Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency Medicine > Drugs, overdose and Poisoning > Flashcards

Drugs, overdose and Poisoning Flashcards

(65 cards)

Start Studying
1
Q

Epidemiology of Poisoning

A

4.3million/yr in US – 90% at home
Common cause of female admission
Increased suicide risk in year after - large proportion of admissions are for children under 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a poison?

A

All substances are poisons depending on dose
A substance can also become a poison by an inappropriate route of adminstration or by side effects or interactions with another drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common agents used in poisoning (7)

A

Paracetamol Carbon monoxide
Aspirin Beta blockers
Antidepressants Street drugs
Iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentations of poisoning

A

Widely vary - some patient will be more vulnerable than others
Any patient with an altered level of consciousness, young person with a life threatening arrhythmia or a puzzling presentation should be suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Principles of treatment of poisoning (5)

A 
Prevent further absorption
Enhance elimination of the poison
Manage side effects 
Support vital functions
Use of antidotes if there are any
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Preventing further absorption

A

Gastric decontamination - washout, Ipecac, gastric lavage or activated charcoal
Drug absorbing agents
Whole bowel irrigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Enhancing elimination

A

Diuresis
Urine acidity manipulation - for salicylates & herbicides
Haemofiltration/Dialysis- for salicylate, alcohol, Lithium,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antidotes

A

Must be Drug specific and dose related. Some drugs have specific antidotes: opiates, paracetamol, digoxin etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Toxidromes

A

A body wide syndrome due to high levels of toxins
They generally fall into six types but there is variation
Anticholinergic, sympathomimetic, Opiate, sedative, Cholinergic, hallucinogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anticholinergic toxidrome

A

‘blind as a bat (blurred vision/dilated pupils), mad as a hatter(coma, hallucination, psychosis), red as a beet (flushing), hot as hell (fever), dry as a bone (dry skin), bowel and bladder (ileus, decreased bowel sounds & urinary retention) lose their tone and the heart runs alone (tachycardia)’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sympathomimetic toxidrome

A

Anxiety, delusions, hyperreflexia, paranoia, piloerection, sweating and seizures. Pupils dilates and sweating. BP, HR and RR increase. Increased bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Opiate toxidrome

A

Coma, pinpoint pupils and respiratory depression

May also have shock, pulmonary oedema, bradycardia, hypothermia, hypotension, Caused by opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cholinergic toxidrome

A

Killer ‘B’s –> bronchospasm & bronchorrhoea
SLUDGE - salivation, lacrimation, urination, diarrhoea, gastrointestinal distress and emesis
Pupils will be pinpoint and bradycardia, may have seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of an Anticholinergic toxidrome

A

Antidepressants, antipsychotics, antiparkinsonian drugs, antihistamines
Also atropine, benztropine, datura, scopolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of an Cholinergic toxidrome

A

Caramates, mushrooms and organophosphates

Also nerve gases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of an Sympathomimetic toxidrome

A

Salbutamol, cocaine, ephedrine, amphetamines, meth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sedative toxidrome (aaccdd)

A

Ataxia, coma, confusion, delirium and general deterioration of CNS functions. possible apnea,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of an Sedative toxidrome

A

Anticonvulsants, barbiturates, benzodiapzepines, GABA, GHB, methaqualone and ethanol
Generally anticonvulsant but GHB and methaqualone can cuase paradoxical seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hallucinogenic toxidrome

A

Disorientation, hallucination, panic, increased bowel sounds, seizures. May lead to raised HR, BP and RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of an Hallucinogenic toxidrome

A

Some amphetamines, cocaine and phencyclidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Algorithm for identifying toxidromes

A

Add image from wiki

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Paracetamol

A

Toxic metabolite is glutathated in liver –> quickly runs out
Leads to hepatototicity and risk of death
One of the most common poisonings and commonest cause of acute liver failure
Often asymptomatic in first 12-24hrs with N&V only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Carbon monoxide

A

Binds to Hb with great affinity causing cellular hypoxia
100% or hyperbaric O2 displaces CO
Severity is indicated by level of COHb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Iron

