxicity with a serum level of __ mg/dl or more
____ for treatment of seizures
Surgery if bezoars form
700
60
Benzodiazepines
112
What is a A bezoar (BE-zor)?
a solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage. Bezoars usually form in the stomach, sometimes in the small intestine or, rarely, the large intestine. They can occur in children and adults.
113
Ibuprofen - ingestion of more than __mg/kg causes gastrointestinal effects such (4)
Larger ingestions can cause (5)
100
abdominal pain, vomiting, diarrhea, and possibly drowsiness.
coma, apnea, acidosis, bradycardia, and renal failure
114
Other NSAIDS include (9)
Ketoprophen (Orudis), naproxen, celecoxib (celebrex), indomethacin (indocin), diclofenac (voltaren), Mefenamic acid (ponstel), phenylbutazone, piroxicam, ketorolac
115
```
NSAID ingestion Treatment
Treatment
____ ____ if within 1 to 2 hours
What two gastric medications?
Supportive treatment for (3)
```
Treatment
Activated charcoal if within 1 to 2 hours
Antacid, proton pump inhibitor
Supportive treatment for seizures, acidosis, renal effects
116
CNS stimulant Toxicity
Give 5 examples
What are 12 examples of S/S of abuse?
Caffeine, acutrim, sudafed, OTC cold remedies, alertness aids are used to make methamphetamines
Pupil dilation, tremors, restlessness, delirium, seizures, coma, NVD, bruxism, hyperthermia, rhabdomyolysis, piloerection (goosebumps), coagulopathies
117
```
CNS stimulant Toxicity
Treatments include (2)
```
Treatment
| Gastric lavage, activated charcoal
118
What are two ways to treat Opiate toxicity?
| What are the routes of administration?
Activated charcoal, narcan
| Can be administered via IV, IM, SQ, or intranasal
119
Tricyclic Antidepressants
Have now been largely replaced by what?
Still used to manage what?
SSRIs
| depression, chronic pain, OCD, and enuresis
120
Tricyclic Antidepressants
| Name 7
Amitriptyline, clomipramine (anafranil), Doxepin (Sinaquan), Nortriptyline (Pamelor), Amoxapine (Asendin) Desipramine (Norpramin), Imipramine (Tofranil)
121
Tricyclic Antidepressants overdose
| Describe the cardiac effects
Cardiac; which are anticholinergic and quinidine like effects such as tachycardia, hypotension, QRS prolongation, prolonged QT intervals, abnormal ST segments and T waves, ventricular tachycardia and ventricular fibrillation are more likely to occur in severe poisonings that are complicated by acidosis, hypotension, and extreme QRS prolongation
122
Tricyclic Antidepressants overdose
| Describe the non-cardiac effects
Other anticholinergic effects such as mydriasis, flushed skin, elevated body temperature, decreased bowel sounds, and urine retention
123
Tricyclic Antidepressants overdose
| What is the dose needed to induce toxicity?
Generally the ingestion of more than 10 mg/kg of body weight is likely to produce significant toxicity. Serum levels do not correlate with clinical effects.
124
Tricyclic Antidepressants overdose
Treatment
Orally, give the patient ____ ____
____ to speed up the drugs transit time.
Avoid the use of gastric lavage because of the risk of ____.
Treat dysrhythmias with ____.
Avoid using ____ and other class 1A because of the risk of QRS widening
```
Activated charcoal
Sorbitol
risk of seizures
amiodarone
Avoid using procainamide
```
125
Tricyclic Antidepressants overdose
Treatment
Administer vasopressors such as ____ or ____, avoid using ____ (intropin)
Administer ____ to control seizures. Phenytoin (Dilantin) is contraindicated because why?
Levophed or phenylephrine, avoid using dopamine (intropin)
| benzodiazepines to control seizures. Phenytoin (Dilantin) is contraindicated because it affects the sodium channels.
126
SSRI Toxicity
| What does SSRI stand for?
selective serotonin reuptake Inhibitor
127
SSRI Toxicity
| name 7
```
Bupropion - wellbutrin
Citalopram - celexa
Escitalopram - lexapro
Paroxetine - Paxil
Sertraline - Zoloft
Trazodone - Desyrel
Venlafaxine - Effexor
```
128
SSRI Toxicity
The S/S of an overdose are usually limited to ____ ____ and ___ depression. However, ____ are common in a bupropion (wellbutrin) overdose and can occur in a citalopram )celexa) or effexor overdose.
sinus tachycardia and CNS depression. However, seizures are common
129
SSRI Toxicity
| An overdose of ____ or ____ may prolong the QT interval
celexa or lexapro
130
SSRI Toxicity
Serotonin Syndrome - a potentially life-threatening drug reaction that most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time.
