Toxidromes Flashcards
What is the MOA of anticholinergics?
They block acetylcholine from binding to muscarinic receptors and thus inhibit parasympathetic nervous system function
what is the mnemonic for anticholinergic syndrome?
mad as a hatter
blind as a bat
hot as a hare
dry as a cracker
What are three classes of medications that can cause anticholinergic overdose?
TCAS, antihistamines, overactive bladder medications (oxybutynin, tolterodine, trospium)
What is the MOA of cholinergic medication?
enhance or mimix acetylcholine; active PNS.
What is the mnemonic for cholinergic overdose?
DUMBBELLS
Diarrhea
Urination
Miosis
Bronchorrhea
Bradycardia
Emesis
Lacrimation
Salivation/sweating
What are two sources of cholinergic poisoning?
organophosphates and nerve agents (-stigmines)
Treatment of cholinergic poisoning?
Atropine
Pralidoxime
How does sympathomimetic overdose present?
Fight or flight:
tachycardia, hypertension, midryiasis, diaphoresis, hyperthermia, agitation
What OTC agents can cause sympathomimetic overdose?
ephedrine containing products
which illicit substances can cause sympathomimetic overdose ?
cocaine, methamphetamine, amphetamine, MDMA , ecstasy
main symptom of sympathomimetic poisoning?
extreme hypertension
pupils in anticholinergic toxicity?
dilated and non reactive
Which 5 classes of medications can cause serotonin syndrome?
- anti-depressants ( SSRI, MAOi)
- stimulants (cocaine, MDMA, meth, triptans)
- opioids (fentanyl, tramadol, meperidine)
- herbs (st. john’s wort, ginseng, nutmeg)
- others (lithium, valproate, dextromethorphan, linezolid, zofran, reglan)
symptoms of serotonin syndrome?
Hyperthermic, hyperreflexia, hypertension, hypertonic muscles, hyperactive BS
Diagnostic tool for serotonin syndrome?
Hunter criteria (Se 84% Sp 97%)
antidote for serotonin syndrome?
cyproheptadine
what causes neuroleptic malignant syndrome?
dopamine blockers or cessation of dopamine agonist (parkinson’s tx)
Which three drug classes cause NMS?
- antipsychotics (haloperidol, clozapine, olanzapine, risperidone, quetipaine)
- anti-emetics (reglan, compazine, droperidol)
- dopamine agonist WITHDRAWAL (carbidopa/levodopa, bromocriptine)
symptoms of NMS?
lead pipe rigidity
brady-reflexia
AMS
catatonia
hyperthermia
treatment for NMS?
restart DA agonist if held
dantrolene
bromocriptine
what causes malignant hyperthermia?
inhaled anesthetics or succinylcholine in a patient with genetic mutation in ryanodine receptor
symptoms of malignant hyperthermia?
hyperthermia >42
Rigor mortis rigidity
Hyporeflexia
Hypercarbia
antidote for malignant hyperthermia
dantrolene
aggressive cooling
antidote for beta blocker tox?
glucagon
antidote for CCBs?
calcium, glucagon, insulin/dextrose
antidote for CO2 ?
oxygen, hyperbaric oxygen
antidote for cyanide poisoning?
hydroxycobalamin or a cyanide kit
antidote for digoxin?
digibind Fab fragments
antidote for hydrofluoric acid?
calcium
antidote for iron?
deferoxamine
antidote for isoniazid
pyridoxine
antidote for local anesthetic?
IV lipid emulsion
antidote for methanol/ethylene glycol
ethanol or fomepizole
antidote for methemoglobinemia
methylene blue
antidote for opioids
naloxone
antidote for organophosphate / insecticide?
atropine and pralidoxime
antidote for snake bite (crotalidae)
crotalidae immune Fab
antidote for sulfonylureas
glucose, octreotide
antidote for TCAs?
sodium bicarb and hypertonic saline