A

Causes gastrointestinal damage –> mucosal sloughing and haemorrhage
Can cause Hypotension.
Treat with desferrioxamine (a chelating agent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Antidepressants
Tend to cause arrhythmias, siezures and coma | Have a prolonged action so require longer term care
26
Drugs of abuse overdose
Give general support Use sedation if anxious or delirious Use beta blockers for tachyarrhythmias Can cause drowiness, convulsions and hyperprexia
27
Psychiatric care
Full assessment of suicidal risk and additional evaluation for any secondary or ongoing risk factors
28
Illegal drug use
Rapid growth in consumption --> younger people are using drugs and many use them with little negative consequence
29
Drugs of abuse
Stimulants --> cocaine, crack, amphetamine, Khat Opiates --> heroin, methadone, DF118's, Over the counter Benzodiazepines, cannabis, tobacco, alcohol Clubber drugs-->MDMA, ketamine,
30
Stimulants
Increase energy, feelings of power and sex Issues in south london with crack Work from the late 90's on increasing engagement with users Increase in afro-caribbean clients in the services to reflect the population
31
Crack Cocaine
White stones/rocks --> £10-20 per rock smoked or injected --> mix with heroin IV (speed-balling) Risks of debt, crime, violence, sex work, psychosis, dependance, CVS diseases, homelessness
32
Heroin
Called 'brown' or 'smack' --> £40-60/g (0.4g referred to as 1/4 or 1/16th of an oz= 1.3/4g Gives a powerful rush and dulls physical or emotional pain Injected or smoked (chasing the dragon)
33
Risks of heroin/opiate use
Infection ---> HIV, HCV, HCB, septicemia | Overdose, DVT, Dependance, Debt, crime and prostitution
34
Abuse of Benzodiapzepines
Limit to short course to prevent dependence Have street value & increased risk if mixed with alcohol or opiates Treat dependence with a switch to diazepam and then a slow reduction Offer counselling and support
35
Cannabis
Hash, resin, ganga, dope, weed, Blow, skunk THC is active ingredient Smoked in joints, pipes or bongs --> £50-80/oz, 1/8th for £15 Can cause anxiety, paranoia, psychosis,
36
Clubber's drugs
Ecstacy, ketamine, cocaine, amphetamines, cannabis | All carry risks of OD, misadventure and mixing with other drugs
37
Alcohol
Binge drinking is a growing problem - particularly in women Increases the risk of OD if mixed with benzos/opiates Can cause depression, anxiety or suicidality
38
Aspirin
An acidic drug which in overdose can cause tinnitus and long term middle ear problems Treat with diuresis or usually haemodialysis Careful as there is lots of salicylate in wintergreen oil
39
Beta-blocker overdose
Can cause bradycardia (treat with atropine) hypotension and complete heart block Glucagon is an effective antidote
40
Activated Charcoal
Used to decontaminate the bowel and prevent further absorption. Poor at absorbing: Iron, ethanol, methanol, ethylene glycol, acids and alkalis, metals (Fe or Li) Good for absorbing: Carbamazepine, Theophylline, Quinine, Phenobarbitone
41
Types of poison exposure
Accidental - most common for children Mainly >12yr and female, suicide/parasuicide or illicit drug use/overdose. 80-100,000 AnE attendances/yr and 1500 deaths/yr
42
Guy's specialist poisoning unit
2/3 of calls from AnE departments, mainly from nurses In 70% of causes the agents ingested were pharmacuticals, next being industrial chemicals at 13% Most common --> Paracetamol, ibuprofen and aspirin
43
How common is paracetamol poisoning?
Common 50% of self-admission with poisoning in UK is paracetamol - 48,000 OD cases per year - 150 deaths/yr
44
Treatment of paracetamol poisoning
N-acetylcysteine (NAC) is 99% effective if given in 8-10hrs | delayed presentations or multiple doses - less effective
45
What determines the toxicity of paracetamol overdose?
Time between ingestion and treatment Dose - toxic above 150mg/kg or 75mg/kg in high risk pts Risk factors --> decreased glutathione (malnutrition, HIV, anorexia) or induction of P450s (alcoholics, TB drugs, anti -epileptics)
46
Hepatic processing of Paracetamol
90% is conjugated by P450s 5% renally eliminated 5% metabolised into toxic NAPQI - if not detoxified by glutathione it binds to hepatic proteins causing cell death
