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98 Cards in this Set
- Front
- Back
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Morphine, codeine, heroin, fentanyl, hydrocodone, oxycodone
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opiates
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Opiate triad
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Miosis
CNS depression Respiratory depression |
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Cocaine, amphetamines
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Sympathomimetics (Stimulants)
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signs and symptoms of person on sympathomimetics
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MAD HHATS:
Mydriasis Agitation Diaphoresis Hyperthermia Hypertension Anxiety Tachycardia Seizures |
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what is the antidote and treatment for Opiates?
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Naloxone (narcan)
Airway -- ventilation (they have respiratory depression) |
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what is the treatment for Sympathomimetics?
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Cooling
Benzos - for sedation |
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What is the tx/ antidote for cholinergics
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2 PAM (Pralidoxime)
Atropine Airway |
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Insecticides, Bio weapons examples of what?
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cholinergics
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What are the sx of cholinergics?
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DUMBBELLS or SLUDGE BBB
Salivation Lacrimation Urination Diarrhea/diaphoresis GI sx Emesis Bradycardia (hence atropine) Bronchospasm Bbronchorrhea |
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Atropine
Tricyclics Antihistamines: Dipenhydrmaine, dimenhydrinate, chlorpheniramine, scopolamine, hyoscyamine, Jimson Weed. |
Anticholinergics
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Respiratory alkalosis and metabolic acidosis caused by what class?
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Salicylates
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Sx of salicylate intoxication
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Tachypnea
Tinnitus Vomiting Diaphoresis Tachycardia |
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Sulonylureas, Insulin
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Hypoglycemics
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Signs and sx of hypoglycemia
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slurred speech, seizures, paralysis, diaphoresis, tachycardia, altered mental status,
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Meperidine
Dextromethorphan SSRIS Tricyclics St. John’s Wart |
Serotonergics
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what are signs sx of serotonergic toxicity?
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increased muscle tone
hyperthermia "wet dog shakes" tremor hyperreflexia |
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Increased mm tone
Hyperreflexia Hyperthermia Tremor “Wet dog shakes” |
serotonergic toxicity
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what are the symptoms of a sedative overdose?
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CNS depression, decreased reflexes, Nystagmus, Hypotension, bradycardia, Resp. depression, hypothermia
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LSD, PCP
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hallucinogens
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What are the signs and sx of hallucinogens intoxication?
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Paranoia
Agitation Tachycardia HTN Euphoria Aggression Diaphoresis Mydriasis |
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What is the tx for hallucinogen toxicity?
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sedation and cooling
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what are possible complications of hallucinogen toxicity
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Rhabdo, Seizures, Trauma
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what things can cause bradycardia?
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PACED
propranolol (BB) / Phenobarbital Anticholinesterases (cholinergics) CCB - clonidine Ethanol Digoxin |
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What substances can cause tachycardia
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FAST
Free base, other cocaines Anticholinergics, antihistamines, amphetamines Sympathomimetics, solvents Theophylline |
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What substances can cause hypothermia?
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COOLS?
Carbon Monoxide Opiates Oral hypogylcemics, insulin Liquor Sedatives |
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what are things that cause hyperthermia
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NASA
neuroleptic malignant syndrome, nicotine Antihistamines Salicylates, sympathomimetics, serotonergics Anticholinergics, antidepressants |
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what are things that cause hypotension?
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CRASH
Clonidine, CCB Reserpine, other antihypertensives Antidepressants, aminophyline Sedative hypnotics Heroin, other narcotics |
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what are things that cause hypertension?
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CT SCAN
cocaine Thyroid supplements Sympathomimetics Caffeine Anticholinergics, amphetamines Nicotine |
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what are things that cause tachypnea
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PANT
PCP, paraquat, pneumonitis (chemical) Aspirin, other salicylates Non-cardiogenic pulm. edema Toxin inuced metabolic acidosis |
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what are things that cause bradypnea?
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SLOW
sedative hypnotics including GHB Liqour Opiates Weed |
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Barbituates, opiates and ethanol can all cause this?
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hypoxia
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what drugs cause MIOSIS?
