Podcast
Questions and Answers
Which of the following symptoms is NOT associated with Neuroleptic Malignant Syndrome?
Which of the following symptoms is NOT associated with Neuroleptic Malignant Syndrome?
Serotonin Syndrome can only occur due to an increase in the dosage of a single serotonergic medication.
Serotonin Syndrome can only occur due to an increase in the dosage of a single serotonergic medication.
False
What is one of the main mechanisms of action responsible for Neuroleptic Malignant Syndrome?
What is one of the main mechanisms of action responsible for Neuroleptic Malignant Syndrome?
Dopaminergic blockade
In cases of tricyclic antidepressant overdose, sodium bicarbonate is used for its ability to _____ the blood.
In cases of tricyclic antidepressant overdose, sodium bicarbonate is used for its ability to _____ the blood.
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Match the condition to its primary treatment:
Match the condition to its primary treatment:
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What is a key sign of Serotonin Syndrome?
What is a key sign of Serotonin Syndrome?
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Carbon monoxide poisoning primarily leads to muscular rigidity and tachycardia.
Carbon monoxide poisoning primarily leads to muscular rigidity and tachycardia.
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What type of medications can precipitate Neuroleptic Malignant Syndrome?
What type of medications can precipitate Neuroleptic Malignant Syndrome?
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What effect does plasma alkalinisation have on plasma protein binding?
What effect does plasma alkalinisation have on plasma protein binding?
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Acidosis can be corrected by the administration of additional HCO3-.
Acidosis can be corrected by the administration of additional HCO3-.
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What is the primary mechanism of toxicity of propranolol?
What is the primary mechanism of toxicity of propranolol?
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Organophosphate (OP) pesticides can be absorbed through the ______ and skin.
Organophosphate (OP) pesticides can be absorbed through the ______ and skin.
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Which of the following is NOT a symptom of propranolol overdose?
Which of the following is NOT a symptom of propranolol overdose?
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Match the following organophosphate pesticides with their characteristics:
Match the following organophosphate pesticides with their characteristics:
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Intracellular alkalosis increases TCA-receptor binding.
Intracellular alkalosis increases TCA-receptor binding.
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What is a mainstay of treatment for propranolol overdose?
What is a mainstay of treatment for propranolol overdose?
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What is one of the common symptoms of sodium nitrite poisoning?
What is one of the common symptoms of sodium nitrite poisoning?
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MDMA is known for its depressant effects.
MDMA is known for its depressant effects.
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What is the primary treatment for clonidine toxicity?
What is the primary treatment for clonidine toxicity?
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Methylene blue is used to convert methaemoglobin back into normal ________.
Methylene blue is used to convert methaemoglobin back into normal ________.
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Match the types of toxicity with their characteristics:
Match the types of toxicity with their characteristics:
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At what dosage does clonidine toxicity occur?
At what dosage does clonidine toxicity occur?
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Symptoms such as somnolence and bradycardia are associated with MDMA toxicity.
Symptoms such as somnolence and bradycardia are associated with MDMA toxicity.
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Name two substances that drugs sold as MDMA may contain instead of MDMA.
Name two substances that drugs sold as MDMA may contain instead of MDMA.
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What is the primary mechanism of action of organophosphate poisoning?
What is the primary mechanism of action of organophosphate poisoning?
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Overstimulation of nicotinic receptors can lead to flaccid paralysis.
Overstimulation of nicotinic receptors can lead to flaccid paralysis.
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List two symptoms of organophosphate poisoning based on its action at muscarinic receptors.
List two symptoms of organophosphate poisoning based on its action at muscarinic receptors.
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In organophosphate poisoning, respiratory failure is commonly caused by paralysis of the __________ muscles.
In organophosphate poisoning, respiratory failure is commonly caused by paralysis of the __________ muscles.
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Which treatment is considered a muscarinic receptor antagonist in organophosphate poisoning?
Which treatment is considered a muscarinic receptor antagonist in organophosphate poisoning?
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Match the sources of carbon monoxide with their description:
Match the sources of carbon monoxide with their description:
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New vehicles are completely safe from carbon monoxide poisoning.
