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AIP: Self-harm > Other drug overdose > Flashcards

Other drug overdose Flashcards

1
Q

What are 9 symptoms of TCA overdose?

A
  1. Dry mouth
  2. Coma
  3. Hypotension
  4. Hypothermia
  5. Hyperreflexia/ extensor plantar responses
  6. Convulsions
  7. Respiratory failure
  8. Cardiac conduction defects and arrhythmias
  9. Metabolic acidosis in severe poisoning
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2
Q

Which 2 tricyclic antidepressants are particularly dangerous in overdose?

A
  1. amitriptyline
  2. dosulepin (dothiepin)
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3
Q

What are 4 features of severe tricyclic poisoning?

A
  1. Arrhythmias
  2. Seizures
  3. Metabolic acidosis
  4. Coma
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4
Q

What are 3 common features during recovery from tricyclic overdose?

A
  1. Delirium with confusion
  2. Agitation
  3. Visual and auditory hallucinations
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5
Q

What are 3 ECG changes seen in tricyclic overdose?

A
  1. Sinus tachycardia
  2. Widening of QRS
  3. Prolongation of QT interval
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6
Q

How does the degree of QRS widening in TCA overdose predict features of the overdose?

A

widening >100ms - increased risk of seizures

>160ms - ventricular arrhythmias

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7
Q

What is the first line therapy for management of TCA overdose with hypotension or arrhythmias?

A

IV sodium bicarbonate

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8
Q

What are 5 aspects of the management of TCA overdose?

A
  1. Asessment in hospital
  2. IV lorazepam or diazepam to treat convulsions
  3. Activated charcoal if within 1h
  4. Sodium bicarbonate infusion
  5. IV lipid emulsion to bind free drug and reduce toxicity
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9
Q

What are 3 drugs which should be avoided in managing TCA overdose?

A
  1. Class Ia antiarrhythmics e.g. quinidine - prolong depolarisation
  2. Class Ic antiarrhythmics e.g. flecainide - prolong depolarisation
  3. class III drugs e.g. amiodarone - prolong QT interval
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10
Q

Is dialysis useful for removing TCAs in overdose?

A

no

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11
Q

What are 6 symptoms of benzodiazepine poisoning?

A
  1. Drowsiness
  2. Ataxia
  3. Dysarthria
  4. Nustagmus
  5. Respiratory depression
  6. Coma
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12
Q

What is the specific antidote to benzodiazepine poisoning?

A

flumazenil (unlicensed)

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13
Q

Why must flumazenil be used with extreme caution?

A

can be hazardous, esp. in mixed overdoses involving TCAs or benzodiazepine-dependent patients

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14
Q

What is the only situation when flumazenil should be used?

A

on expert advice only (NOT diagnostic test in reduced consciousness), can prevent need for ventilation in some instances

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15
Q

What are 9 effects of beta-blocker poisoning?

A
  1. bradycardia
  2. hypotension
  3. syncope
  4. heart failure
  5. drowsiness, confusion
  6. convulsions
  7. hallucinations
  8. coma
  9. respiratory depression and bronchospasm
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16
Q

What are 10 aspects of the management of beta blocker overdose?

A
  1. clear airway + ventilation
  2. activated charcoal if within 1h
  3. IV glucagon
    • severe hypotension, heart failure, cardiogenic shock
  4. insulin and glucose infusion
    • can improve myocardial contracility + perfusion
  5. IV sodium bicarbonate
    • correction of metabolic acidosis
  6. atropine sulfate
    • symptoatic bradycardia
  7. dobutamine
    • bradycardia + hypotension
  8. temporary pacemaker
    • increase HR
  9. bronchodilators and steroids
    • bronchospasm
  10. IV diazepam/lorazepam/midazolam
    • convulsions
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17
Q

What is the key drug used to treat beta blocker overdose?

A

glucagon

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18
Q

What are 7 features of calcium channel blocker poisoning?

A
  1. nausea and vomiting
  2. dizziness
  3. agitation
  4. confusion
  5. coma
  6. metabolic acidosis
  7. hyperglycaemia
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19
Q

What are the 3 drugs which may be used to manage CCB overdose?

A
  1. acitvated charcoal if first hr
  2. calcium chloride or calcium gluconate
    • blocking the calcium channels so give calcium
  3. atropine sulfate
    • for symptomatic bradycardia
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20
Q

What is lithium poisoning usually caused by?

A

long-term therapy complication due to reduced excretion of drug (dehydration, deterioration of renal function, infections, diuretics/NSAIDs)

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21
Q

How long will it take for deliberate lithium overdose to have symptoms and why?

A

12 hours - slow entry into tissues, and modified release formulations

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22
Q

What are 10 features of lithium toxicity?

A
  1. apathy and restlessness
  2. vomiting
  3. diarrhoea
  4. ataxia
  5. weakness
  6. dysarthria
  7. muscle twitching
  8. convulsions
  9. coma
  10. dehydration and hypotension
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23
Q

What is the therapeutic serum lithium range?

A

0.4 - 1 mmol/L

24
Q

What serum lithium concentration is usually associated with serious toxicity?

A

concentrations over 2 mmol/L

25
Q

What treatment may be indicated for lithium toxicity >2 mmol/L?

A

haemodialysis: if neurological symtoms or renal failure present

26
Q

What may be the management of high serum concentrations of lithium without features of toxicity?

A

increase urine output e.g. increase fluid intake, avoid diuretics

supportive with regard to electrolyte balance, renal function, control convulsions

27
Q

What should be considered for significant deliberate overdose of lithium?

A

gastric lavage if wihtin 1h, whole-bowel irrigation for significant

28
Q

What are the features of cocaine poisoning?