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COPS
Clonidine, cholinergics Opiates, organophosphates Phenothiazines, pilocarpine Sedative hypnotics |
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What durgs cause MYDRAISIS?
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AAAS
Antichoinergics, atropine, antihistamines, antidepressants, sympathomimetics |
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What drugs cause dry skin?
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antidhistamines, anticholinergics
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What drugs cause wet skin?
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sympathomimetics, cholinergics
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What can we use to treat seizures from drug toxicity?
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Benzodiazepines
Phenobarbs Pyridoxine Propofol Don't use phenytoin |
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what is the calculation for osmolar gap with ethanol consideration?
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(2*Na) + (GLUC/18) + (BUN/2.8) + (ETOH/ 4.6)
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What is the triad associated with Thiamine Deficiency? (Beriberi)
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Ocular-motor palsy, nystagmus
Altered mental status - memory impairment Ataxia |
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one pill of these can kill
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TCAs
antimalarials antipsychotics CV agents - CCB, clonidine Opiods oral hypogycemics topical (oil of wintegreen, lindane, benzocaine) alcohols (methanol, ethylene glycol) theophylline colchicine |
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which are the dirty rotten stinking drugs we should be very afraid of?
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Tricyclic anti-depressants
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what is the initial treatment for TCA toxicity?
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NaHCO3
1-2 mEq/kg bolus; drip made from 3 amps of NaHCO3 in 1L of D5W |
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MAO-I/ Tyramine Reaction results in what sxs?
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Rapid onset of:
Diaphoresis HA Neck pain Chest pain/ palpitations Mydriasis HTN Neuromuscular excitation |
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What is the tx for MAO-I/Tyramine reaction?
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Nitroprusside and alpha blocker - phentolamine
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MC complaint of SSRIs?
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GI
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What are the sxs associated with SSRIs?
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GI complaints
N/V Sedation Tremor Tachycardia Seizures or QT prolongations very rare |
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What is the treatment for SSRI's if the QT is prolonged?
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NaHCO3
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what are the sx of serotonin syndrome?
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Hyperreflexia
Hypertension Hyperthermia Hyperactivity Altered mental status Ataxia Myoclonus mm rigidity in lower extremeties |
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What is the treatment for serotonin syndrome?
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Benzos or
Cyproheptadine (Periactin) more effective 4mg q2 hr to 16mg |
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What are the SE of Trazadone an Atypical antidepressant?
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Orthostatic hypotension
sedation priapism elevated LFTs higher doses = QT prolongation |
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What are the SE of Buproprion an Atypical antidepressant?
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Seizures
OD: tachycardia, lethargy, tremor and confusion |
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What are the SE of Venlafexine(effexor) an Atypical antidepressant?
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OD: tachy, HTN, diaphoresis, tremor, mydriasis
Seizures, QT prolongation/QRS widening rare |
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What are the SE of Anipsychotics?
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schizophrenia, psychosis
chemical restraint N/V HA hiccups Tourettes |
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What SE do we see with Typical Antipsychotics?
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Alpha adrenergic blockers : orthostatic hypotension
Anticholinergics: hyperthermia, tachy, mydriasis, sedation |
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What SE do we see with Atypical Antipsychotics?
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less likely than typicals to cause extrapyramidal effects
OD - sedation, seizures, temp instability, hypotension, tachy, QT prolongation |
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What is the SE of Lithium in the body?
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TREMOR, worsens with toxicity
also, N/V/D (looks like a GI bug) Cardiotoxicity thru intracellular hypokalemia |
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What are the three grades of lithium toxicity?
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grade 1: 1.5-2.5 mEq/L
Sx: Tremor, ataxia, N/V Tx: Fluids and kayexalate Grade 2: 2.5-3.5 Sx: stupor, rigidity, hypotension Tx: consider dialysis Grade 3: >3.5 Sx: coma and seziure Tx: hemodialysis |
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Benzo's act on which receptors? Causing what sx?
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GABA
sedation, anxiolysis, +/- mm relaxation |
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What are the sx of benzo toxicity?
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drowsiness or coma
slurred speech ataxia disinhibtion resp. depression if parenteral |
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What is the treatment for benzo toxicity?
