Overdose Flashcards by Sumaya L

What is the HR in class I haemorrhagic shock?

Over 100 bpm`

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What is the HR in class II haemorrhagic shock?

100-120

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What is the HR in class III haemorrhagic shock?

Over 120

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What is the HR in class IV haemorrhagic shock?

Over 140bpm

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How soon after overdose does aspirin overdose cause metabolic acid-base disturbances?

Takes 6 hours minimum for metabolic acidosis to appear

-> prior to this, it is respiratory alkalosis

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What are the features of serotonin syndrome?

altered mental status, autonomic hyperactivity, and neuromuscular abnormalities

Management is supportive with Close observation, monitoring for clonus, autonomic instability, and hyperthermia

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What can be used in severe cases of serotonin syndrome?

Cyroheptadine

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What is the threshold for paracetomol ingestion for immediate treatment?

150mg/kg

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What is the criteria for immediate treatment of paracetomol overdose?

*plasma paracetamol concentration on or above the treatment line
* presentation within 8 h if ingested >150 mg/kg where plasma paracetamol levels are delayed;
* presentation more than 24 h after ingestion if clearly symptomatic or found to have deranged liver-function tests (jaundiced, hepatic tenderness, raised alanin transaminase (ALT)/international normalised ratio (INR

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What substances can cause methanol poisoning?

It commonly results from accidental or intentional consumption of substances containing methanol, such as antifreeze, windshield washer fluid, or adulterated alcohol.

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How does methanol poisoning present?

Gastrointestinal:
Nausea, vomiting, abdominal pain
Neurological:
Headache, dizziness, confusion, seizures, coma
Visual:
Blurred vision, “snowfield” vision, photophobia
Optic disc hyperaemia on fundoscopy
Metabolic:
Kussmaul respiration (due to acidosis

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What is the antidote for methanol poisoning?

Fomepizole: first-line (inhibits alcohol dehydrogenase)
Ethanol: used if fomepizole unavailable (competes with methanol for metabolism)
Supportive Measures:
Folinic acid (leucovorin) or folic acid to enhance formate metabolism
Anticonvulsants if seizures occur

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When is haemodialysis indicated for methanol poisoning?

Haemodialysis indicated if:
Severe acidosis
Visual symptoms
Methanol level >50 mg/dL
Deteriorating clinical status

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How does digoxin toxicity present?

nausea, vomiting, confusion, bradycardia, prolonged PR interval, and QRS complexes, along with a high serum potassium

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What is used in TCA overdose?

IV sodium bicarbonate

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What is the indication of use of sodium bicarbonate in TCA overdose?

evidence of hypotension, arrhythmias or widening of the QRS interval. Bicarbonate increases the serum pH and the extracellular sodium.

Alkalisation favours the neutral form of the drug thus reducing the amount of active cyclic antidepressants

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What are medication overuse headaches?

Headaches that occur in patients who use analgesics such as paracetamol, NSAIDs, and weak opiates to manage existing headaches.

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What paradoxical effect occurs with medication overuse headaches?

Patients develop frequent, almost daily headaches which worsen with the frequent use of analgesics.

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What is thought to cause medication overuse headaches?

Down-regulation of pain receptors, leading to a lack of efficacy of analgesics when they are used.

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List three types of analgesics that can lead to medication overuse headaches.

Paracetamol
NSAIDs
Weak opiates

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True or False: Medication overuse headaches improve with the frequent use of analgesics.

False

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Fill in the blank: Medication overuse headaches are caused by the down-regulation of _______.

pain receptors

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What are the symptoms of TCA overdose?

Palpitations
Drowsiness

Dry mouth
Hot, dry skin
Confusion
Hallucinations
Headache
Nausea and vomiting

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What are the signs of TCA overdose?

Reduced level of consciousness Seizures Mydriasis Urinary retention Ileus Hypotension Tachycardia

What is given for ventiruclar tachycardia in TCA overdose?

Sodium bicarbonate, by alkalinising the blood, which reduces the binding of TCAs to sodium channels, and increases extracellular sodium concentration, counteracting sodium channel blockade

Why to avoid amiodarone for TCA overdose ventiruclar tachycardia?

amiodarone is not recommended because it can exacerbate sodium channel blockade, worsening QRS prolongation

What to do for delayed paracetomol presentation and deranged liver enzymes?

Commence N-acetylcysteine and refer urgently to a liver transplant centre

Which drugs can precipitate digoxin toxicity?

Thiazide diuretics Amiodarone Calcium channel blockers quinidine

What is the indicating for NAC infusion before obtaining serum paracetomol?

*staggered ingestion *presentation > 8 hours post-ingestion *unavailability of serum levels * clinical signs of hepatotoxicity

How does lidocaine toxicity present?

Initial CNS over activity then depression as lidocaine initially blocks inhibitory pathways then blocks both inhibitory and activating pathways

What is the maximum total dose of lidocaine alone?

1% lidocaine 3mg.Kg

What is the maximum total dose of lidocaine with adrenaline?

7mgkg

What is the maximum dose of bupivicaine?

2mg/kg

How does coal anaesthetic toxicity present?

severe agitation or loss of consciousness, seizures, cardiovascular collapse

What are the cardiovascular complications of local anaesthetic toxicity?

sinus bradycardia, conduction blocks, systole and ventricular tachyarrhythmias

How to treat bradycardia with digoxin toxicity?

Atropine 500mg

What is digifab used for in cardiac arrythmias in dog in toxicity?

For ventricular dysrhythmias

What causes respiratory depression in a patient who had a fall a few hours ago and managed by the pain team?