New vehicles are completely safe from carbon monoxide poisoning.
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At what stage do patients with carbon monoxide poisoning typically start to show symptoms?
At what stage do patients with carbon monoxide poisoning typically start to show symptoms?
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What is the primary mechanism of action for tricyclic antidepressants?
What is the primary mechanism of action for tricyclic antidepressants?
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N-acetylcystine is effective when administered up to 8 hours after a paracetamol overdose.
N-acetylcystine is effective when administered up to 8 hours after a paracetamol overdose.
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What are common symptoms observed in the first 24 hours after paracetamol overdose?
What are common symptoms observed in the first 24 hours after paracetamol overdose?
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Sodium bicarbonate is the mainstay pharmacological therapy for managing __________ overdose.
Sodium bicarbonate is the mainstay pharmacological therapy for managing __________ overdose.
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Match the following symptoms with their corresponding classification in tricyclic antidepressant overdose:
Match the following symptoms with their corresponding classification in tricyclic antidepressant overdose:
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What is the risk threshold for severe toxicity in adults for tricyclic antidepressant overdose?
What is the risk threshold for severe toxicity in adults for tricyclic antidepressant overdose?
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Paracetamol overdose can lead to hypertension as a symptom.
Paracetamol overdose can lead to hypertension as a symptom.
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What is one of the main concerns in tricyclic antidepressant overdose?
What is one of the main concerns in tricyclic antidepressant overdose?
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The toxic metabolite produced during paracetamol overdose can cause hepatic and renal __________.
The toxic metabolite produced during paracetamol overdose can cause hepatic and renal __________.
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What ECG change is often seen with tricyclic antidepressant toxicity?
What ECG change is often seen with tricyclic antidepressant toxicity?
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Study Notes
Neuroleptic Malignant Syndrome (NMS)
- NMS is a rare but potentially life-threatening condition caused by antipsychotic medications.
- All antipsychotics (first and second generation) can trigger NMS, including dopamine antagonist anti-emetics like metoclopramide.
- NMS can occur after a single dose of medication.
- NMS occurs over days to weeks.
- The mechanism of action involves dopaminergic blockade in the basal ganglia and the hypothalamus, which regulates motor control, thermoregulation, and the autonomic nervous system.
- Symptoms include: labile blood pressure, muscle rigidity, altered mental status, hyperthermia, tachycardia, dilated pupils, acute kidney injury, hyporeflexia, diaphoresis, and rhabdomyolysis.
Serotonin Syndrome
- Serotonin syndrome is a group of symptoms caused by excess serotonin activity.
- Severity can range from mild to severe, with fatal cases possible.
- It can result from an increase in a single medication, a change in serotonergic medications without adequate washout period, or interactions between prescribed and illicit drugs.
Sodium Nitrite Poisoning
- Sodium nitrite poisoning leads to methemoglobinemia, a condition where hemoglobin is unable to bind to oxygen, resulting in inadequate oxygen transport.
- Symptoms include relative hypovolemic shock, cyanosis, altered level of consciousness, seizures, and methemoglobinemia (with serious exposures).
- SpO2 readings are inaccurate and may be around 85%.
- Blood appears chocolate-brown in color.
- Treatment involves supportive care with high-flow oxygen, fluids, and methylene blue (in-hospital).
Clonidine Toxicity
- Clonidine is a centrally acting alpha-2 receptor agonist used to treat hypertension, ADHD, autism, migraines, sleep disorders, and Tourette's syndrome.
- Toxicity occurs at 10 mcg/kg, with onset within 30 minutes to 4 hours, and effects lasting 24-72 hours.
- Symptoms include somnolence, miosis (pupil constriction), bradycardia, hypotension, and hypoventilation.
- Treatment focuses on ABC supportive care, atropine for bradycardia, fluids for hypotension, and naloxone is likely ineffective.
MDMA (Ecstasy) Toxicity
- MDMA, also known as ecstasy, XTC, E, Molly, etc., is a synthetic drug with stimulant, empathogen, and mild hallucinogenic properties.