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Supportive
Charcoal if alert |
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What are the sx of mild OD with Barbiturates?
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Drowsiness
Ataxia Disinhibtion Slurred speech (Skin bullae possible) |
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What are the sx of Severe OD with Barbiturates?
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Coma
Hypothermia Bradypnea Hypotension |
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Death to do OD of barbiturates would most likely involve what mechanisms?
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Resp. arrest
Cardiovascular collapse Hypoglycemia |
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How does a pt present with Barbiturate OD?
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cold apneic shocky patient
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How do we treat an OD of Barbiturates?
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Airway
IV fluids Pressors Gastric lavage if <60 min from ingestion Urine alkalinization forced diuresis if not shock multi-dose charcoal, dialysis |
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What toxin has the highest morbidity/mortality than combo of al other poisonings
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Carbon Monoxide
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What has a higher affinity for Hgb, O2 or CO?
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CO has a 240x higher affinity
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what are signs of CO poisoning?
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Mild: HA, N, dizzy, weak, poor concentration
Mod: 30-40% Severe: confusion, lethargy, syncope, coma, c/p Pt with syncope, AMS >25% CO hgb in danger |
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75% rx overdoses are caused by?
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Rx painkillers
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what should you include in your differential of a child with ataxia?
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Ingested Hydrocarbons
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Causes of airway compromise:
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1. posterior displacement of tongue (from CNS and resp. depressants)
2. Oropharyngeal mucosal injury/edema (from caustic ingestions) 3. Angioedema (ACEIs) 4. Trauma |
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what is the antidote for cyanide?
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amyl nitrite, sodium nitrite, sodium thiosulfate, hydroxycobalamin
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What is the antidoe for TCAs
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sodium bicarb
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What is the antidote for Isoniazid
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B6, pyridoxine
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What is the antidote for methemoglobinemia(Pyridium)
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methylene blue
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What is the antidote for cholinergics?
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2 - Pam
atropine |
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What is the antidote for ethylene glycol, methanol?
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ethanol, fomepizole
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What is the antidoe for beta blockers?
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Glucagon
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What is the antidoe for valproic acid?
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carnitine
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what is the antidote for digitalis?
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digibind Fab
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Succimer, EDTA, dimercaprol are the antidotes for what?
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heavy metals
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what is the antidote for copper?
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Penicillamine
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NAC is the antidote for what?
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Acetaminophen
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what type of alcohol does not cause metabolic acidosis?
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Isopropryl
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how is Isopropyl digested in the body?
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Alcohol dehydrogenase converts it to acetone which is thereby excreted by the lungs &
kidneys |
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how is Methanol digested in the body?
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Alcohol dehydrogenase converts methanol to formaldehyde & formic acid
– Toxins that inhibit mitochondrial respiration |
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when might we see snowstorm vision
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methanol intoxication
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this substance is Metabolized by alcohol dehydrogenase to glycoaldehyde, glycolic acid and calcium oxalate
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Ethylene glycol
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what sxs would you see in severe salicylate intoxication?
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>300mg/kg -- hyperthermia, ARDS, pulm. edema, hypoglycemia
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what is the MC OTC med involved in OD?
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Acetominophen, Tylenol
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which med is the most deadly of the cardiac meds?
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calcium channel blockers
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vicodin, tramadol and oxycodone are ?
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opiates
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what are the terrible opiates?
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meperidine (demerol)
(Darvon) Lomotil Tramadol |
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what is the most diagnostic sign seen with an overdose of salicylates
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metabolic acidosis and respiratory alkalosis
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what test screens for salicylates in urine?
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ferric chloride test. Will turn purple
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what can happen with severe salicylate intoxication?
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>300mg/kg --> hyperthermia, ARDS, hypoglycemia, pulm. edema
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when might you use flumezenil?
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with rohypnol
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what is the treatment for serotonin syndrome?
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Cyproheptadine (periactin) 4mg q2 hrs to 16mg
Benzos may help with some sx |
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when do we consider using Cyproheptadine (periactin)?
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patient with serotonin syndrome
or overdose on serotonergics |
