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Overdose Flashcards

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1
Q

Drugs which can cause anticholinergic syndrome

A 
Antihistamines 
Atropine 
Cyclic antidepressants 
Anti-parkinson's drugs 
Scopolamine
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2
Q

Clinical features of peripheral anticholinergic toxicity

A 
Tachycardia 
Hyperthermia 
Mydriasis 
Dry skin 
Decreased bowel sounds 
Urinary retention
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3
Q

Clinical features of central anticholinergic toxicity

A

Hallucinations
Psychosis
Seizures
Coma

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4
Q

Management of anticholinergic toxidrome

A

IV benzodiazepines

Physostigmine

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5
Q

Physostigmine contraindications

A

Reactive airway disease
Cardiovascular disease(bradycardia, heart block)
May precipitate seizures

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6
Q

Effects of sympathomimetics on mental status

A

Hyperalert
Agitation
Hallucinations
Paranoia

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7
Q

Effect of sympathomimetics on pupils

A

Mydriasis

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8
Q

Effect of sympathomimetics on vital signs

A

Hyperthermia, tachycardia, hypertension, widened pulse pressure, tachypnea,

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9
Q

Common manifestations of sympathomimetics

A

Diarphoresis
Tremors
Hyperreflexia
Seizures

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10
Q

Examples of toxic sympathomimetics

A

Cocaine
Amphetamines
Theophylline
Caffeine

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11
Q

Effect of hallucinogens on pupils

A

Mydriasis(usually)

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12
Q

Effects of opioids on mental status

A

CNS depression

Coma

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13
Q

Effect of opioids on pupils

A

Miosis

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14
Q

Effect of opioids on vital signs

A

Bradypnea, apnea characteristic; may develop: hypothermia, bradycardia, hypotension

Hyporeflexia
Pulmonary edema

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15
Q

Clinical manifestations of sedative/hypnotics(benzos, barbiturates)

A

Hypothermia
Bradycardia
Hypotension
Hyporeflexia

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16
Q

Effects of cholinergic syndrome on mental status

A

Confusion

Coma

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17
Q

Effect of cholinergics on pupils

A

Miosis

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18
Q

Effects of cholinergics on vital signs

A

Bradycardia, hypertension or hypotension, tachypnea or bradypnea

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19
Q

Effects of cholinergics

A

Salivation, urinary and fecal incontinence, diarrhea, emesis, diaphoresis, lacrimation, GI cramps, bronchoconstriction, muscle fasciculations and weakness, seizures

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20
Q

Examples of cholinergics

A

Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium

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21
Q

Management of cholinergic crisis

A

Cessation of any cholinergic agents

Atropine

Gastric lavage inly if a poisoned patient presents within 1 hr of ingestion

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22
Q

Management of sympathomimetic crisis

A

Supportive
Benzodiazepines
Management of arrhythmias
External cooling if pyrexic

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23
Q

Early features of TCA overdose

A

Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.