A
  • agitation
  • dilated pupils
  • tachycardia, hypertension
  • hallucinations
  • hyperthermia
  • hypertonia and hyperreflexia
  • cardiac effects: chest pain, MI, arrhythmias
29
Q

What is the management of cocaine poisoning?

A
  • initial treatment: IV diazepam to control agitation, cooling measures
  • hypertension and cardiac effects: specific treatment, seek advice
30
Q

What are the features of ecstasy (aka MDMA) poisoning?

A
  • delirium
  • coma
  • convulsions
  • ventricular arrhythmias
  • hyperthermia
  • rhabdomyolysis
  • acute renal failure
  • acute hepatitis
  • DIC
  • ARDS
  • hyperreflexia
  • hypotension
  • ICH
31
Q

What is the management of ecstasy (MDMA) poisoning?

A

supportive: diazepam to control agitation/convulsions, close ECG monitoring

32
Q

What is liquid ecstasy?

A

term for soidum oxybate (gamma-hydroxybutyrate, GHB), which is a sedative

33
Q

What is water intoxication, sometimes seen in ecstasy poisoning?

A

rare + fatal condition - leads to low sodium

can occur with consumption of excess water without adequate replacement of sodium e.g. in strenuous exercise

34
Q

What is the treatment of choice for ethylene glycol and methanol poisoning?

A

Fomepizole

35
Q

What treatment is sometimes used if necessary to treat ethylene glycol/methanol poisoning (but not first line)?

A

ethanol (i.e. alcohol)

36
Q

What is the key source of ethylene glycol that can cause poisoning?

A

antifreeze

37
Q

What is the key source of methanol that can cause poisoning?

A

windshield washer fluid

38
Q

What is the mechanism of action of digoxin?

A

cardiac glycoside with positive inotropic properties

decreases conduction througoh AVN, slows ventricular rate in AF and atrial flutter

increases force of cardiac muscle contraction due to inhibition of Na/K/ATPase pump. also stimulates vagus nerve

39
Q

When should digoxin concentrtations be measured if toxicity is suspected?

A

measure within 8-12 hours of last dose

40
Q

What determines whether a patient has developed digoxin toxicity?

A

not plasma concentration alone (can occur in therapeutic range), also clinical features

41
Q

What are 8 clinical features of digoxin toxicity?

A
  1. generally unwell
  2. lethargy
  3. nausea + vomiting
  4. anorexia
  5. confusion
  6. yellow-green vision
  7. arrhythmias (AV block, bradycardia)
  8. gynaecomastia
42
Q

What is the classic precipitating factor for digoxin toxicity?

A

hypokalaemia

43
Q

Why can hypokalaemia precipitate digoxin toxicity?

A

digoxin normally binds to the ATPase pump on the same site as potassium

hypokalaemia means digoxin can bind more easily to the ATPase pump, leading to increased inhibitory effects of digoxin

44
Q

What are 9 precipitating factors for digoxin toxicity?

A
  1. Hypokalaemia
  2. Increasing age
  3. Renal failure
  4. Myocardial ischaemia
  5. Hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
  6. Hypoalbuminaemia
  7. Hypothermia
  8. Hypothyroidism
  9. Drugs: amiodarone, quindine, verapamil, diltiazem, spironolactone
45
Q

What are 3 key aspects of the management of digoxin toxicity?

A
  1. Digibind
  2. Correct arrhythmias
  3. Monitor potassium
46
Q

What are the 5 categories of ‘high INR’ related to warfarin that require specific management?

A
  1. INR 5.0-8.0, no bleeding
  2. INR 5.0 - 8.0, minor bleeding
  3. INR >8.0, no bleeding
  4. INR >8.0, minor bleeding
  5. Major bleeding
47
Q

What is the management of high INR related to warfarin, for INR 5.0-8.0, no bleeding?

A
  • withold 1 or 2 doses of warfarin
  • reduce subsequent maintenance dose
48
Q

What is the management of high INR related to warfarin, for INR 5.0-8.0, minor bleeding?

A

stop warfarin

give IV vitamin K 1-3mg

restart when INR <5.0

49
Q

What is the management of high INR related to warfarin, for INR >8.0, no bleeding?

A
  • stop warfarin
  • give vitamin K 1-5mg by mouth, using IV preparation orally
  • repeat dose of vitamin K if INR still too high after 24h
  • restart when INR <5.0
50
Q

What is the management of high INR related to warfarin, for INR >8.0, minor bleeding?

A
  • stop warfarin
  • give IV vitamin K 1-3mg
  • repeat dose of vitamin K if INR still too high after 24h
  • restart warfarin when INR <5.0
51
Q

What is the management of high INR related to warfarin, for major bleeding?

A
  • stop warfarin
  • IV vitamin K 5mg
  • prothrombin complex concentrate - if not available then FFP
52
Q

How is protamine overdose reversed?

A

protamine sulfate (only partially reverses effect of LMWH)

53
Q

What is one of the key toxic effects of organophosphate poisoning?

A

inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission

54
Q

What are the key features of organophosphate insecticide poisoning?

A

accumulation of acetylcholine - SLUD

  • Salivation
  • Lacrimation
  • Urination
  • Defecation/diarrhoea
  • Cardiovoascular: hypotension, bradycardia
  • Small pupils
  • Muscle fasciculation
55
Q

What is the key maangement of organophosphate poisoning?

A

atropine

56
Q

What is sometimes used as an adjunct to atropine sulfate in moderate to severe organophosphate poisoning?

A

pralidoxime chloride

57
Q

What is the key service which should be accessed for any specialist information about poisoning?

A

NPIS: National Poisons Information Service

AIP: Self-harm (15 decks)

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