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Terms in this set (21)
What are the cardinal symptoms of anticholinergic toxicity
What is the primary cause of death in AcH poisoning
What is unique about chronic anticholinergic toxicity
No real peripheral effects and Generally central symptoms
Which patients are most at risk of developing chronic anticholinergic toxicity
Elderly on anticholinergic agent for parkinsons or Psych patient treated with neuroleptics with new Rx for anticholinergic agent
Which drugs exhibit primary anticholinergic toxicity
Which drugs have ACh effects in large doses
Which symptoms make ACh poisoning less likely
Severe agitation (PCP, cocaine)
Describe potential ECG changes from ACh toxicity
Peaked T (rhabdo - hyperK)"
Which other common tox agents must be screened for in ACh poisoning?
ASA -- Tylenol
What agents should be used in ACh toxicity for agitation?
Which agents should be avoided in ACh agitations
Haldol -- Decreased seizure threshold and Has endogenous ACh effects
What are the cornerstones of supportive care in ACh tox?
Close temperature measurement with Fluid rehydration and Cooling as needed. Rule out other possible causes (infection).
What are first and second line seizure treatments in ACh poisoning
Benzodiazepines then Barbiturates
What is physostigmine
An acetylcholinesterase inhibitor
What pharmacological property of physostigmine makes it the agent of choice for treatment of ACh toxicity
Crosses the blood-brain barrier
What is a clear contraindication for administration of physostigmine
Any suspicion of TCA toxicity AND QRS > 100msec
What are the indications for administration of physostigmine
Coma, seizure, depressed GCS, agitation and hyperthermia due to ACh
What dose of physostigmine should be used in ACh tox?
1-2mg IV for adults and 0.02 mg/kg (max 0.5) kids AND repeat q10-15min. Atropine at the bedside to reverse cholinergic toxicity.
What is the duration of effect of physostigmine
~ 1 hour
What are relative contraindications to physostigmine use
reversible airway disease, PVD, bladder/intestinal obstruction, conduction delays or AV blocks
How long should patients who have ingested D stramonium be observed
8 hours due to delayed gastric emptying
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ASA / NSAIDS
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