Poisonings and Overdose

Question 1

Naloxone has a longer half-life than street opiates. True or false?

Answer 1

False - Naloxone has a shorter half life than most opiates

Question 2

A patient has taken a high dose of opiates and experiences respiratory depression. What drug can you give to reverse this and how should it be given?

Answer 2

Naloxone
Infusion
(naloxone has a short half-life than the opiates and so will “wear-off” before opiates and the patient could have a second episode of respiratory depression if treated with stat naloxone)

Question 3

How should paracetamol overdose be treated?

Answer 3

• if ingested within past hour then give activated charcoal

- if longer then use N-acetyl cisteine (common to have a reaction - if this occurs then slow the infusion rate)

Question 4

How should SSRI overdose be treated?

Answer 4

supportive care

Question 5

How should TCA overdose be treated?

Answer 5

sodium bicarbonate

Question 6

How should benzodiazepine overdose be treated?

Answer 6

• flumazenil

- consider HDU or critical care admission due to multi-system depression

Question 7

How should B-blockade overdose be treated?

Answer 7

inotropes (needs critical care setting)

Question 8

How should NSAID or aspirin overdose be treated?

Answer 8

supportive care

Question 9

How should CO poisoning be treated?

Answer 9

• critical care support

- lots of O2

Question 10

How should cyanide poisoning be treated?

Answer 10

hydroxycobalamin (high dose)

Question 11

What are the potential effects of SSRI overdose?

Answer 11

• sweaty
• shaky
• tachycardia
• fever

Question 12

What are the potential effects of TCA overdose?

Answer 12

• tachyarrythmias (often VT)
• mydriasis (large pupils)
• metabolic acidosis

Question 13

What are the potential effects of antipsychotic medication overdoses?

Answer 13

malignant neuroleptic syndrome:

• high fever
• confusion
• rigid muscles
• tachycardia
• variable blood pressure
• sweating

Question 14

What are the potential effects of benzodiazepine overdose?

Answer 14

• CNS depression (varies from excessive sedation to coma in large doses)
• respiratory depression
• anterograde amnesia

Question 15

What are the potential effects of B blockade overdose?

Answer 15

• bradycardia

- hypotension

Question 16

What are the potential unwanted effects of cocaine use / overdose?

Answer 16

• coronary artery spasm
• tachycardia
• psychosis
• feeling of skin crawling

Question 17

What are the potential unwanted effects of amphetamine use / overdose?

Answer 17

psychosis

Question 18

What are the potential unwanted effects of MDMA use / overdose?

Answer 18

malignant hyperpyrexia

Question 19

What are the potential unwanted effects of cannabis use / overdose?

Answer 19

vomiting (can have implications re: dehydration / alkalosis if severe / sustained)

Question 20

What are the potential unwanted effects of ketamine use / overdose?

Answer 20

depersonalisation

Question 21

What are the potential effects of aspirin overdose?

Answer 21

Nausea and vomiting
Rapid or deep breathing
Ringing in the ears
Sweating
Initially a respiratory alkalosis then a metabolic acidosis

Question 22

How should organophosphate poisoning be treated?

Answer 22

atropine

Question 23

What part of paracetamol is hepatotoxic?

Answer 23

NAPQI

Question 24

What usually detoxifies NAPQI in the body?

Answer 24

GSH

Question 25

How does N-acetytl cysteine help in paracetamol OD?

Answer 25

Replenishes GSH to promote detoxification of NAPQI