Toxicology Flashcards
What toxidrome / drug could cause the following symptoms:
tachy, htn, increased temp, mydriasis (pupil dilitation), diarhoresis
Sympathomimetic toxidrome:
Ie: nose beers , amphetamines , MDMA
Others include: adreanline, pseudoephedrine, MAOIs, SNRI (duloxetine)
Pt B/G of Bioplar
Started recently on Perindopril for HTN. Presents with mild tataxia, fine tremor, and nausea
? cause
? other symptoms that can be present
? Rx
Lithium toxicity
- usually triggered by dehydration, GI issues, new meds - ARB/ACE/NSAIDS
CNS : tremor, hyperrefelxia, ataxia, rigidity, drowsiness, confusion, coma, seizures,
CVS: QTc prolongation, Brady, hypotension
GI: Nausea + vomiting
Pt. Depression. On SSRI, loves the st john wort and started recently on tramadol for LBP.
PT return 1 week later with behavioural changes.
What other Signs would you look for and what is the possilbe dx
Serotonin syndrome
other symptoms
CNS: change in mental status/ behavours: agitation, anxiety, confusion, seizures
MSK: tremor, hyperreflexia, , clonus
autonomic instabiliy: sweating, HTN, tachy, fever, diarrhoea
Pt with schizophrenia taking olanzapine and dose was doubled due to naughty behaviour.
Been doing well then started developing fevers and confusion. O/E pt was stiff/ ridgid, Septic work up / LP were normal
DX + other symtpoms associated with toxidrome
Neuroleptic malignant syndrome
pt needs to be on dopamine antagonist or dopaminergic drug
> antispychotics
> also consider with w/d-ing Levodopa drugs
Occurs in 1-2 weeks of change/starting drugs
Tetrade:
Extrapyramidal effects: lead pipe rigidity, bradykinesea, akinesia, dystonia , tremor, dysphagia.
temp dysregulation: temp > 39
Autonomic: tachy, labiale bp, sweating
CNS : drowsiness, confusion, coma , mutism
IX;
CK 3x higher than nroamal, WCC up, Low iron,
17 yr old , nasuea and vomiting, preg negative. Given Metoclopramide.
Developed lip smacking and rigidity.
What dx called
What is rx
Young females - risk of EPSE incuding tardive dyskinesia. Dopamine antagonist.
EPSE :
> acute dystonia: involutnary mm contraction –> abnormal movements
> parkinsonism tremor- ridgidity, bradykinesia
> akathisia> inner restlessness and compulsion to move
tardive dyskinesia- rhythmic involuntary movements of tongue face and jaw
RX: benzatropine
