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Psychiatry2 > Toxidromes > Flashcards

Toxidromes Flashcards

1
Q

Anticholinergic Toxidromes

A
  • Heart rate + BP: Increase
  • Resp rate: No change
  • Temp: Increase
  • Pupils: Dilated
  • Bowel Sounds: Decrease
  • Diaphoresis: Decrease
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2
Q

Cholinergic Toxidromes

A
  • Heart rate + BP: No change
  • Resp rate: No change
  • Temp: No change
  • Pupils: Constricted
  • Bowel Sounds: Increase
  • Diaphoresis: Increase
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3
Q

Opioid Toxidromes (morphine, heroine, hydromorophone)

A
  • Heart rate + BP: Decrease
  • Resp rate: Decrease
  • Temp: Decrease
  • Pupils: Constricted
  • Bowel Sounds: Decrease
  • Diaphoresis: Decrease
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4
Q

Sympathomimetic Toxidromes (Epiinephrine, cocaine, amphetamine, and methylphenidate)

A
  • Heart rate + BP: Increase
  • Resp rate: Increase
  • Temp: Increase
  • Pupils: Dilated
  • Bowel Sounds: Increase
  • Diaphoresis: Increase
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5
Q

Sedative Hypnotic (benzos, barbs, Z-drugs, antihistamines)

A
  • Heart rate + BP: Decrease
  • Resp rate: Decrease
  • Temp: Decrease
  • Pupils: No change
  • Bowel Sounds: Decrease
  • Diaphoresis: Decrease
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6
Q

Hypnotics and Sedatives

A
  • GABA-ergic
  • Includes: Benzo, barbiturates, anti-epileptics, Z-drugs, propofol, baclofen
  • Effects:
    • CNS depression
    • Slurred speech
    • Ataxia
    • Nystagmus
    • Usually relatively normal vital signs. In severe cases can develop apnea
    • Treatment is usually supportive - flumazenil is historically used for benzo overdose, but it can trigger withdrawal seizures
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7
Q

Which toxidromes Increase HP and BP

A
  • Anticholinergic
  • Sympathomimetic
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8
Q

Whcih toxidromes decrease HP and BP

A
  • Opioid
  • Sedative-hypnotic
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9
Q

Which toxidromes increase resp rate

A
  • Sympathomimetic
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10
Q

Which toxidromes decrease resp rate

A
  • Opioids
  • Sedative hypnotics
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11
Q

Which toxidromes increase temp

A
  • anticholinergic
  • sympathomimetic
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12
Q

which toxidromes decrease temp

A
  • opioid
  • sedative-hypnotic
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13
Q

Which toxidromes cause pupil dilation

A
  • anticholinergic
  • Sympathomimetic
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14
Q

which toxidromes cause pupil contriction

A
  • cholinergic
  • opioids
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15
Q

Which toxidromes cause increase bowel sounds

A
  • cholinergic
  • sympathomimetic
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16
Q

which toxidromes cause decrease bowel sounds

A
  • anticholinergic
  • opioid
  • sedative-hypnotic
17
Q

which toxidromes cause increase diaphoresis

A
  • cholinergic
  • sympathomimetic
18
Q

which toxidrome decreases diaphoresis

A
  • anticholinergic
  • opioid
  • sedative hypnotic
19
Q

Sympathomimetic

A
  • Examples - caffeine, cocaine, crack, amphetamines, MDMA
  • Symptoms: tachycardia, arrhythmias, hypertensions, diaphoresis, piloerection, psychosis, seziures, hyperthermia, mydriasis (pupil dilation)
  • Management: Symptom control
    • Control agitation with benzodiazepines
    • Control BP (nitroprusside, labetalol) -DONT use B-blockers
    • Cooling, IV fluids
    • Monitory for arrhythmias, MI, seizure
    • Consider antipsychotic. However, there increase risk of dystonia, so always administer with benzotropine
20
Q

Anticholinergic

A
  • Mad as a hatter
  • Blind as a bat
  • Dry as a bone
  • Red as a beet
  • Hot as a dessert
  • Full as a flask
  • Examples: Benzotropin, Atropine, TCAs, antihistamines, antipsychotics, antispasmodics
  • Treatment: Decontaminations with activated charcoal and supportive - IV fluids, benzodiazepines for agitation and seziures, antipyretics, avoid antipsychotics.
    • Physostigme (reversible cholinesterase inhibitor) for severe agitation, refractory seizures, or tachycardia causing hemodynamic compromise.
21
Q

Cholinergic

A
  • Rare presentation as people typically do not come into contact with these substances
  • EX: phosphorous compounds used in industrial agricultural settings and biological weapons like sarin gas
  • Salivation

Lacrimation

Urination

Defecation

Gastric upset

Emesis

  • Treatment: Support airway and respiration, volume resuscitation, decontaimination.
    • For organophosphate or carbamate poisoning give high dose atrophoine (anticholinergic)
    • For seizures give benzos
22
Q

Opioids

A
  • Examples: Morphone, hydromorphone, codeie, oxycodone, tramadol, methadone, fentanyl
  • Symptoms: Pinpoint pupils, decrese LOC, respiratory depression, bradycardia, hypotension, hypothermia, hyporeflexia
  • Treatment: Naloxone (0.4mg). Duration is 45mins (important because you may have to give multiple doses)

Psychiatry2 (14 decks)

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