Drug Overdose

Question 1

Dysrhythmia

Wide complex

Answer 1

Sodium bicarb

IV

Question 2

Torsade de pointes

Answer 2

Magnesium sulfate

Question 3

Seizure

Answer 3

Benzos first line:
Lorazepam IV/IM preferred
Midazolam IV/IM, drip
Barbituates or Propofol to sedate

Question 4

Hypoglycemia

Answer 4

Oral load
Amp of D50
Glucagon IM

Question 5

Females

Answer 5

HCG test (pregnancy)

Question 6

Activated Charcoal

Answer 6

decreases AUC of macromolecules

Use 1 hr after ingestion of toxin

Question 7

Cathartics = induce diarrhea

Answer 7

Sorbitol, Mag citrate
diarrhea within a few hours
Cause volume depletion and elec abnormalities

Question 8

How to alkalize the urine

Answer 8

Sodium bicarb
Titrate to serum pH of 7.45-7.55 and urine pH of 7.5-8.5
Replace K+ though!

Question 9

Hemodialysis for drugs with these properties

Answer 9

Low Vd, Low molecular weight, and poor serum protein binding
the ones that can’t be used for charcoal
ex. Methanol, ethylene glycol, salicylates, lithium, theophylline.
CVVHF if high Vd

Question 10

Opioid overdose

Answer 10

Activated charcoal
IV fluids if hypotens
Whole bowel flush for ER formulations or body packers
Naloxone

Question 11

Naloxone

Answer 11

Competes with a displaces opioids at receptor sites.
IV/IM/nasal
AEs: opiod withdrawal, AGGRESSIVE

Question 12

Tylenol overdose

Answer 12

Causes liver failure instead of killing you…
Charcoal if within 1 hr
N-acetylcystine

Question 13

N-acetylcysteine

Answer 13

binds to NAPQI to decrease liver toxicity

Repletes glutathione stores

Question 14

APAP levels

Answer 14

must draw 4 hours after ingestion or more. 150+–> treat.
Rumack-Matthew line will progress to liver failure to treat a little below that line
Ali Oliyei says if you suspect APAP OD, treat with NAC no matter the levels

Question 15

Salicyclate OD mechanism

Answer 15

Disturbs carb metabolism, ketones form-->lactate-->metabolic acidosis
Fever, volume loss, nausea/vomit
Acute lung injury and resp stimulant
Anion gap
Entry into CNS->edema->death

Question 16

Salicylate overdose

Answer 16

Charcoal w/o sorbitol w/in 1 hr
IV fluids unless pulm edema
Sodium Bicarb
Dialysis

Question 17

Calcium Channel Blocker OD mechanism

Answer 17

DHPs (-pines): hypotens and reflex tachy
Non-DHP: brady and decreased contractility
Decrease insulin release
Metabolic acidosis

Question 18

CCB OD treatment

Answer 18

Charcoal
asymptomatic can be observed
IV fluids for hypotens
IV Calcium to improve contract and BP
Norepi or Epi
Lipid drip for coding patients because CCBs are lipophilic
Pacemaker?
Sodium bicarb if acidotic

Question 19

What is HIET

Answer 19

Hyperinsulinemia/Euglycemia Therapy
High dose insulin–>inotropic effect to resolve cardio shock
+Dextrose infusion
monitor Mag, K, Phos

Question 20

Serotonin syndrome caused by

Answer 20

SSRIs
Antidepressents
MAOis
Linezolid

Question 21

Serotonin syndrome treatment

Answer 21

Charcoal
Benzos for agitation
5-HT antagonist (Cyproheptadine, Olanzapine, Chlorpromazine)
Vecuronium or cistracuronium
DO NOT GIVE SUCCINYLCHOLINE
HTN with nitroprusside or esmolol

Question 22

TCAs

Amitriptyline, doxepin, Desipramine, Nortriptyline

Answer 22

Very lipophilic and high conc in CNS and cardiac
Benzos for seizure
Sodium Bicarb for arrhythmias (a lot)