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Pharm Toxidromes

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darodri6's version from 2016-05-19 15:24

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OBTUNDATION, MIOSIS, nystagmus, RESPIRATORY DEPRESSION, diminished bowel sounds, bradycardia, hypotension, hypothermia.Opiate Toxicity [Morphine, Codeine, Tramdol, hydromorphone, Oxy, etc]
AGITATION, increased PAIN, MYDRIASIS, DIARRHEA, tachycardia, YAWNING, and “Cold turkey”: pilorection, diaphoresis, pallor.Opiate W/D
OBTUNDATION, MYDRIASIS, nystagmus, RESPIRATORY DEPRESSION, diminished bowel sounds, bradycardia, hypotension, hypothermia.Meperidine (Opiate) OD
Naloxone "dont get aggressive, reLAX with NaLAXone"Opiate OD Antidote
Opiate drug that can cause Serotonin Syndrome as wellTramadol
Cyproheptadine is the antidote for.....Serotonin Syndrome
OD can be fatal from respiratory depression. W/D is generally safe.Opiates [Morphine, Codeine, Tramdol, hydromorphone, Oxy, etc]
Presentation: Nystagmus, diplopia, respiratory depression, hypothermia, hypotension, SEDATION, CONFUSION, DELIRIUM, HALLUCINATIONS, COMAO/D of GABAnergics (GHB, Benzos "Zepams/Zolams", Barbiturates
Antidote for Benzo (GABAergic) that can cause seizures in dependent patientsFlumazenil
Withdrawal: Anxiety, agitation, muscle spasms, if severe, SEIZURES MAY OCCURGABAnergics [GHB, Benzos “Zepams/Zolams”, Barbiturates]
withdrawal can be fatal (Status epilepticus). Overdose is generally safe.Benzodiazepines (treat w/Benzos)
Presentation: Similar to GABAnergic toxicity (b/c it is a subtype of GABAnerigcs). CHRONIC USE DEPLETES THIAMIN-B1Ethanol
Withdrawal: Withdrawal can be fatal! Most commonly managed with Benzodiazepines.
Stage1 [6-12hr]: Tremors/Shaky. Stage2 [24hr]: Hallucinations. Stage3 [24hr]: Seizures. Stage4 [72hr]: Delirium tremens.
-Treat with Lorazepam/Oxazepam (Benzos). Replace Thiamine, glucose, and Mg.
Ethanol
Presentation: Usually cause CNS depression with other metabolic manifestations (anion gap acidosis). Competes for ADH (alcohol dehydrogenase)
-Leads to calcium chelation, hypocalcemia, and crystalluria leading to renal failure.
Ethylene Glycol (antifreeze)
Presentation: Usually cause CNS depression with other metabolic manifestations (anion gap acidosis). Competes for ADH (alcohol dehydrogenase)
-Metabolized to formate, a mitochondrial toxin to the eyes --> “Snowfield” blindness and scotoma.
