Presentation is loading. Please wait.

Presentation is loading. Please wait.

Toxidromes and Drug Ingestions. Toxidromes What is a Toxidrome? What is a Toxidrome? A constellation of clinical signs that may suggest a particular type.

Similar presentations


Presentation on theme: "Toxidromes and Drug Ingestions. Toxidromes What is a Toxidrome? What is a Toxidrome? A constellation of clinical signs that may suggest a particular type."— Presentation transcript:

1 Toxidromes and Drug Ingestions

2 Toxidromes What is a Toxidrome? What is a Toxidrome? A constellation of clinical signs that may suggest a particular type of ingestion 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 may indicate what type of drugs a patient has taken if they are unable or unwilling to tell you

3 Toxidromes The most common toxidromes seen are: The most common toxidromes seen are: Anticholingeric Anticholingeric Cholinergic Cholinergic Sympathomimetic Sympathomimetic Sedative Sedative Hallucinogenic Hallucinogenic Serotonergic Serotonergic

4 Anticholinergic Toxidromes

5 Anticholinergic Toxidrome Due to drugs that block muscarinic and nicotine acetylcholine receptor Due to drugs that block muscarinic and nicotine acetylcholine receptor Antihistamines (1 st generation) Antihistamines (1 st generation) Tricyclic antidepressants Tricyclic antidepressants Antitussives (cough mixtures) Antitussives (cough mixtures) Antipsychotics Antipsychotics Anticonvulsants Anticonvulsants Antimuscularinic drugs Antimuscularinic drugs Atropine Atropine Scopolamine Scopolamine Ipatroprium bromide Ipatroprium bromide Plants Plants Mushrooms Mushrooms Datura Datura

6 Anticholinergic Toxidrome The anticholinergic toxidrome consists of: The anticholinergic toxidrome consists of: Delirium + peripheral antimuscarinic effects Delirium + peripheral antimuscarinic effects Mad as a hatter Mad as a hatter Confusion/hallucinations/seizure/coma Confusion/hallucinations/seizure/coma Red as a beet Red as a beet Flushed skin Flushed skin Blind as a bat Blind as a bat Mydriasis Mydriasis Hot as a hare Hot as a hare Hyperthermia Hyperthermia Dry as a bone Dry as a bone Dry skin, urinary retention, ileus Dry skin, urinary retention, ileus

7 Cholinergic Toxidromes

8 Cholinergic Toxidrome Due to drugs that activate acetylcholine receptor Due to drugs that activate acetylcholine receptor ie the opposite of anticholinegric toxidromes ie the opposite of anticholinegric toxidromes

9 Cholinergic Toxidrome Caused by: Caused by: Organophosphate insecticides Organophosphate insecticides Carbamate insecticides Carbamate insecticides Chemical warfare agents eg Ricin, Tabun, Soman, VX Chemical warfare agents eg Ricin, Tabun, Soman, VX Alzheimer's medication eg donepezil Alzheimer's medication eg donepezil Agents used for myasthenia gravis Agents used for myasthenia gravis Neostigmin Neostigmin Edrophonium Edrophonium Pilocarpine Pilocarpine Phyostigmine Phyostigmine

10 Cholinergic Toxidrome The cholinergic toxidrome =“DUMBELS”: The cholinergic toxidrome =“DUMBELS”: D Diaphoresis Diaphoresis Diarrhoea (and abdo cramps) Diarrhoea (and abdo cramps) U urination urination M Miosis (or mydriasis) Miosis (or mydriasis) B Bronchospasm Bronchospasm Bronchorrhoea Bronchorrhoea Bradycardia Bradycardia E Emesis Emesis L Lacrimation Lacrimation S Salivation Salivation

11 Sympathomimetic Toxidromes

12 Sympathomimetic Toxidrome Act via stimulation of sympathetic nervous system Act via stimulation of sympathetic nervous system Toxidrome – everything stimulated Toxidrome – everything stimulated Hypertension Hypertension Tachycardia Tachycardia Tachypnoea Tachypnoea Hyperthermia Hyperthermia Agitation Agitation Dilated pupils (usually) Dilated pupils (usually) Diaphoresis/flushing Diaphoresis/flushing c.f: anticholinergic – dry c.f: anticholinergic – dry

