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Home , Barbiturate overdose

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1. TCA overdose -hyperthermia 13. How do you decide -draw serum acetaminophen levels symptoms -anticholionergic effects: dilated whether to administer AFTER FOUR HOURS of overdose pupils, intestinal ileus the in - Can administer N-acetylcysteine -seizures acetaminophen w/in 8 hrs of ingestion -QRS prolongation--> poisoning? -four hours after ingestion is ventricular arrhythmia minimum to predict hepatotoxic -death: hypotension effects of acetaminophen overdose

2. Managment of pt with -ABCs 14. cyanosis and pink hue poisoning TCA overdose -Sodium bicarbonate to skin --improves hypotension, long 15. cyanosis and bluish Methemoglobinuria QRS, ventricle arrhythmia skin color -due to antibiotics (trimethoprim, 3. EKG finding in -peaked T waves sulfonamides and dapsone), hyperkalemia -long PR and QRS intervals aniline dyes, nitrates -sine wave -blue baby syndrome: infant drinks nitrates in water 4. of atropine and pralidoxime -tx: O2 + methylene blue anticholinesterase (insecticides, 16. Symptoms of carbon -Headaches, N/V, abdominal physostigmine, monoxide poisoning discomfort, confusion, coma donepezil) -pink hue to skin

5. Most reliable *dec respiratory rate 17. Diagnosis of carbon -h/o smoke inhalation, furnaces indication of -miosis may or may not be seen monoxide poisoning -get carboxyhemoglobin levels toxicity 18. Treatment of carbon hyperbaric oxygen administration 6. opioid intoxication *decreased respiratory rate monoxide poisoning symptoms -hypotension, , dec 19. Burning of rubber or (v automobiles, bowel sounds, miosis plastic can result in furnaces with carbon monxide) 7. treatment of beta -hypotension: IV fluids what kind of blocker intoxication -bradycardia: Atropine poinoning? -seizures: 20. v BOTH: substitutes for , (lorazepam) poisoning metab anion gap acidosis, inc -IV glucagon, IV calcium salts, symptoms osmolar gap Vasopressor (epinephrine), high methanol: optic disc hyperemia, dose insulin and glucose vision loss infusions, Lipid emulsion therapy ethylene: hypocalcemia, calcium 8. Beta Blocker bradycardia and hypotension oxalate deposits in kidney- intoxication hematuria, renal failure symptoms 21. Symptoms of aspirin -anion gap metab acidosis, resp 9. drowsiness, slurred speech, overdose alk intoxication unsteady gait -tinnitis, fever, hyperventilation symptoms 22. Opioid withdrawal anxiety, insomnia, flu-like symp, 10. Treatment of Flumazenil symptoms piloerection, fever, rhinorrhea, benzodiazepine lacrimation, yawning, nausea, intoxication stomach cramps, diarrhea, mydriasis 11. treatment of acute naloxone- goal of inc respiratory opioid intoxication rate 23. Treatment of -clonidine, buprenorphine, moderate to severe methadone 12. Most important -QRS prolongation: best symptoms of opioid feature of TCA predictor of seizures and withdrawal overdose ventricular arrythmia 24. Treatment od mild antiemetics, muscle relaxants, symptoms of opioid NSAIDs withdrawal 25. ethanol and -NO SEIZURES in opioid withdrawal 36. Symptoms within - HTN, agitation, 4-7 days of tachycardia, delirium, possible death, withdrawal vs cessation autonomic instability opioid -mortality rate 5% withdrawal 37. Treatment of Benzodiazepines -eg chlordiazepoxide features alcohol (Librium); CNS depressants that will 26. Management of -hospitalize, IV hydration, serial withdrawal limit the effects of alcohol withdrawal pt who ingested abdominal and chest XRs hallucinations- haloperidol strongly -endoscopy: assess esophageal damage -thiamine, folate, multivitamin alkaline -perforation? Gastrografin study replacement substance 38. Organophosphate -inhibits acetylcholinesterase leading to 27. complications -immediate esophageal damage - poisoning cholinergic excess: bradycardia, miosis, of ingesting liquefactive necrosis of esophageal wall symptoms rhonchi, muscle fasciculations, lye/alkaline leading to perforation and mediastinitis salivation, lacrimation, urination, substance defecation

