toxidromes and drug ingestions
DESCRIPTION
Toxidromes and Drug Ingestions. Toxidromes. What is a Toxidrome? A constellation of clinical signs that may suggest a particular type of ingestion Toxidromes may indicate what type of drugs a patient has taken if they are unable or unwilling to tell you. Toxidromes. - PowerPoint PPT PresentationTRANSCRIPT
Toxidromes and
Drug Ingestions
Toxidromes What is a Toxidrome?
A constellation of clinical signs that may suggest a particular type of ingestion
Toxidromes may indicate what type of drugs a patient has taken if they are unable or unwilling to tell you
Toxidromes The most common toxidromes seen
are: Anticholingeric Cholinergic Sympathomimetic Sedative Hallucinogenic Serotonergic
Anticholinergic Toxidromes
Anticholinergic Toxidrome Due to drugs that block muscarinic
and nicotine acetylcholine receptor Antihistamines (1st generation) Tricyclic antidepressants Antitussives (cough mixtures) Antipsychotics Anticonvulsants Antimuscularinic drugs
Atropine Scopolamine Ipatroprium bromide
Plants Mushrooms Datura
Anticholinergic Toxidrome The anticholinergic toxidrome
consists of: Delirium + peripheral antimuscarinic effects
Mad as a hatter Confusion/hallucinations/seizure/coma
Red as a beet Flushed skin
Blind as a bat Mydriasis
Hot as a hare Hyperthermia
Dry as a bone Dry skin, urinary retention, ileus
Cholinergic Toxidromes
Cholinergic Toxidrome
Due to drugs that activate acetylcholine receptor ie the opposite of anticholinegric
toxidromes
Cholinergic Toxidrome Caused by:
Organophosphate insecticides Carbamate insecticides Chemical warfare agents eg Ricin, Tabun,
Soman, VX Alzheimer's medication eg donepezil Agents used for myasthenia gravis
Neostigmin Edrophonium Pilocarpine Phyostigmine
Cholinergic Toxidrome The cholinergic toxidrome =“DUMBELS”: D
Diaphoresis Diarrhoea (and abdo cramps)
U urination
M Miosis (or mydriasis)
B Bronchospasm Bronchorrhoea Bradycardia
E Emesis
L Lacrimation
S Salivation
Sympathomimetic Toxidromes
Sympathomimetic Toxidrome
Act via stimulation of sympathetic nervous system
Toxidrome – everything stimulated Hypertension Tachycardia Tachypnoea Hyperthermia Agitation Dilated pupils (usually) Diaphoresis/flushing
c.f: anticholinergic – dry
Sympathomimetic Toxidrome
In New Zealand the most commonly seen sympathomimetic ingestion is methamphetamine
Can also be seen with Alpha receptor agonists
Phenylephrine eg OTC cold preparations eg - coldrex Beta receptor agonist
Salbutamol Theophylline Caffeine
Alpha and beta agonists Amphetamine Cocaine Pseudo/ephedrine MDMA (ecstasy)
Sedative or Hypnotic
Toxidromes
Sedative or Hypnotic Toxidrome
Caused by any medication that causes CNS depression, such as: Benzodiazepines Barbiturates Alcohols Opioids Anticonvulsants Antipsychotics
Sedative or Hypnotic Toxidrome
Toxidrome Decreased Level of consciousness Hypoventilation Hypotension Bradycardia
Opioids + barbiturates also cause Miosis Hypothermia
Hallucinogenic Toxidromes
Hallucinogenic Toxidrome As it sounds, this is caused by drugs
and agents that cause hallucinations Amphetamine Cannaboids Cocaine LSD PCP Magic mushrooms (Psilocybin spp.)
Hallucinogenic Toxidrome Primarily presents with hallucination
Also can present with: Frank psychosis Panic attacks and anxiety Sympathomimetic symptoms esp.
tachycardia, hypertension and fever
Serotonergic Toxidromes
Serotonergic Toxidrome
A collection of signs and symptoms produced by excess serotonin in the central, peripheral and autonomic nervous systems
Serotonergic Toxidrome
Multiple medications can cause serotonergic toxidrome (or serotonin syndrome) Most commonly occurs when ≥ 2
medications which affect either serotonin reuptake or metabolism are given, but can also occur with a single agent
Serotonergic Toxidrome Associated with:
Selective serotonin reuptake inhibitors (SSRI -antidepressants) Eg paroxtetine, fluoxetine
Serotonin noradrenalin reuptake inhibitors (SNRI –antidressants)
Eg venlafaxine, citaloprma Tricyclic antidepressants Monoamine oxidase iunhibitors (Block serotonin break down –
used as antidepressants) Eg moclobmide
Analgesic Eg pethidine, tramadol, fentanyl
Antiemetics Eg metoclopramide, ondansteron
Anticonvulsants Eg valproaic acid
Dietary supplements Eg St johns wort, ginseng
Serotonergic Toxidrome Produces wide variety of signs and
symptoms due to CNS, peripheral and autonomic dysfunction Most commonly produces
Tremor Hyperreflexia and muscle rigidity esp in the
legs Clonus Fever Tachycardia and hypertension