Methanol
Antidote for either Ethylene Glycol or Methanol poisoningFomepizole (or even plain EtOH) (both have a higher affinity/lower Km for alcohol dehydrogenase)
Presentation: Defecation, Urination, Miosis (blurry vision), Bronchospasm, Emesis, Lacrimation,Salivation, Sweating, (DUMBBELSS) + HYPOtensionDirect Muscarinics (cross CNS: musCARine, piloCARpine) (dont cross CNS: BethaneCHOL, methaCHOLine)
Presentation: Defecation, Urination, Miosis (blurry vision), MUSCLE FASCICULATIONS, Bronchospasm, Bradycardia, Emesis, Lacrimation, Salivation, Sweating, SEIZURES (dumMbbelssS) + HYPERtension + Respiratory ParalysisACh-ase Inhibitors/Nicotinic Agonists [edroPHONium, NEOstigmine, PYRIDOstigmine, Physostigmine, Donepezil, and Organophosphates]
Antidote for AChE-I Toxidrome (dumMbbelssS + hypertension + respiratory paralysis) OR Muscarinic Toxidrome (dumbbelss + hypotension)Atropine (muscarinic blocker)
Antidote for AChE-I Toxidrome (dumMbbelssS + hypertension + respiratory paralysis) if subjected to an organophosphatePralidoxime
Presentation: Hyperthermia, tachycardia, HYPERtension DIAPHORESIS, cold skin (a1), MYDRIASIS, tremor, anxiety, restlessness, rhabdo.Sympathomimetics [Amphetamines, Meth, Khat, Bath Salts, MDMA, Ecstasy]
Presentation: Hyperthermia, diarrhea, hyperreflexia, hypertonicity, tremor, myocolonus, ocular clonus, agitation, hypomania, ANS instabilitySerotonin Syndrome from Serotoninergics [FLUXETINE, TCA, SNRI, Fentanyll, Meperidine, TRAMADOL, Tapentadol, DEXTROMETHORPHAN, etc]
Antidote for Serotonin Syndrome caused by MAO-I, SNRIs, TCAs, Opiates, etcCyproheptadine
Presentation: Fever, tachycardia, mydriasis, blurred vision, flushing, dry skin, agiation, hallucination, psychosis, dry mouth, dry eyes, urinary retention, constipation, and absent bowel sounds. “Hot as a hare, dry as a bone, red as a beet, mad as a hatter”. (Anti-DUMBBELSS)Anti-Muscarinics [ATROPine, TROPs/SCOPEs, TCA’s, Belladonna, Jimsonweed, Moonflower]
Antidote for Anti-Muscarinic Toxidrome (anti-DUMBBELSS)Physostigmine (but risk of cholinergic excess; give if also CNS signs = delirium/hallucination ('Mad as a Hatter')) or Pyridostigmine (for no CNS signs)
Presentation: Exhibits zero order kinetics. The origin of toxic symptoms is mitochondrial in origin --> uncoupling of the ETC.
-Respiratory rate increases as body strives to make ATP --> Respiratory Alkalosis.
-Body shifts to anaerobic metabolism --> Metabolic acidosis.
-Substrates are still fed to the TCA cycle, electrons can’t be coupled to form ATP --> Body dissipates as heat -->Hyperthermia.
-Other Symptoms: Tinnitus and widened anion gap acidosis.
Salicylic Acid Toxidrome (ASA = Aspirin)
What classes of drugs cause hypokalemia?MAINLY FUROSEMIDE, then thiazides, insulin/secretogauges.
Presentation: Risk of re-entry, slowed AV conduction, increased intracellular Ca (+ inotropism), N/V, color perception disturbance (yellow), HYPERkalemia.Digoxin
Antidote/Treatment: -Use SODIUM NITRITE to INDUCE METHEMOGLOBINEMIA (Pulls the toxic substance out of mitochondria into blood due to affinity for ferric iron) -Then use THIOSULFATE to form Thiocyanate (Cleared in urine), HYDROXYCOBALAMIN will form CYANOCOBALAMIN (Vitamin B12)!Cyanide Toxicity
Presentation: Headache, nausea, dyspnea, feeling of impending doom, metabolic acidosis, red skin, hypotension, syncope, coma. Almond odor.Cyanide Poisoning
Hx: inhalation anesthetics (except NO2) or succinylcholine
Presentation: HTN, tachycardia, tachypnea, hyperthermia (up to 115 degrees F), diaphoresis, agitation, rigidity, hyporeflexia, decreased bowel sounds
Malignant Hyperthermia
Antidote for Malignant HyperthermiaDantrolene
Hx: D2 antagonists
Presentation: HTN, tachycardia, tachypnea, hyperthermia (> 105 degrees F), sialorrhea, diaphoresis, pallor, stupor, mutism, lead pipe rigidity, bradyreflexia
Neuroleptic malignant syndrome
Antidote for Neuroleptic Malignant SyndromeBZD or Dopaminergics
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