Você está na página 1de 5

1.

PCM

2.

3.

Acetylsalicylic
acid (Aspirin)
Methyl
salicylate (Oil
of
Wintergreen)

Pathways of conjugation are


saturated and co-factors are
depleted and as such more
paracetamol is metabolised via
CYP450
Glutathione (GSH) becomes
depleted so cannot detoxify
NAPQI
Toxic effects

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

150 mg/kg or 12gm Fatal


75 mg/kg if malnourished

Mild Toxicity - 150 mg/kg


Moderate Toxicity 250 mg/kg
Severe Toxicity - > 500 mg/kg
Fatal - > 700 mg/kg

Phase 1 0-24 hours


Nausea, vomiting, nothing
Phase 2 24-72 hours
RUQ pain, elevated liver
enzymes, prolonged PT
Phase 3 72-96 hours
Hepatic necrosis,
encephalopathy, coagulopathy,
ATN
Phase 4 4 days- 2 weeks
If damage is not irreversible,
complete resolution of hepatic
dysfunction will occur

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

Symptomatic & Supportive


IV fluids
1.26% Sodium Bicarbonate
Alkalinization of Urine (If Plasma
Salicylate level - > 500mg/L)
Hemodialysis(If Plasma Salicylate
level - > 700mg/L)

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

Most common in infants and


children

MILD: Drowsiness , Ataxia ,

Induce Emesis / Gastric lavage


Specific Therapy
Iron chelating agent Desferrioxamine
15 mg/kg/hr IV Infusion
Max 80 mg/kg/day

60mg/kg iron causes serious toxicity


Haemorrhage
Hepatic necrosis
Brain damage

Three major toxic syndromes of TCA


Poisoning
1. Anticholinergic effects
2. Cardiac toxicity
3. CNS toxicity (sedation and
seizures)
Death in TCA overdose is usually due
to CNS and Cardiotoxic effects.
Anticholinergic Syndrome
Hot as hell
Blind as a bat
Dry as a bone
Mad as a hatter

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

COMA 1 (Stage 1): Responsive to

SUPPORTIVE PROCEDURES &

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 ).

painful stimuli but not to verbal or


tactile stimuli, no disturbance in
respiration or BP.
COMA 2 (Stage 2):Unconscious, not
responsive to painful stimuli, no
disturbance in respiration or BP.

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

Generally manifests in minutes to


hours
Evidence of cholinergic excess
SLUDGE =
Salivation,
Lacrimation,
Urination,
Defecation,
Gastric Emptying.
BBB
=
Bradycardia,
Bronchorrhea,
Bronchospasm.

Respiratory insufficiency can


result from muscle weakness,
decreased central drive,
increased secretions, and
bronchospasm and it is the
leading cause of death.
Cardiac arrhythmias, including
heart block and QTc prolongatio

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

Inhibit serotonin reuptake. Increased


concentrations of the neurotransmitter in the
synaptic cleft and ultimately, to greater
postsynaptic neuronal activity.

Depression, OCD, PTSD, Panic disorder,


generalised anxiety disorder, premenstrual
dystrophic disorder, bulimia nervosa (fluoxetine)

TCA
AMITRIPTYLINE

Inhibits neurotransmitter reuptake.


Blocking of receptors

Moderate to severe depression. Panic disorder.


Migraine, chronic pain syndrome.

SNRI VENLAFAXINE
st
1 generation HALOPERIDOL
nd
2 generation
OLANZAPINE
Risperidone
Quetiapine
Aripiprazole
Clozapine

Inhibits NA reuptake and mild inhibitor of


dopamine reuptake at high doses.

Depression

Competitive inhibitor of D2 dopamine receptors.


Dopamine receptor-blocking activity in the brain
and periphery.
Serotonin receptor-blocking activity in the brain,
particularly 5-HT2A receptors

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

Você também pode gostar