28. Symptoms of dysphagia, severe pain, heavy salivation 39. Treatment of atropine, pralidoxime ingesting an and mouth burns organophosphate alkaline or -necrosis of tissue lining the GI tract poisoning caustic -perforation of the stomach or esophagus 40. Symptoms of Beta asthma exacerbation (wheezing), substance can occur causing peronitis or blocker overdose bradycardia, AV block, hypotension, mediastinitis potential cardiogenic shock 29. Drugs that dopaminergic antagonists, espcially 41. Treatment of beta -hypotension: IV fluids cause typical neuroleptics such as haloperidol blocker overdose -bradycardia: Atropine Neuroleptic -seizures: benzodiazepines (lorazepam) Malignant -IV glucagon, IV calcium salts, Syndrome Vasopressor (epinephrine), high dose 30. symptoms of -hyperthermia (fever), muscle rigidity, insulin and glucose infusions, Lipid neuroleptic autonomic instability and mental status emulsion therapy malignant changes 42. treatment of TCA -Sodium bicarbonate narrows the QRS syndrome -elevated CK, leukocytosis overdose complex (thus preventing ventricular 31. Symptoms of -hypocalcemia, calcium oxalte deposition arrhythmia) by increasing the ethylene glycol in kidneys--> flank pain, hematuria, extracellular sodium conc poisoning oligouria, renal failure 43. Treatment of -dantrolene (muscle relaxant) -anion gap metabolic acidosis neuroleptic -bromocriptine (dopamine agonist) 32. treatment of -Fomepizole or ethanol (ADH inhibition) malignant -amantadine (antiviral with ethylene glycol -Sodium bicarbonate to alleviate acidosis syndrome dopaminergic properties) poisoning - if end organ damage 44. Benzodiazepine benzos: NO severe respiratory 33. danger of -Fluphenazine (more potent than haldol) overdose v opioid depression, NO pupillary constriction typical and other "typical" antipsychotics inhibit overdose (usually but not always in opioid antipsychotic autonomic thermoregulation, can get overdose) and extreme hhypothermia with prolonged 45. Benzodiazepine no nystagmus in benzos cold exposure to cold overdose v alcohol temperature -all patients taking antiipsychotic meds are and phenytoin advised to avoid prolonged exposure to intoxication extreme temperatures 46. Phenytoin toxicity horzontal nystagmus, cerebellar ataxia, 34. Symptoms in -anxiety, insomnia, tremors, diaphoresis symptoms confusion the first 6-12 hours of 47. Symptoms of -anti-histamine effects: drowsiness, alcohol diphenhydramine confusion cessation overdose -anticholinergic effects: dry mouth, dilated pupils, blurred vision, reduced 35. Symptoms in -Hallucinations and withdrawal seizures bowel sounds, urinary retention the first 48 hrs -tachycardia, HTN,agitation, seizures of alcohol cessation 48. Treatment of physostigmine, a cholinesterase 66. iron intoxication five phases: diphenhydramine inhibitor symptoms 30 min- 6 hours after ingestion: GI overdose phase (N/V, hematemesis, melena, abd pain) 49. Management of -Fresh frozen plasma - immediately -6-24 hrs later: asx Warfarin induced reverses action of warfarin -72 hrs; shock, metabolic acidosis bleeding -Vitamin K - takes 8-12 d to be effective -12-96 hrs: hepatotoxicity 50. urgent reversal of protamine sulfate -iron tox>350 heparin 67. Tx of Neuroleptic -fever, muscle rigidity, auto instability, 51. Vit A def night blindness, dry skin Malignant AMS Syndrome -dantrolene (muscle relxant) 52. Vit B1/thiamine -beriberi: polyneuritis, dilated def cardiomyoppathy, high output CHF, +bromociptine (dopa agonist) edema +amantidine (antiviral with dopa -Wernicke- properties)

68. Tx of AV block -atropine and IV fluids 53. Vitamin B2 def angular stomatitis, cheilosis, corneal vascularization caused by Beta -glucagon blocker intox 54. Vit B3/niacin def pellagra: diarrhea, dermatitis, dementia 69. TCA overdose tx Sodium bicarbonate 55. Vit B5 def dermatitis, enteritis, alopecia, adrenal pathophys -alkalinize serum, TCA then less insufficiency protein bound, dec bioavailability

56. Vit B6 def convulsions, hyperirritability; required -Na+ reverses the sodium channel during INH treatment blocking effects of TCA

57. Vit macrocytic, megalobalstic anmeia, 70. Bleomycin SE pulmonary fibrosis B12/cobalamin neuro symp, glossitis 71. cyclophosphamide hemorrhagic cystitis def SE 58. Vit C def scurvy: swollen gums, bruising, anemia, 72. isoniazid SE vitamin B6 def, lupus like syndrome, poor wound healing liver toxicity 59. Vit D def rickets (in children - bending bones); 73. cyclosporine SE renal toxicity osteomalacia in adults (soft bones); hypocalcemic tetany 74. ACE I SE cough, angioedema