13 Sympathomimetic Toxidrome In New Zealand the most commonly seen sympathomimetic ingestion is methamphetamine In New Zealand the most commonly seen sympathomimetic ingestion is methamphetamine Can also be seen with Can also be seen with Alpha receptor agonists Alpha receptor agonists Phenylephrine eg OTC cold preparations eg - coldrex Phenylephrine eg OTC cold preparations eg - coldrex Beta receptor agonist Beta receptor agonist Salbutamol Salbutamol Theophylline Theophylline Caffeine Caffeine Alpha and beta agonists Alpha and beta agonists Amphetamine Amphetamine Cocaine Cocaine Pseudo/ephedrine Pseudo/ephedrine MDMA (ecstasy) MDMA (ecstasy)

14 Sedative or Hypnotic Toxidromes

15 Sedative or Hypnotic Toxidrome Caused by any medication that causes CNS depression, such as: Caused by any medication that causes CNS depression, such as: Benzodiazepines Benzodiazepines Barbiturates Barbiturates Alcohols Alcohols Opioids Opioids Anticonvulsants Anticonvulsants Antipsychotics Antipsychotics

16 Sedative or Hypnotic Toxidrome Toxidrome Toxidrome Decreased Level of consciousness Decreased Level of consciousness Hypoventilation Hypoventilation Hypotension Hypotension Bradycardia Bradycardia Opioids + barbiturates also cause Opioids + barbiturates also cause Miosis Miosis Hypothermia Hypothermia

17 Hallucinogenic Toxidromes

18 Hallucinogenic Toxidrome As it sounds, this is caused by drugs and agents that cause hallucinations As it sounds, this is caused by drugs and agents that cause hallucinations Amphetamine Amphetamine Cannaboids Cannaboids Cocaine Cocaine LSD LSD PCP PCP Magic mushrooms (Psilocybin spp.) Magic mushrooms (Psilocybin spp.)

19 Hallucinogenic Toxidrome Primarily presents with hallucination Primarily presents with hallucination Also can present with: Also can present with: Frank psychosis Frank psychosis Panic attacks and anxiety Panic attacks and anxiety Sympathomimetic symptoms esp. tachycardia, hypertension and fever Sympathomimetic symptoms esp. tachycardia, hypertension and fever

20 Serotonergic Toxidromes

21 Serotonergic Toxidrome A collection of signs and symptoms produced by excess serotonin in the central, peripheral and autonomic nervous systems A collection of signs and symptoms produced by excess serotonin in the central, peripheral and autonomic nervous systems

22 Serotonergic Toxidrome Multiple medications can cause serotonergic toxidrome (or serotonin syndrome) 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 Most commonly occurs when ≥ 2 medications which affect either serotonin reuptake or metabolism are given, but can also occur with a single agent

23 Serotonergic Toxidrome Associated with: Associated with: Selective serotonin reuptake inhibitors (SSRI -antidepressants) Selective serotonin reuptake inhibitors (SSRI -antidepressants) Eg paroxtetine, fluoxetine Eg paroxtetine, fluoxetine Serotonin noradrenalin reuptake inhibitors (SNRI –antidressants) Serotonin noradrenalin reuptake inhibitors (SNRI –antidressants) Eg venlafaxine, citaloprma Eg venlafaxine, citaloprma Tricyclic antidepressants Tricyclic antidepressants Monoamine oxidase iunhibitors (Block serotonin break down –used as antidepressants) Monoamine oxidase iunhibitors (Block serotonin break down –used as antidepressants) Eg moclobmide Eg moclobmide Analgesic Analgesic Eg pethidine, tramadol, fentanyl Eg pethidine, tramadol, fentanyl Antiemetics Antiemetics Eg metoclopramide, ondansteron Eg metoclopramide, ondansteron Anticonvulsants Anticonvulsants Eg valproaic acid Eg valproaic acid Dietary supplements Dietary supplements Eg St johns wort, ginseng Eg St johns wort, ginseng

24 Serotonergic Toxidrome Produces wide variety of signs and symptoms due to CNS, peripheral and autonomic dysfunction Produces wide variety of signs and symptoms due to CNS, peripheral and autonomic dysfunction Most commonly produces Most commonly produces Tremor Tremor Hyperreflexia and muscle rigidity esp in the legs Hyperreflexia and muscle rigidity esp in the legs Clonus Clonus Fever Fever Tachycardia and hypertension Tachycardia and hypertension


Download ppt "Toxidromes and Drug Ingestions. Toxidromes What is a Toxidrome? What is a Toxidrome? A constellation of clinical signs that may suggest a particular type."

Similar presentations


Ads by Google