Week 11 Opioid/CNS depressant overdoses

Question 1

what are the different types of CNS depressants?

Answer 1

opiates- morphine, heroin, codeine, tramadol and methadone

Sedative-hypnotic drugs - benzodiazapines and barbituites

GHB - gamma hydroxybutrate

alcohol

Question 2

what are some of the clinical presentations of opioide overdoeses?

Answer 2

lower conciousness
resp depression 
pinpoint pupils
hyoptensive
vomitting

Question 3

in terms of synthetic opoid overdoses what symptoms might you see?

Answer 3

seizures

rarley resp depression but frequently tachycardia, agitation and serotonin syndrome

Question 4

what are the clinical presentations of benzo ODs?

Answer 4

drowsie, confused, dizziness
slurred speach
nystagmus, blurred vision 
hypotension
ataxia, weakness lack of cordination
coma
resp depression

Question 5

what might be the clinical presentation of a large benzo OD?

Answer 5

hypothermia, bradycarida, hypotension

Question 6

what are the clinical presentation of GHB overdoses?

Answer 6

resp and CNS depression

myoclonic jerkin, bradycardia, sweating, agitation, vomiting, delerium, cheyne-stoke breathing

Question 7

what is a recreational dose of GHB?

Answer 7

30-40mg/kg

Question 8

what is GHB recovery associated with?

Answer 8

agitation, delirium and vomiting

Question 9

how does narcane work?

Answer 9

opiate antagonist - competes for same receptors
greater affinity
shorter half life- wear off

Question 10

what should the other opiod parm of the opioide cpg be used for?

Answer 10

prescription - oxycodone, morphine, codien, fentynal, methadoe
latrogenic - secondary to analgesia
polypharmacy - opioid and meth
unknown - heroin nos suspected

Question 11

what is the mecanisim of action for opioids?

Answer 11

agonists at opiod receptros (delta, kappa, mu) which modulates pain pathways in the body

Question 12

what are the central effects of opiods?

Answer 12

analgesis
CNS depression
resp depression
couch suppresion
miosis - pupil constrction
nausea/vom
hypotension and bradycardia

Question 13

what are the peripheral effects of opiods?

Answer 13

decreased gut motility- constipation
histamine relases
spasm of sphincter muscles

Question 14

how do TCAs work?

Answer 14

preventing re-uptake of seritonin and nor-adrenaline. antagonists of seritonin, adrenaline, histamibe and acetylcholine
potent sodium and calcium channel blockers

Question 15

what does the inhibition of nor-adrenaline/serotonin reuptake result in in an overdose?

Answer 15

delirium, seizures and coma

Question 16

what are the anticholonergic effects of a TCA overdose?

Answer 16

hyperthermia, flushing, dry mucosa membranes

Question 17

what does the blockage of sodium channels cause in a TCA overdose?

Answer 17

tachycardia, QRS widening, ventricular arythmias

Question 18

what does the blockage of sodium channels cause in a TCA overdose?

Answer 18

tachycardia, QRS widening, ventricular arythmias

Question 19

how long does it take for sevre toxicity to occur after TCA overdose?

Answer 19

1-2 hours

Question 20

what is a toxic level of TCA injestion?

Answer 20

> 10mg / kg

Question 21

what are the inital sings of TCA overdose?

Answer 21

mad as a hatter - delirium agitation
blind as a bat - mydriasia, blurred vision
hot as a hare- hyperthermia
dry as a bone - mucosa membranes and skin
red as a beet - flushed

Question 22

what are the later sings and symptoms of TCA overdose?

Answer 22

sedation/coma
seizures
arythmias - SVT, VT, torsades de pointes
hypotension
bradycardia
asystole, death

Question 23

what is one of the most accurate tools for TCA overdose diagnosis?

Answer 23

ECG
prolonged PR interval
widening QURS >100ms
large r wave

Question 24

what are the symptoms of opiod withdrawal?

Answer 24

agitation

nausea, vomiting, diarrhoea, lacrimation, diaphoresis, pain, tachycardia, hypertension