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10 Cards in this Set

  • Front
  • Back
Regarding GHB T/F
1. intoxication may cause CNS and resp depression, sustained clonus and tachycardia
2. toxic effects are prolonged (>24 hours)
3. maximal toxicity is usually evident by arrival in ED
4. recovery of consciousness is usually sudden and accompanied by short period agitation or delirium and vomiting
5. deaths occur from airway obstruction, pulmonary aspiration or respiratory arrest
6. mydriasis is a feature
7. tolerance and withdrawal develop in regular users
8. supportive care is the mainstay of therapy, physostigmine is also beneficial
9. suspect in any young person found collapsed in nightclub
10. dx is typically made via urine tox screen
1. F - myoclonic jerks (rare feature, may mimic seizures) and bradycardia
2. F - usually 4-6
3. T
4. T
5. T
6. F - miosis
7. T
8. F - supportive care IS the mainstay, physostigmine has NO evidence
9. T
10. F - not detected on this screen, clinical dx in ED
Regarding phenothiazines (Chlopromazine, prochloperazine) and butyrophenones (Haloperidol) - e.g. typical antipsychotics - which is incorrect
1. CNS depression, orthostatic hypotension and anticholinergic effects (including agitated delerium, urinary retention) predominate
2. >5gm of chlorpromazine can cause coma requiring ETT
3. cardiac dysrhythmias, QT prolongation and torsades are common
4. seizures are uncommon with any dose
5. children should be admitted after even one tablet due to coma, agitation, tachycardia and extrapyramidal effects after even small ingestions
3. FALSE - common only with thioridazine in large doses, which has been withdrawn from the market

If coma present, then caution with extubating in ED once it resolves, as agitated delerium may emerge at this point and complicate extubation
Regarding atypical antipyschotics which is incorrect
1. quetiapine produces dose dependent CNS depression and characteristic brisk tachycardia
2. QT prolongation and torsades are described
3. delerium and seizures may occur at higher doses
4. coma, if it occurs, usually lasts <12/24
5. the mainstay of treatment is good supportive care, and charcoal is only indicated if ETT in situ (bc of rapid onset of coma)
4 INCORRECT - prolonged effect 18-48 hours
Regarding risperidone which is incorrect
1. mild sedation, tachycardia, orthostatic hypotension are features
2. both miosis and mydriasis may occur
3. extrapyramidal movements are seen
4. QT prolongation occurs but not torsades
5. anticholinergic features and coma are common
5 INCORRECT both of these are rare.
Supportive care ensures good outcome. Features usually mild.
Regarding SSRIs T/F
1. Citalopram and escitalopram are least likely to cause dose-dependent QT interval prolongation
2. overdose is usually benign - serotonin sx in less than 20%
3. seizures occur in less than 4% and are more likely with venlafaxine
4. severe serotonin syndrome does not develop unless coingestion of other serotonergic agents
5. activated charcoal is not indicated unless coingestants unless >600mg citalopram and administered <4/24
6. coma may be seen
1. F - citalopram and escitalopram are unique in that they cause dose-dependent QT interval prolongation. Torsades rare. Wide complex bradycardias may also occur
2. T
3. F - more likely with citalopram (the real baddy)
4. T
5. T
6. F - indicates coingestion or complication
Regarding TCAs which is incorrect
1. onset of severe toxicity usually occurs within 2/24
2. >10mg/kg ingestion amitryptiline, dothiepin, doxepin or trimipramine in a 10kg toddler may be lethal, >5mg/kg requires admission
3. CVS signs usually precede sedation and coma
4. ECG features include prolonged PR and QRS, large terminal R wave aVR, increased R/S ratio >0.7 in aVR, QT prolongation
3. INCORRECT - sedation and coma usually precede CVS signs
Regarding TCA which is CORRECT
1. broad complex bradycardia is a pre-arrest rhythm
2. QRS >120ms is predictive of seizures
3. QRS widening is a manifestation of slow sodium channel blockade
4. QRS >120ms is predictive of VT
1. Correct
2. >100ms predicts seizures
3. FAST sodium channel blockade
4. QRS >160ms predicts VT
Regarding TCA T/F
1. Intubation and hyperventilation is indicated at the onset of QRS widening
2. in vent dysrhythmia cardioversion and defibrillation are efficacious
3. in ventricular dysrhythmia NaHCO3 is administered every 1-2 mins until perfusing rhythm restored
4. amiodarone, betablockers and lignocaine are all 3rd line therapies for ventricular dysrhythmia
5. hypotension management includes crystalloid, NaHCO3 and adrenaline or NA infusion
6. significant ingestions >10mg/kg should be treated with activated charcoal but ONLY after intubation
1. F - intubation/hyperventilation indicated at onset of CNS depression eg GCS <12
2. F - unlikely to be effective
3. T
4. F - amiodarone and betablockers are CONTRAINDICATED, lignoaine is 3rd line once pH >7.5 (after NaHCO3 and cardioversion/defib??)
5. T
6. T
Regarding MAO inhibitors which is incorrect
1. moclobemide alone causes minor symptoms only; larger ingestions may cause prolonged QT but torsades not reported
2. co-ingestion of moclobemide with other serotonergic agents is associated with high risk severe serotonin syndrome
3. irreversible non selective MAO inhibitors (phenelzine, tranylcypromine) are associated with dose dependent, potentially lethal serotonin and sympathomimetic toxicity
4. phenelzine and tranylcypromine toxicity is rapid in onset and short lived
4. INCORRECT - delayed and prolonged
Regarding MAOIs which is incorrect
1. DIC and MOF may occur
2. intoxication may last several days
3. tyramine reactions may occur, with acute hypotension
4. hyperthermia requires rapid and aggressive therapy with core temperature monitoring, sedation and fluid resuscitation; if >39.5 paralysis, intubation, ventilation
3. INCORRECT - tyramine reaction is where ingestion of a tyramine containing food e.g. cheese causes severe occiptal HA, pronounced hypERtension, sweating, agitation, mydriasis and chest pain. Cx include ICH, rhabdomyolysis, ARF, DIC
4. CORRECT - this is caused by muscle rigidity, which also leads to respiratory compromise, respiratory acidosis, rhabdomyolysis