antidepressant toxicity Flashcards
1
Q
Which antidepressants have highest # of exposures w/ severe outcomes
A
TCAs and Bupropion
2
Q
What is the toxidrome of TCAs and s/s of it
A
Anticholinergic
- inital inc then dec in bp, varies in HR, inc temp, rapid decline in mental status
3
Q
what EKG changes do we see with TCA toxicity
A
- R wave in aVR
- QRS > 100 msec
- Larger R wave= higher incidence of seizures
4
Q
Treatment options for TCA toxicity
A
- Hypertonic Na Bicarb 1-2 mEq/kg bolus (for widen QRS and acidosis)
- Hyperventilation/Alkalization (goal: QRS <100, pH>7.55)
- Mag and Lido for dysrhythmias/ torsades
- Vasopressors, High dose insulin, Lipid emulsion (HypoTN)
- Benzo > barbiturates
5
Q
Decontamination Treatments for TCA toxicity
A
- Orogastirc Lavage
> must be small enough, have no other antidote, cause serious AEs if it remains in system - Activated charcoal
6
Q
What must you always do before treating with activated charcoal
A
Protect airway first
7
Q
Bupropion toxidrome
A
- Sympathomimetic
8
Q
AE of bupropion toxicity
A
- seizures can appear up to 24 hours post ingestion
- wide complex dysrhytmias
- sympathomimetic crisis, cariogenic shock, status epilepticus, Lazarus effect, death
9
Q
Bupropion decontamination treatments
A
- activated charcoal
- whole bowel irrigation
10
Q
Bupropion toxicity treatment
A
- supportive care
- benzos for HTN
- Lipid emulsion, cold fluids, antipyretics for fever
11
Q
SSRI toxicity s/s
A
AMS
Tachycardia
myoclonus
tremors
diarrhea
seizures
Serotonin syndrome
12
Q
SSRI monitoring
A
(Es)Citalopram most likely to cause seizures also widens QTC and QRS