60. Vit E def inc fragility of RBCs 75. demeclocycline SE diabetes insipidus

61. Vit K def neonatal hemorrhage, inc PT and PTT; 76. lithium SE diabetes insipidus, thyroid dysfunction NOMRAL Bleeding time 77. methoxyflurane SE diabetes insipidus 62. Biotin def dermatitis, enteritis 78. sulfa drugs SE allergy, kernicterus in neonates caused by raw egg ingestion, or antibiotic use 79. halothane SE liver necrosis

63. folic acid def -Most common vit def in US 80. phenytoin SE lateral gaze nystagmus, ataxia, -sprue, macrocytic, megaloblastic hirsutism, folate deficiency, teratogen anemia, without neuroologic symp (cranio-facial abnorm), gum

64. Magnesium def -lead to def Ca2+ and K hypertrophy

-weakness, muscle cramps, 81. vincristine SE peripheral neuropathy hypocalcemic tetany, CNS hyperirritability, tremors, 82. amiodarone SE thyroid dysfunction, pulmonary toxicity

choreoathetoid movement 83. valproic acid SE neural tube defects in offspring

65. def Keshan disease (cardiomyopathy) 84. thioridazine SE -typical antipsychotic -retinal deposits, cardiac toxicity

85. vancomycin SE red man syndrome

86. quinolones SE cartilage damage-teratogen

87. quinine SE (tinnitus, vertigo)

88. morphine SE sphincter of Oddi spasm 89. Clindamycin SE pseudomembranous 112. antidote for sodium bicarbonate (cardio-protective) colitis quinidine or TCAs

90. chloramphenicol SE gray baby 113. antidote for normalize potassium and other syndrome, aplastic digoxin electrolytes anemia 114. antidote for -stabilize with Sodium bicarb, 91. doxorubicin SE cardiomyopathy methanol/ethylene benzodiazepine () glycol -ethanol, fomepizole 92. bulsulfan SE pulmonary fibrosis 115. antidote for flumazenil 93. monoamine oxidase inhibitors SE tyramine crisis benzodiazepines (after wine, cheese) (diazepam, 94. hydralazine SE lupus like syndrome alprazolam)

95. procainamide SE lupus like syndrome 116. antidote for beta glucagon blockers 96. minoxidil SE hirsutism 117. antidote for lead EDTA 97. aminoglycosides SE ototoxicity, renal -use succimer for children toxicity 118. antidote for penicillamine 98. chlorpropamide SE -old sulfonylurea copper or gold (its use no longer recommended) 119. antidote for naloxone -SIADH 120. antidote for -physostigmine (cholinesterase 99. didanosine SE pancreatitis, peripheral muscarinic inhibitor) neuropathy blockers (ex scopolamine, or 100. halogen anesthesia SE malignant atropine, hyperthermia ipratropium)

101. succinylcholine SE malignant 121. aspirin and nasal do not give aspirin to pts with nasal hyperthermia, CI in polyps polyps bc hypersensitivity reactions hyperkalemia involving an asthmatic attack

102. Zidovudine SE bone marrow 122. Drug induced -sx: fever, myalgias, arthralgias, supression lupus arthritis, erythematous rash in

103. acetazolamide SE metabolic acidosis sun exposed skin -drugs: procainamide, hydralazine, 104. HMG Co reductase inhibitors SE (simvastatin) minocycline, diltiazem, penicillamine, -muscle and liver isoniazid, quinidine, anti-TNF alpha toxicity therapy (infliximab and etanercept), 105. ethambutol SE optic neuritis INF-alfa, methyldopa, chlorpromazine

106. metronidazole SE disulfiram reaction 123. Metronidazole SE -inhibits acetaldehyde dehydrogenase: with alcohol "disulfiram-like reaction" if taken with alcohol!! 107. cisplatin SE nephrotoxicity 124. how does -metabolizes to form mercapturic acid 108. methyldopa SE hemolytic anemia acetominophen -needs conjugated to glutathione for (coombs test cause liver toxicity excretion positive) -depletion of glutathione, mercapturic 109. SE alpha 1 antagonists (terazosin, -first dose metabolites bind to hepatocytes--> prazosin) orthostatic liver failure hypotension 125. metformin -lactic acidosis 110. antidepressant that causes methyldopa toxicity -GI problems, nausea, diarrhea, depression anorexia, abd pain

111. antidote for cholinesterase -atropine, 126. salicylate tinnitis, fever, vertigo inhibitors (insect repellant, pralidoxime poisoning sx -anion gap metab acidosis + resp donepezil, rivastigmine, alkalosis pyridostigmine) 127. amitriptyline overdose sx -TCA -3 Cs: coma, convulsions, cardiotoxicity

128. overdose severe CNS depression, resp depression

129. hypertensive crisis -tyramine interacts with antidepressants of MAOI class -hypertensive crisis: very high BP, headache, epistaxis