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24
Q

Features of severe TCA overdose

A

arrhythmias
seizures
metabolic acidosis
coma

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25
ECG changes caused by TCA overdose
sinus tachycardia widening of QRS prolongation of QT interval
26
What is a widening of QRS associated with
Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias
27
Mx of TCA overdose
IV bicarbonate Other drugs for arrhythmia IV lipid emulsion
28
CVS effects of cocaine overdose
coronary artery spasm → myocardial ischaemia/infarction both tachycardia and bradycardia may occur hypertension QRS widening and QT prolongation aortic dissection
29
Neuro effects of cocaine toxicity
seizures mydriasis hypertonia hyperreflexia
30
Psych effects of cocaine toxicity
agitation psychosis hallucinations
31
Metabolic disturbance in cocaine toxicity
metabolic acidosis
32
What type of GI complication can occur in cocaine toxicity
Ischaemic colitis
33
Mx of cocaine toxicity
Benzos GTN PCI if MI develops
34
What might lithium toxicity me precipitated by
Dehydration Renal failure Drugs
35
Drugs which can precipitate lithium toxicity
diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole
36
Features of lithium toxicity
``` Coarse tremor(tremor is fine, worse when holding out arms against gravity in therapeutic range) hyperreflexia acute confusion polyuria seizure coma ```
37
Mx of lithium toxicity
Fluid rests with saline in mild-moderate Haemodialysis in severe toxicity
38
Monitoring in digoxin treatment
digoxin level is not monitored routinely, except in suspected toxicity if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose
39
Features of digoxin toxicity
generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia
40
Digoxin precipitating factors
``` Hypokalaemia Increasing age MI Hypothermia Hypothyroidism Hypomag, hypocalc, hypernatraemia, acidosis ```
41
Drugs which can precipitate digoxin toxicity
``` amiodarone quinidine verapamil diltiazem spironolactone ```
42
Mx of digoxin toxicity
Digiband Correct arrhythmias Monitor potassium
43
Features of CO poisoning
``` Headache Nausea and vomiting Vertigo Confusion Subjective weakness ```
44
Features of severe CO toxicity
``` 'Pink' skin and mucosal Hyperperxia Arrhythmias Extrapyramidal features Coma ```
45
Use of pulse oximetry in CO toxicity
pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin Therefore, VBG/ABG should be taken
46
Mx of CO toxicity
100% high-flow oxygen via non-rebreather - Target sats - 100%
47
Causes of serotonin syndrome
``` Monoamine oxidase inhibitors SSRIs St John's Wort Ecstasy Amphetamines ```
48
Features of serotonin syndrome
``` Hyperreflexia Myoclonus Rigidity Hyperthermia Sweating Confusion ```
49
Mx of serotonin syndrome
IV fluids Benzodiazepines Serotonin antagonists in severe cases(chlorpromazine)
50
Clinical features of ecstasy poisoning
neurological: agitation, anxiety, confusion, ataxia cardiovascular: tachycardia, hypertension hyponatraemia hyperthermia rhabdomyolysis
51
Mx of ecstasy poisoning
Supportive | Dantrolene
52
Features of opioid misuse
``` rhinorrhoea needle track marks pinpoint pupils drowsiness watering eyes yawning ```
53
Complications of opioid misuse
Viral infections secondary to IVDU Bacterial infection VTE Respiratory depression and death Psychological problems Social problems
54
1st line treatment in opioid detox
NICE recommend methadone or buprenorphine as the first-line treatment in opioid detoxification
55
Symptoms of PCP intoxication
Violence/aggression Analgesia Psychosis
56
Withdrawal symptoms of PCP
Insomnia | Mood disturbance
57
What is PCP intoxication associated with
Rotary(torsional) nystagmus
58
Symptoms of MDMA intoxication
Hallucinations Euphoria Disinhibition Altered sense of time
59
Withdrawal symptoms of MDMA
Anxiety, concentration difficulties, depression
60
What is MDMA intoxication associated with
Serotonin syndrome Bruxism Hyponatraemia Hallucinogen persisting perception disorder
61
Symptoms of marijuana intoxication
Calmness Altered judgement slow reaction time Conjunctivial injection
62
Withdrawal symptoms of marijuana
Decreased appetite Insomnia Irritability
63
Marijuana associations
Psychosis Paranoia Cannabinoid hyperemesis syndrome
64
Alcohol withdrawal 6-24 hrs
GI upset Tremors Agitation Insomnia
65
Alcohol withdrawal 12-24 hrs
Alcoholic hallucinosis(orientation is intact)
66
when do alcohol withdrawal seizures occur
6-48 hrs
67
When does delirium tremens occur
48 hrs after alcohol withdrawal
68
Type of cardiomyopathy associated with alcohol
Dilated cardiomyopathy
69
Dry beri beri vs wet beri beri
Dry - symmetrical peripheral neuropathy Wet - High output heart failure
70
Opioid associations
``` Hepatitis Abscesses Right sided endocarditis HIV/AIDS Overdose ```
71
Abscess presentation in opioid overdose
Leukocytosis CRP Procalcitonin
72
Cocaine overdose associations
``` Nasal septum perforation Cocaine induced cardiomyopathy Paranoia Drug induced depression(withdrawal) RTA Rhabdomyolysis ```
73
Methamphetamine associations
Meth mouth

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