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Daddy Pharm > Toxicity Article > Flashcards

Toxicity Article Flashcards

1
Q

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

A

False
they can treat insomnia

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2
Q

Anxiolytics and Sedative-Hypnotics
drug families

A

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

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3
Q

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

A

central nervous system

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4
Q

most common etiologies for anxiolytic & sedative toxicity

A

improper dosing
misuse/abuse
drug-drug interactions

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5
Q

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

A

improper dosing

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6
Q

fluvoxamine inhibits the metabolism of ___

A

alprazolam (xanax)

results in build-up in the blood –> sedation

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7
Q

fluvoxamine is a(n) ….

A

3A4 inhibitor

(SSRI; often used for OCD)

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8
Q

use of benzodiazepines or barbiturates with alcohol

A

enhance intoxication
unintended respiratory depression & death

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9
Q

more commonly abused anxiolytic

A

benzodiazepine class

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10
Q

highest rate of misuse of benzos

A

Adults 18 to 49

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11
Q

Age group most often prescribed benzodiazepines

A

adults 50 to 65

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12
Q

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

A

1.0 and 1.1%

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13
Q

prevalence of anxiolytic and sedative use disorder in the USA

A

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

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14
Q

Anxiolytic and sedative toxicity
Risk factors

A

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

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15
Q

Benzodiazepines (BZDs) & barbiturates MoA

A

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

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16
Q

T/F
GABA-A receptors are metabophores.

A

False
ligand-gated chloride ion channels

influx of Cl-

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17
Q

BZDs and barb increase GABA’s inhibitory effect by…

A

increasing the frequency and time of channel openings

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18
Q

T/F
Nonbenzodiazepine receptor agonists are nonselective.

A

False
selectively target one type of GABA-A receptor

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19
Q

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

A

True
different chemical structure

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20
Q

T/F
Melatonin agonists have high affinity for MT.

A

False
slight affinity to MT

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21
Q

MT location

A

suprachiasmatic nucleus (hypothalamus)

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22
Q

Antihistamines target ___ receptors in the …

A

H1
gastrointestinal, blood vessel, and respiratory tracts

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23
Q

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

A

True

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24
Q

Opiates MoA

A

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

(release dopamine by enhancing GABA disinhibition of dopamine release)

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25
Q

receptor responsible for pain relief and euphoria, & respiratory depression

A

mu

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26
Q

receptors affected by opioids

A

mu, kappa, and sigma

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27
Q

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

A

opioids affect the mu receptor, which causes respiratory depression

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28
Q

T/F
Antidepressants cause sedation

A

True

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29
Q

How do antidepressants and antipsychotics cause sedation?

A

antihistamine H1 blockade

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30
Q

Anticonvulsants cause sedation by…

A

enhance GABA neurotransmission

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31
Q

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

A

temazepam and zopiclone/zolpidem

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32
Q

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

A

lithium

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33
Q

Which was more likely to result in death?
Clozapine
chlorpromazine

A

Clozapine

34
Q

Which is less toxic?
Risperidone
chlorpromazine

A

Risperidone

35
Q

T/F
overdose of oral BZDs rarely cause toxicity

A

True
unless co-ingested with another agent

36
Q

most common presentation of BZD toxicity

A

CNS depression
stable vital signs
drowsy but arousable
can give history

37
Q

most intentional overdoses with BZDs occur with ___ co-ingestion

A

ethanol

38
Q

Severe toxicity

A

stuporous or comatose

39
Q

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

A

NonBZD hypnotics

40
Q

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

A

zolpidem
zaleplon
eszopiclone

40
Q

Complex-sleep related behaviors

A

sleepwalking/driving/eating

and other behaviors that can be completed while not fully awake

41
Q

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

A

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

42
Q

serotonin syndrome

A

overstimulation of central and peripheral serotonin receptors

43
Q

serotonin syndrome
S/S

A

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

44
Q

SSRI/SNRIs that can precipitate seizures

A

bupropion and venlafaxine
(status epiltcs rare)

45
Q

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

A

TCAs

46
Q

anticholinergic toxicity can occur with overdose of which drug class

A

TCAs

47
Q

TCA overdose

A

AMS
sedation
confusion
delirium
hallucination

cardiac conduction delays
arrhythmias
hypoTN
anticholinergic toxicity

48
Q

anticholinergic toxicity
S/S

A

hyperthermia
flushing
pupillary dilation

49
Q

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

A

False

50
Q

T/F
Opiate OD is always accompanied by bradycardia.

A

False
Heart rate ranges from bradycardia to tachycardia

51
Q

Hypotension in opiate OD results from…

A

histamine release

52
Q

Hypothermia in opiate OD results from…

A

impaired thermogenesis or environmental exposure.

53
Q

antiseizure drugs
most severe reactions

A

suicidality

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

54
Q

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

A

False
History is often unreliable in this case

55
Q

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

A

True

56
Q

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

A

QRS and QTc intervals

anxiolytics, sedatives, & TCAs can prolong the QRS

antipsychotics prolong QT

57
Q

Some antipsychotic drugs ___ the QT interval due to…

A

blocking K efflux

58
Q

Toxin-induced QRS interval prolongation occurs in

A

TCA poisoning

immediate action is necessary!

59
Q

Cons of toxicological screening

A

false +’s

60
Q

first priority

A

ensure hemodynamically stable

specific attention to the airway, breathing, and circulation

61
Q

BZD toxicity treatment

A

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

62
Q

most important in BZD toxicity treatment

A

Airway protection

63
Q

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

A

hypoventilation

64
Q

T/F
activated charcoal is ideal for isolated BZD overdose

A

False
can cause aspiration

65
Q

flumazenil

A

nonspecific competitive antagonist for the BZD receptor

reverse BZD-induced sedation following GA, procedural sedation, or OD

66
Q

flumazenil controversy

A

risk withdrawal seizures in patients w/ tolerance for BZDs

esp w/ concomitat pro-convulsants

67
Q

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

A

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

68
Q

SSRI/SNRI treatment

A

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

69
Q

given or those with signs of serotonin syndrome or seizures

A

BZDs

70
Q

given for those with cardiac toxicity

A

Sodium bicarbonate

71
Q

risk of developing torsades de pointes

A

Magnesium sulfate intravenously

72
Q

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

A

Sodium bicarbonate

73
Q

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

A

TCA

74
Q

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

A

2

(Unless bowel obstruction, ileus, or perforation)

75
Q

naloxone

A

short-acting opiate antagonist

76
Q

preferred admin route for naloxone

A

IV

77
Q

Differential diagnosis may be broad d/t…

A

pts unable to contribute to a meaningful history

78
Q

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

A

less

79
Q

Differential diagnosis is broad and can consist of which causes?

A

metabolic
structural
infectious causes
Hypoglycemia

80
Q

Secondary complications that may make the effects of an OD permanent

A

cerebral ischemia
cardiac ischemia

81
Q

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

A

True

Daddy Pharm (13 decks)

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