Opioids -> more likely to accumulate in the elderly

What is ethylene glycol broken down into?

Toxic metabolites: -> glycoaldehyde -> oxaliplatin acid

What is the intial treatment within one hour of toxic alcohol treatment?

gastric decontamination (e.g. gastric lavage, NG aspiration

Which system may be affected in alcohol poisoning?

AKI due to deposition of calcium o late crystals in renal tubules

What is the first line management of ethylene glycol poisoning?

Fomepizole, competitive inhibitor of alcohol dehydrogenase to prevent breakdown and formation of toxic metabolites

What is 2nd line for ethylene glycol broken poisosining?

Haemodialysis

How does ethylene glycol intoxication present?

Decreased consciousness Headache Seizure

How is ethylene glycol toxicity diagnosed?

Clinical history ABG showing metabolic acidosis with raised anion gap and high omsolairty -> obtaining toxic alcohol concentration may be too long

What level of lithium is required for diagnosis of toxicity?

Over 1.2 mmol/L -. Symptoms appear at 1.5 mmol/L

What feature of lithium affects

Lithium is a monovalent cation similar to sodium. Therefore, anything that causes sodium or volume depletion can enhance lithium reabsorption in the kidneys Dehydration, renal failure, diuretics (in particular thiazides)

How does lithium affect the heart??

Causes first degree heart block

What is a movement disorder seen at therapeutic levels of lithium?

Fine tremor

What is a movement disorder seen at toxic levels of lithium?

Coarse tremor

What is the management of significant lithium ingestion?

Whole bowel irrigation ->Consider haemodialysis and benzodiazepines in seizure

How are the eyes affected in opioid toxicity?p

Pinpoint pupils due to bilateral miosis

What is the presentation of opioid overdose?

Myoclonic jerks Seizures Pinpoint pupils Absent gag reflex Hypothermia

What should be done after adminstering first dose of Naloxone for opioid overdose?

Naloxone has a 30-90 minute duration - many opioids have a duration of action longer than this so a repeat dose may be required

What are the U&Es in salicylate poisoning?

Hypokalemia due to renal failure

How does salicylate poisoning affect body heat?

Salicylate poisoning causes uncoupling of oxidative phosphorylation leading to reduced ATP production Leads to increased oxygen consumption, CO2 production and heat production

What age group will show a specific ABG for metabolic acidosis?

Young children will show metabolic acidosis with raised

What is the rpesentation of serotonin syndrome?

HAHA Hyperthermia Autonomic dysfunction Hyperreflexia Altered mental status

What autonomic dysfunction?

Sweating Mydriasis Hypertension Tachycardia

Which recreational drugs cause serotonin syndrome?

Cocaine MDMA

Which prescriptions cause serotonin syndrome?

MAOIs SSRIs Opioids NMDA receptor antagoniosts

What’ drug class indirectly increases risk of serotonin syndrome?

CYP450 inhibitors: CRAPGPS

What is the management of serotonin in syndrome?

Supportive ->Benzodiazepine for neuromuscular instability ->Antihypertensives ->Cyrohepatidine

Difference in onset between serotonin syndrome and neuroleptic malignant syndrome?

Serotonin syndrome: few hours NMS: days to weeks

What occcurs in TCA toxicity?

TCA toxicity causes inhibition of sodium channel inhibition and muscarinic ACh receptor inhibition

What are the features of TCA overdose?

Dry mouth Hyperthermia Ileus Thirst Tachycardia/arrhythmias Dilated pupils (mydriasis) Confusion

How is ECG affected in TCA overdose?p

Prolonged QTc interval Widened QRS

Which drugs are contraindicated in TCA overdose?

Anti-arrythmia drugs from class 1 because they worsen sodium channel blockade and depress contractility

What form of sodium bicarbonate is given for TCA overdose?

Hypertonic

What is thre antidote for heparin toxicity?

protamine sulphate

What is the risk of use of Flumazenil or benzodiazepine toxicity?

Risk of seizures, especially in those chronically dependent

What is the reversal agent of apixaban?

Andexanet Alfa

Which DOAC haas no refusal agent?

Edoxaban

Web should DOACs be stopped in low risk patients?

1 day prior to surgery

When should DOACs be stopped in high risk patients?

3-5 days before surgery

When can DOACs be restarted after surgery?

12-24 hours after surgery

When should unfractionated heparin be stopped before surgery?

6 hours

What causes hypotension, bradycardia, salivation and incontinence?

Acetylcholinesterase inhibitor/organophosphate excessive stimulation

What are the expected results of carboxyhaemoglobin in smokers?

Mildly elevated baseline up to 10%

What will the carboxyhaemoglobin be in a smoker wit carbon monoxide poisoning?

level of 14% is abnormally high and indicative of significant exposure avR

What is the most important initial management of carbon monoxide poisoning?

100% oxygen via non rebreather mask to help displace carbon monoxide -> this is followed by hyperbaric oxygen therapy

What causes widened QRS on ECG?

Tricyclic antidepressant overdose

How to manage medication overuse headaches?

simple analgesia + triptans: stop abruptly opioid analgesia: withdraw gradually

What is the reversal agent for adrenaline?

Phentolamine: This drug is a competitive α-adrenoreceptor antagonist which can be injected to reverse the effects of adrenaline on the vasculature.

How to manage staggered paracetamol overdose?

Immediate NAC three bags of NAC over a period of 21 hours

What to do for patient with intentional overdose?

A psychosocial assessment by a mental health professional must be completed before discharge

Overdose Flashcards

(89 cards)