Toxicology - Antidepressants

Question 1

TCA Toxicity - Clinical Effects

Answer 1

increased, then decreased BP
increased HR
increased temperature
rapid decline in mental status

Question 2

TCA Toxicity - EKG Interpretation

Answer 2

QRS > 100 msec - ~30% seizure
QRS > 160 msec - ~50% seizure
depends on the R wave

Question 3

TCA Toxicity - Treatment

Answer 3

hypertonic sodium bicarbonate:
provides sodium for sodium channel blockade
provides alkalization, which reduces TCA binding

Question 4

Hypertonic Sodium Bicarbonate - Dose

Answer 4

1-2 mEq / kg bolus
or
150 mEq in 1 L D5W x 2

Question 5

TCA Dysrhythmias - Treatment

Answer 5

magnesium
lidocaine

Question 6

TCA Hypotension - Treatment

Answer 6

norepinephrine, epinephrine, vasopressin, phenylephrine
methylene blue, lipid emulsion, high-dose insulin

Question 7

TCA Seizures - Treatment

Answer 7

benzodiazepines
barbiturates

Question 8

TCA - Decontamination

Answer 8

orogastric lavage
charcoal

Question 9

Bupropion - Toxidrome

Answer 9

sympathomimetic

Question 10

Bupropion Toxicity - Potential Consequences

Answer 10

sympathomimetic crisis
cardiogenic shock
status epilepticus
Lazarus effect
death

Question 11

Bupropion - Decontomination

Answer 11

orogastric lavage
activated charcoal
whole bowel irrigation

Question 12

Bupropion - Treatment

Answer 12

supportive care
lipid emulsion
ECMO

Question 13

SSRI Toxicity - Clinical Effects

Answer 13

altered mental status
tachycardia
myoclonus
tremors
diarrhea
seizures

Question 14

SSRI Toxicity - Treatment

Answer 14

supportive care
monitoring

Question 15

Serotonin Syndrome - Treatment

Answer 15

supportive care (to decrease temperature)
benzodiazepines
propranolol
antidote - cyproheptadine