What part of the body makes serotonin?
What are some S/S of this syndrome?
It causes the body to have too much serotonin, a chemical produced by nerve cells, and may produce agitation or restlessness, hallucinations, loss of coordination, overactive reflexes, tachycardia, rapid changes in blood pressure, hyperthermia, and NVD.
131
SSRI Toxicity
Serotonin Syndrome
May result from the enhancement of the drugs normal effects or from a drug interaction with (7)
Benylin, Robitussin, Demerol, amphetamines, cocaine, lithium, a monoamine oxidase inhibitor, or another SSRI
132
SSRI Toxicity Treatment
Remove the offending drug with ____ ____
____ to manage seizures
____ (____) is a serotonin antagonist that can block serotonin syndrome
Monitor the patient using cardiac monitor and spo2
activated charcoal
Benzodiazepines
Cyproheptadine (Periactin)
133
Benzodiazepines
| Name 14
```
Alprazolam - Xanax
Chlordiazepoxide - Librium
Clonazepam - Klonopin
Diazepam - Valium
Flunitrazepam - Rohypnol
Lorazepam - Ativan
Midazolam - Versed
Oxazepam - Serax
Temazepam - Restoril
Triazolam - Halcion
Phenobarbitol - Luminal
Primidone - Mysoline, which is metabolized to phenobarbitol
Thiopental - Pentothal, which is a general anesthetic
Butalbital - Fioricet
```
134
Benzodiazepines Toxicity
| describe the effects and prognosis
the toxic effects of Benzodiazepines are an extension of their therapeutic effects, and mg/kg toxic doses have not been established, but generally produce mild toxicity, and usually with a good prognosis
S/S; drowsiness and confusion, slurred speech, unsteady gait, hypothermia
135
```
Benzodiazepines Toxicity
Treatment
____ ____
Do not use ____ ____
What is the antidote and what should you consider before administering it?
```
Treatment
Activated charcoal
Do not use gastric lavage
Antidote - Flumazenil; competes directly with benzos at their receptor sites
Flumazenil administration can induce withdrawal symptoms and seizures in patients with a benzo addiction or concomitant tricyclic antidepressant OD. Because benzo toxicity is associated with low mortality and morbidity, carefully consider the administration to administer Flumazenil.
136
Benzodiazepines Toxicity
| What are the S/S? (12)
S/S; Lethargy, slurred speech, nystagmus, ataxia, decreased bowel sounds, cardiac dysrhythmias, bradycardia, hypotension, coma, respiratory arrest, hypothermia, skin bullae or “barb blisters”
137
Antihistamines Toxicity
| In therapeutic doses, these medications cause ____ ____. In an overdose, they cause these effects.
OTC antihistamines such as benadryl, and prescription such as hydroxyzine (Atarax, Vistaril), are seen commonly in an overdose alone or with opiates or with alcohol.
CNS depression. In an overdose, they cause anticholinergic effects such as hallucinations, agitation, decreased gastric motility, and dysrhythmias.
138
```
Antihistamines Toxicity
Chloral Hydrate
What is it?
What is it metabolized by?
What does it cause?
How should it be treated?
```
Chloral Hydrate
| Sleep aid, metabolized by the liver, causes ventricular dysrhythmias that should be treated with beta blockers
139
Calcium channel blockers
| name 4
Amlodipine (Norvasc)
Diltiazem (Cardizem)
Nifedipine (Procardia)
Verapamil (Calan)
140
Calcium channel blockers toxicity
| What are the S/S
bradycardia, hypotension, AV block
| Hyperglycemia as a result of inhibited insulin release, confusion, NV, metabolic acidosis
141
Calcium channel blockers toxicity
Treatment
name 4 medications
Activated charcoal
Calcium gluconate or calcium chloride up to 4 g IV
Rapid acting insulin (Humalog)
Glucagon 5 to 15 mg for its inotropic effect when hypotension does not respond to fluid resuscitation
Urinary alkalinization
