1. Slow and shallow respirations

2. Miosis

3. Needle Tracks

Naloxone

(Takes more to displace propoxyphene)

Competitive inhibitor

1. Tachycardia

2. Mydriasis

3. Diarrhea

4. Cramps

5. Piloerection

6. Yawning

7. Itching

Has both mydriasis and diarrhea, symptoms which rule out cholinergic toxidrome

Sludge

Salivation

Lacrimation

Urination

Defecation

Gastric Cramping

Emesis

DUMBELS

Diarrhea

Urination

Moist Mucosa

Bronchorrhea

Emesis

Lacrimation

Salivation

1. Organophosphate insecticides

2. Nerve Gas

1. Atropine (blocks Mus. receptors)

-Dries Secretions

2. Pralidoxime

-Removes the phosphate added by the Organophosphate/Nerve agent to the AChE and restores its activity

3. Diazepam: Seizure control

1. Fever

2. Tachycardia

3. Flush, dry, warm skin

4. Dry mouth

5. Decreased visual acuity

6. Agitated delirium

7. Constipation

8. Urinary Retention

1. Atropine

2. Antihistamines

3. Tranquilizers

4. TCAs

5. Plants: Deadly nightshade, Jimson weed, Angel's trumpet

1. Hypertension

2. Tachycardia

3. Hyperthermia

4. Agitated Delirium

5. Dilated Pupil

Cocaine

Meth

Diet Pills

1. Benzodiazepines

*Avoid BB: might get unopposed alpha effects--> HTN

1. Confusion or coma

2. Respiratory Depression

3. Hypotension

4. Decreased Temperature

5. Variable pupillary changes

6. Bullae

1. Altered mental status

2. Tachycardia

3. Elevated Tempeature

4. Tinnitus

5. Respiratory alkalosis first, followed by metabolic acidosis (mixed acid base disorder)

1. Alkalinize urine (NAHCO3 IV, K+)

2. Dialysis if ASA is near 100 mg/dL for acute OD (or above 40-50 for older person with chronic OD)

1. Psych history

2. Hypotension

3. Tachycardia

4. Altered mental state

5. Wide QRS/QTc prolongation (over 100 is bad)

1. Anticholinergic

2. Serotonin and NE reuptake inhibition

3. Alpha-Antagonist: Hypotension

4. Quinidine like Na channel blocke: Wide QRS

5. iKR blockade: QTC prolongation - torsades de points

6. GABA antagonist:Seizures

7. Histamine Blockade: Sedation

1. Amitriptyline (prototypical)

2 newer non-CA drugs

Citolopram (Celexa)

Venlafaxine (Effexor)

1. Hyperventilate and/or + NAHCO3 to achieve serum pH >7.5

2. Barbituate, Benzodiazepine, Propofol: Terminate Seizures

-Avoid phenytoin

3. Secure airway

1. Alkaline pH increases protein binding and decreases free drug

2. Hypertonic sodium overcomes sodium channel blockade

+Avoid phentoin and lidocaine (both sodium channel blockers)

1. Cognitive: Anxiety to catatonia

2. Autonomic: Tachycardia, high or low BP, nausea, abdominal cramps

3. Neuromuscular: Myoclonus (tremor), hyperreflexia, increased tone

4. Exposure to drug affecting serotonin

1. MAO inhibitors

2. SSRIs

3. Serotonin, NE Reuptake Inhibitors

4. Sympathomimetics

5. Others: Miperidine, Dextromethorphan (cough syrup), Li+

1. Treated for positive PPD

2. Seizures with poor response to diazepam

Pyridoxine (Vitamin B6)

1. Lab tests show a wide anion gap metabolic acidosis

2. Metabolized first by alcohol dehydrogenase then by aldehyde dehydrogenase

Antifreeze

MOA: EG--> Glycoaldehyde --> glycolic acid --> glycoxalic acid --> oxalic acid --> renal failure

1. Blockade of EG metabolism

2. Detox Metabolite

3. Dialysis

1. Fomepizole: ADH inhibitor

2. Ethanol: Higher binding affinity for ADH

1. Thiamine + Magnesium

2. Pyridoxine

Both convert glyoxalate to a non-toxic metabolite

1. If [EG] > 20: Give antidote

2. If [EG] > 50: Give antidote +/- dialysis

1. Formic acid --> Blindness

2. Headache

3. Nausea

4. Vomiting

5. Abdominal Pain

1. Fomepizole and Ethanol

2. Folic acid or folinic acid: Decrease toxic metabolite

3. Dialysis:

>20 = antidote

>50 = antidote + dialysis

1. No need for antidote

2. Usually supportive care, IV fluids

calcium, glucagon

(insulin in severe cases)

Crotalidae Fab Fragments

Wyeth anti-venom

2[Na] + [BUN]/2.8 + Gluc/18 + EtOH/4.6