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PCM
2.
3.
Acetylsalicylic
acid (Aspirin)
Methyl
salicylate (Oil
of
Wintergreen)
Inhibition of cyclooxygenase
results in decreased synthesis of
Prostaglandins, Prostacyclin, and
Thromboxanes
Stimulation of the CTZ in the
medulla causes nausea and
vomiting
CNS Direct toxicity
Activation of the respiratory
center of the medulla results in
tachypnea, hyperventilation,
respiratory alkalosis
Uncoupled oxidative
phosphorylation in the
mitochondria generates heat and
may increase body temperature
Interference with cellular
metabolism leads to metabolic
acidosis
MILD - MODERATE
Fever
Tinnitus
Vertigo
Nausea & Vomiting
Diarhoea
Dehydration
Hyperventilation
SEVERE
Morphine
50 mg of Morphine IM produces
toxicity in Non-tolerant adult
Fatal Dose 250 mg
Haemorrhages
Hallucinations
Hyper/Hypoglycaemia
Pulmonary edema
Convulsions
Coma
Death
Cyanosis
Pin point pupil
Shallow breathing
Stupor
Flaccidity
Hypotension
Convulsions
GI DECONTAMINATION
1. Induce Emesis /Gastric Lavage
2. Activated Charcoal
SPECIFIC ANTIDOTE
N-Acetyl Cysteine (NAC) 150
mg/kg IV Infusion over 15 Minutes
followed by the same dose IV over
next 20 hours
Respiratory Support
IV fluids & Vasopressors
Gastric Lavage with Potassium
permanganate
Specific Antidote Naloxone 0.4
2 mg IV repeat every 2 minutes
until breathing is adequate
Iron
TCA
BDZ
Inhibition of Presynaptic
neurotransmitter reuptakeNoradrenaline & Seratonin
Cardiac fast sodium channels
Central and peripheral
muscarinic acetylcholine
receptors
Peripheral alpha-1 adrenergic
receptors
Histamine (H1) receptors
CNS GABA-A receptors
Coma
Death due to Respiratory
paralysis
Supportive
ABC
ECG monitoring
GI Decontamination
If patients are alert and cooperative and have ingested > 5
mg/kg, charcoal may be
administered orally
If the patient is unconscious and
requires intubation to protect
the airway insert an orogastric
tube, aspirate stomach contents
then give activated charcoal
Seizures
Diazepam 5-20 mg IV
Phenobarbitone 15-18 mg/kg IV
Phenytoin should be avoided (
sodium-channel blocking)
Anticholinergic delirium
Mild delirium can often be
managed with reassurance plus
or minus benzodiazepines
Neuroleptics should be avoided
(most of which have significant
anticholinergic activity)
Weakness
MODERATE TO SEVERE :Vertigo ,
slurred speech, nystagmus,
partial ptosis, lethargy ,
hypotension, respiratory
depression, coma (stage 1 & 2 ).
SYMPTOMATIC / SPECIFIC
TREATMENT:
Airway , breathing & circulation.
IV fluid administration.
Endotracheal intubation.
Assisted ventilation.
DECONTAMINATION:
Stomach wash within 6-12 hrs.
Activated charcoal.
Emesis is contraindicated.
Organophosp
horus
SPECIFIC ANTIDOTE
Flumazenil reversing the coma
induced by benzodiazepines.
Mode of action competitive
antagonism.
Complete reversal of
benzodiazepine effect with a
total slow iv dose of 1mg.
Administered in a series of
smaller doses beginning with 0.2
mg & progressively increasing
by 0.1- 0.2 mg every minute until
a cumulative total dose of 3.5
mg is reached.
Termination of exposure by
removal of contaminated
clothes, washing of skin
Gastric lavage.
Maintenance of patent airway
Artificial respiration
Intravenous fluids
Specific Antidotes
(a) Inj.atropine 2mg iv (every 10 min
till signs of atropinization appears)
(b) Inj.pralidoxime 1-2g iv (children
20-40 mg/kg)
MENTAL
HEALTH
SSRI
FLUOXETINE
Sertraline
Citalopram
Mirtazapine
MOA
INDICATION
TCA
AMITRIPTYLINE
SNRI VENLAFAXINE
st
1 generation HALOPERIDOL
nd
2 generation
OLANZAPINE
Risperidone
Quetiapine
Aripiprazole
Clozapine
Depression
4.
5.
6.
Schizophrenia
Severe N&V
Agitated and disruptive behaviour
ADVERSE EFFECTS
Nausea, sleep disturbance, sexual dysfunction,
drowsiness, drug interaction
Mirtazapine weight gain + sedation
Blurred vision, dry mouth, urinary retention,
sinus tachycardia, constipation, and aggravation
of narrow-angle glaucoma.
Nausea, headache, sexual dysfunction,
constipation, sedation, insomnia, dizzy
Movement disorder. High potential of EPS
Did not ameliorate negative symptoms
EPS dystonias, akathisias (x leh duduk diam,
nak jalan je), bradykinesia, rigidity, tremor,
tardive dyskinesia