47
Aspirin Poisioning
Less common now but still happens. Severity depends on dose: 150mg/kg - mild, 250mg/kg - moderate, 500mg/kg - severe/fatal Children and the elderly at a greater risk
48
Symptoms of Aspirin Poisoning
Mild to moderate --> vomiting, tinnitus, sweating, hyperventilation and respiratory alkalosis Severe --> Acute renal failure, pulmonary oedema, CNS features (agitation, confusion, coma, convulsions), metabolic acidosis is a bad prognostic sign as it allows increased salicylate into the CNS
49
Symptoms of NSAID overdose
Ibuprofen and mefenamic acid most commonly taken in OD Vomiting, diarrhoea and abdominal pain Seizures in 5% of cases with ibuprofen and 20% with mefenamic acid Very large doses can cause metabolic acidosis, renal failure and CNS depression
50
Benzodiazepine overdose
Common, OD of just benzos is generally fine (drowsiness, ataxia, dysarthria, confusion) More severe cases do happen, especially if drugs were mixed or in elderly patients --> coma, resp depression & hypotension
51
Treatment of Benzodiazepine overdose
Flumazenil is a benzodiazepine antagonist which can be used in severe cases but should not be used routinely as it can cause arrhyhmias and convulsions (particularly if patient has Hx or taken other drugs which increase the risk of them) Usually supportive care is all that is needed
52
How common is antidepressant overdose?
Can be SSRIs or Tricyclics - overdose is responsible for 1/10 suicides Common as 60-70% of suicides are depressed and 1/3 of depressed people are given antidepressants
53
Tricyclic antidepressant overdose
Pharmacologically dirty drugs - can cause severe toxicity 10-20mg/kg is life threatening TCA's include Dothiepin
54
Clinical features of Tricyclic antidepressant overdose
Rapid onset (1/2hr) - anticholinergic effects (dilated pupils, blurred vision, hot+dry skin, urinary retention, hyperreflexia, delirium, myoclonic jerks) CVS - broad QRS, VT arrhythmia & cardiac arrest, hypotension CNS - Drowsiness, coma, resp depression, convulsions, hypertonia
55
SSRI overdoses
Clean pharmacologically and better tolerated in overdose | Usually cause N&V and dizziness, if >1500mg taken CNS depression and seizures can occur
56
Symptoms of untreated paracetamol overdose
Will present late with jaudice, encephalopathy & coagulopathy Can develop renal failure, metabolic acidosis, hypotension and cerebral oedema
57
Criteria for giving NAC
Give NAC if concentration is at or over line At 4hrs --> 200mg/L or 100mg/L in high risk patient At 8hrs --> 100mg/L or 50mg/L in high risk patients
58
Relative Antidepressant toxicities
TCA's - 34 Lithium - 15 MAOI's - 14 Atypical's - 6 SSRI's - 2 (Numbers are deaths/million prescriptions)
59
Lead poisoning
Can present with abdominal pain, peripheral motor neuropathy, fatigue, constipation. can also have blue lines on the gums (20% of adults but very rare in children). Blood lead >10mcg/dL and microcytic anaemia with basophilic stippling. Treat with EDTA, D-penicillamine, DMSA. can be caused by Pica (paint)
60
Digoxin poisoning
Used for rate control in AF but can also be used for symptomatic improvement in HF. toxicity risk increases from 1.5-3mcg/L. Can be brought on by hyperkalaemia, renal failure, MI, acidosis/metabolic disturbance, hypthermia or other drugs. Presents with lethargy,N&V, anorexia, confusion, yellow-green vision and arrhythmias (AV block or bradycardia)
61
Treatment of Digoxin toxicity
Digibind Treat and correct arrhythmias Monitor potassium
62
Opiate overdose
Causes respiratory depression and pinpoint pupils | Treat with naloxone but careful as this acutely induces withdrawal which is dangerous in addicts
63
Features which potentiate warfarin
Liver disease P450 inhibitors - amiodarone, ciprofloxacin, isonizaid etc Cranberry juice Drugs which displace warfarin from albumin (NSAIDs) Or drugs which inhibit platelet function (NSAIDs again).
64
Treatment of amitriptyline (and other tricyclic) overdose
IV bicarbonate to treat cardiac issues
65
Treatment of benzodiazepine overdose
Flumazenil

Emergency Medicine (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions