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Poison Lecture
Toxidromes, etc
29
Pharmacology
Graduate
06/09/2011

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Term
Alpha Adrenergic Toxidrome
Definition
Hypertension with reflex bradycardia
CNS excitation
sweating, dilated pupils, decreased bowel sounds
Phenylephrine
Term
Anticholinergic toxidrome
Definition
mad as a hatter, dry as a bone, blind as a bat, red as a beet, hot as a hare
tachycardia, hypertension
antihistamines, TCA, atropine, scopolamine
If antidote needed, use benzos, and sometimes physostigmine
Term
beta adrenergic toxidrome
Definition
tachicardia
seizures
constricted pupils
hyperglycemia, hypokalema
tremor
albuterol, caffeine
Term
cholinergic toxidrome
Definition
SLUDGE
die from bronchorrhea, muscle fasciculations, and paralyssi
OPs, insecticides
Term
mixed adrenergic/sympathomimetic toxidrome
Definition
a lot like anticholinergic, but moist skin
amphetamine, cocaine
Term
nicotinic toxidrome
Definition
hpertension, tachycardia then bradycardia
moist skin
hyperactive bowel
muscle fasciculations, then paralysis
Term
Opioid toxidrome
Definition
hypothermia, hypopnea, apnea
lethargy, coma
pinpoint pupils
decreased bowel sounds
codeine, morphine, etc
Term
sedative-hypnotic toxirome
Definition
poikilothermy, hypopnea, hypotension
coma
dilated pupils
barbiturates, ethanol, benzos
Term
serotonin toxidrome
Definition
hyperthermia, tachycardia, diarrhea
hypertonia, clonus
confusion, agitation
Usually a drug-drug interaction
SSRI, TCA, MAOI, etc
Rx: stop culprits. If must, use benzos
Term
sympatholytic toxidrome
Definition
hypothermia, hypotension, apnea
lethargy, coma
constricted pupils
clonidine, oxymetazoline, etc
Term
Causes of anion gap metabolic acidosis
Definition
MUDPILES
Methanol
Uremia
DKA
Inhaled, iron, INH
Lactic acidosis
Ethylene glycol
Salicylates, stimulants/sympathomimetics
Term
Antidote for acetaminophen
Definition
n-acetylcystein
Term
n-acetylcystein
Definition
antidote for acetaminophen
Term
antidote for benzos
Definition
flumazenil
Term
flumazenil
Definition
antidote for benzos
be careful, this can cause seizures!
Term
diphenhydramine
Definition
antihistamine
anticholinergic toxidrome
antidote- sodium bicarbonate
Term
glyburide/sulfonylureas
Definition
cause hypoglycemia
great with glucose, octreotide, D5, D10
Term
octreotide
Definition
blocks insulin release
treats hypoglycemia
Term
opiate antidote
Definition
naloxone
Term
antidote of carbon monoxide
Definition
oxygen
Term
cyanide
Definition
blocks cytochome c oxidase
antidotes:
- hydroxocobal- makes B12
- sodium nitrite- makes MetHb, dangerous
- sodium thiosulfate- ehnhances endogenous rhodanese
Term
hydroxocobalamin
Definition
- antidote for cyanide
- makes B12
- safe but expensive
Term
sodium nitrite
Definition
- antidote for cyanide
- Hb->MetHb
- causes vasodilation, so dangerous
Term
sodium thiosulfate
Definition
- antidote for cyanide
- enhances endogenous rhodanese
- inexpensive and safe
Term
Antidote for toxic alcohols
Definition
fonepizole
ethanol
Term
Effects of ethylene glycol
Definition
renal failure, seizure, stroke, death
Term
effects of methanol
Definition
blindness, acidosis, seizure, death
Term
fonepizole
Definition
antidote for toxic alcohols
Term
antidotes for organophosphates
Definition
atropine, pralidoxime
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