Toxicity Article

Question 1

T/F
Sedatives(hypnotics) are contraindicated for insomnia.

Answer 1

False
they can treat insomnia

Question 2

Anxiolytics and Sedative-Hypnotics
drug families

Answer 2

benzos
nonbenzodiazepine receptor agonists
opiates
melatonin agonists
antidepressants
antipsychotics
anticonvulsants
barbiturates
antihistamine

Question 3

Anxiolytics and Sedative-Hypnotics exert their most significant effect on the ____.

Answer 3

central nervous system

Question 4

most common etiologies for anxiolytic & sedative toxicity

Answer 4

improper dosing
misuse/abuse
drug-drug interactions

Question 5

use of diazepam 5 to 10 mg in an older person with liver disease causing build-up & toxic side effects (sedation and falls)

Answer 5

improper dosing

Question 6

fluvoxamine inhibits the metabolism of ___

Answer 6

alprazolam (xanax)

results in build-up in the blood –> sedation

Question 7

fluvoxamine is a(n) ….

Answer 7

3A4 inhibitor

(SSRI; often used for OCD)

Question 8

use of benzodiazepines or barbiturates with alcohol

Answer 8

enhance intoxication
unintended respiratory depression & death

Question 9

more commonly abused anxiolytic

Answer 9

benzodiazepine class

Question 10

highest rate of misuse of benzos

Answer 10

Adults 18 to 49

Question 11

Age group most often prescribed benzodiazepines

Answer 11

adults 50 to 65

Question 12

lifetime prevalence of anxiolytic and sedative use disorders in the US
(%)

Answer 12

1.0 and 1.1%

Question 13

prevalence of anxiolytic and sedative use disorder in the USA

Answer 13

0.16% of the total population
6% of ppl w/ concomitant illicit drug use disorder

Question 14

Anxiolytic and sedative toxicity
Risk factors

Answer 14

White race
Female sex
Uninsured
Unemployed
Panic symptoms
Other psychiatric symptoms
Alcohol abuse or dependence
Cigarette use
Illicit drug use
History of IV drug use

Question 15

Benzodiazepines (BZDs) & barbiturates MoA

Answer 15

gamma-aminobutyric acid type A (GABA-A) receptor agonists

Question 16

T/F
GABA-A receptors are metabophores.

Answer 16

False
ligand-gated chloride ion channels

influx of Cl-

Question 17

BZDs and barb increase GABA’s inhibitory effect by…

Answer 17

increasing the frequency and time of channel openings

Question 18

T/F
Nonbenzodiazepine receptor agonists are nonselective.

Answer 18

False
selectively target one type of GABA-A receptor

Question 19

T/F
Nonbenzodiazepine receptor agonists are structurally different than BZDs.

Answer 19

True
different chemical structure

Question 20

T/F
Melatonin agonists have high affinity for MT.

Answer 20

False
slight affinity to MT

Question 21

MT location

Answer 21

suprachiasmatic nucleus (hypothalamus)

Question 22

Antihistamines target ___ receptors in the …

Answer 22

H1
gastrointestinal, blood vessel, and respiratory tracts

Question 23

T/F
Opiates act on multiple receptors, both centrally and peripherally.

Answer 23

True

Question 24

Opiates MoA

Answer 24

Increases dopamine thru GABA, which opposes the natural inhibition of dopamine release

(release dopamine by enhancing GABA disinhibition of dopamine release)

Question 25

receptor responsible for pain relief and euphoria, & respiratory depression

Answer 25

mu

Question 26

receptors affected by opioids

Answer 26

mu, kappa, and sigma

Question 27

Why does opioid overdose result in respiratory depression, coma, and death?

Answer 27

opioids affect the mu receptor, which causes respiratory depression

Question 28

T/F Antidepressants cause sedation

Answer 28

True

Question 29

How do antidepressants and antipsychotics cause sedation?

Answer 29

antihistamine H1 blockade

Question 30

Anticonvulsants cause sedation by...

Answer 30

enhance GABA neurotransmission

Question 31

(self-poisoning) more likely to have a fatal outcome compared to diazepam

Answer 31

temazepam and zopiclone/zolpidem

Question 32

Carbamazepine was over twice as like to result in death compared to ___

Answer 32

lithium

Question 33

Which was more likely to result in death? Clozapine chlorpromazine

Answer 33

Clozapine

Question 34

Which is less toxic? Risperidone chlorpromazine

Answer 34

Risperidone

Question 35

T/F overdose of oral BZDs rarely cause toxicity

Answer 35

True unless co-ingested with another agent

Question 36

most common presentation of BZD toxicity

Answer 36

CNS depression stable vital signs drowsy but arousable can give history

Question 37

most intentional overdoses with BZDs occur with ___ co-ingestion

Answer 37

ethanol

Question 38

Severe toxicity

Answer 38

stuporous or comatose

Question 39

Which class is more often associated with complex-sleep related behaviors?

Answer 39

NonBZD hypnotics

Question 40

Complex-sleep related behaviors are more common with which sleeping drugs?

Answer 40

zolpidem zaleplon eszopiclone

Question 40

Complex-sleep related behaviors

Answer 40

sleepwalking/driving/eating and other behaviors that can be completed while not fully awake

Question 41

T/F Nearly all fatal overdoses of SSRI/SNRIs involve the co-ingestion of another substance or massive quantities.

Answer 41

True Overdoses associated with SSRI/SNRIs rarely cause death or serious injury

Question 42

serotonin syndrome

Answer 42

overstimulation of central and peripheral serotonin receptors

Question 43

serotonin syndrome S/S

Answer 43

anxiety, agitation, delirium, diaphoresis, tachycardia, hypertension, hyperthermia, gastrointestinal distress, tremor, muscle rigidity, myoclonus, and hyperreflexia

Question 44

SSRI/SNRIs that can precipitate seizures

Answer 44

bupropion and venlafaxine (status epiltcs rare)

Question 45

Patients may initially present normally and then deteriorate rapidly due to the variable absorption kinetics involved in ___

Answer 45

TCAs

Question 46

anticholinergic toxicity can occur with overdose of which drug class

Answer 46

TCAs

Question 47

TCA overdose

Answer 47

AMS sedation confusion delirium hallucination cardiac conduction delays arrhythmias hypoTN **anticholinergic toxicity**

Question 48

anticholinergic toxicity S/S

Answer 48

hyperthermia flushing pupillary dilation

Question 49

T/F Normal pupils can rule out a diagnosis of opiate toxicity

Answer 49

False

Question 50

T/F Opiate OD is always accompanied by bradycardia.

Answer 50

False Heart rate ranges from bradycardia to tachycardia

Question 51

Hypotension in opiate OD results from...

Answer 51

histamine release

Question 52

Hypothermia in opiate OD results from...

Answer 52

impaired thermogenesis or environmental exposure.

Question 53

antiseizure drugs most severe reactions

Answer 53

suicidality severe skin reactions: -Stevens-Johnson synd (SJS) -toxic epiderm necrolysis (TEN) -drug reaction with eosinophilia and systemic symptoms (DRESS)

Question 54

T/F We can obtain a reliable history in patients who intentionally ingested medication in an attempt to commit suicide

Answer 54

False History is often unreliable in this case

Question 55

T/F Assessing odor & skin changes can help identify the potential intoxicant.

Answer 55

True

Question 56

What to look for on an EEG in an OD pt.

Answer 56

QRS and QTc intervals anxiolytics, sedatives, & TCAs can prolong the QRS antipsychotics prolong QT

Question 57

Some antipsychotic drugs ___ the QT interval due to...

Answer 57

blocking K efflux

Question 58

Toxin-induced QRS interval prolongation occurs in

Answer 58

TCA poisoning immediate action is necessary!

Question 59

Cons of toxicological screening

Answer 59

false +'s

Question 60

first priority

Answer 60

ensure hemodynamically stable specific attention to the airway, breathing, and circulation

Question 61

BZD toxicity treatment

Answer 61

supportive care close monitoring (unless the toxicity is severe) Airway protection

Question 62

most important in BZD toxicity treatment

Answer 62

Airway protection

Question 63

End-tidal CO2 monitoring can be useful to monitor those at risk of

Answer 63

hypoventilation

Question 64

T/F activated charcoal is ideal for isolated BZD overdose

Answer 64

False can cause aspiration

Question 65

flumazenil

Answer 65

nonspecific competitive antagonist for the BZD receptor reverse BZD-induced sedation following GA, procedural sedation, or OD

Question 66

flumazenil controversy

Answer 66

risk withdrawal seizures in patients w/ tolerance for BZDs esp w/ concomitat pro-convulsants

Question 67

Is it safe to give flumazenil to patients who have a chronic use of BZDs?

Answer 67

Not always risk withdrawal seizures in patients w/ tolerance for BZDs

Question 68

SSRI/SNRI treatment

Answer 68

monitoring for: serotonin syndrome seizures cardiac conduction abnormalities -QT prolongation

Question 69

given or those with signs of serotonin syndrome or seizures

Answer 69

BZDs

Question 70

given for those with cardiac toxicity

Answer 70

Sodium bicarbonate

Question 71

risk of developing torsades de pointes

Answer 71

Magnesium sulfate intravenously

Question 72

TCA toxicity QRS interval >100 msec or ventricular arrhythmia treatment?

Answer 72

Sodium bicarbonate

Question 73

use of activated charcoal is permitted in which OD? TCA BZDs opiates SSRI/SNRI

Answer 73

TCA

Question 74

TCA OD activated charcoal is recommended within ___ hours of ingestion.

Answer 74

2 (Unless bowel obstruction, ileus, or perforation)

Question 75

naloxone

Answer 75

short-acting opiate antagonist

Question 76

preferred admin route for naloxone

Answer 76

IV

Question 77

Differential diagnosis may be broad d/t...

Answer 77

pts unable to contribute to a meaningful history

Question 78

If the patient overdosed intentionally, history becomes (more/less) reliable.

Answer 78

less

Question 79

Differential diagnosis is broad and can consist of which causes?

Answer 79

metabolic structural infectious causes Hypoglycemia

Question 80

Secondary complications that may make the effects of an OD permanent

Answer 80

cerebral ischemia cardiac ischemia

Question 81

T/F Early treatment of an overdose may result in no long-term complications.

Answer 81

True