- MDMA increases serotonin and noradrenaline in the synapse.
- Drugs sold as MDMA may contain other substances like amphetamines, PMA, PMMA, ketamine, NBOMe, or other substances.
- PMA and PMMA have more toxic effects than MDMA and cause hepatic and renal necrosis.
- Symptoms onset:
- Less than 24 hours: asymptomatic, nausea and vomiting, diaphoresis, malaise.
- 18-72 hours: right upper quadrant pain, tachycardia.
- 72-96 hours: abdominal pain, tender hepatic edge, gastrointestinal hemorrhage, jaundice, nausea and vomiting, and fatality.
Paracetamol Overdose Treatment
- Treatment includes supportive care with ABC management, addressing co-ingestion (e.g., naloxone), and considering mental health aspects of intentional overdose.
- N-acetylcysteine (Parvolex®) is a safe and effective antidote that acts as a precursor for glutathione, promoting normal conjugation of remaining paracetamol and supplying thiols that act as antioxidants.
Tricyclic Antidepressant (TCA) Overdose
- TCAs are used to treat depression, chronic pain, migraine, peripheral neuropathies, and nocturnal enuresis.
- Overdose symptoms and toxicity can occur at doses above 10mg/kg in adults and 5mg/kg in children.
- Severe toxicity results from ingestion of more than 20mg/kg.
- TCAs cause cardiotoxicity by blocking myocardial fast sodium channels (QRS prolongation, tall R wave in aVR), inhibiting potassium channels (QTc prolongation), and direct myocardial depression.
- Other toxic effects include anti-muscarinic, histamine (H1), and α1-adrenergic receptor antagonism.
TCA Overdose - Symptoms
- Anticholinergic effects: agitation, delirium, dilated pupils, warm dry skin, tachycardia.
- Neurotoxicity: sedation, coma, seizures.
- Cardiotoxicity: tachycardia, wide QRS, ventricular dysrhythmias, hypotension.
- Coma, seizures, and cardiovascular toxicity manifest rapidly and can be fatal without aggressive intervention.
Sodium Bicarbonate in TCA Overdose
- Sodium bicarbonate is the primary pharmacological therapy for managing serious TCA overdose.
- It corrects acidosis and increases TCA plasma protein binding, reducing active drug, by:
- Increasing plasma pH and promoting intracellular alkalosis, both of which decrease TCA-receptor binding.
- Increasing sodium load, overriding sodium channel blockade and promoting intravascular volume loading.
Propranolol Overdose
- Propranolol is a beta blocker and a sodium channel blocker.
- Sodium bicarbonate may be beneficial in managing toxicity.
- Mechanical circulatory support (eCPR) is a mainstay of treatment.
Propranolol Toxicity - Mechanism
- Beta adrenergic receptor blockade (β1 and β2): decreased intracellular cAMP, reduced chronotropy and inotropy (heart rate and contractility), and possible bronchospasm.
- Sodium channel blockade: prolonged cardiac action potential, QRS widening, ventricular dysrhythmias, and neurotoxic effects (seizures, coma).
Organophosphate Poisoning
- Organophosphate pesticides are used widely on crops, livestock, and for pest control.
- Systemic absorption occurs through mucus membranes (eyes), skin, lungs, and gastrointestinal exposure.
Organophosphate Poisoning - Mechanism of Action
- Organophosphates bind to acetylcholinesterase, making it inactive and leading to excess acetylcholine in synapses and neuromuscular junctions.
- Overstimulation of nicotinic receptors results in fasciculations, myoclonic jerks, and eventually leads to flaccid paralysis.
- Nicotinic receptors in the adrenal glands cause hypertension, sweating, and tachycardia.
- Muscarinic receptor stimulation leads to the classic "DUMBELS" or "SLUDGE" symptoms.
Organophosphate Poisoning - Symptoms
- DUMBELS: Defecation/diaphoresis, Urination, Miosis, Bronchospasm/bronchorrhea, Emesis, Lacrimation, Salivation.
- SLUDGE: Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis.
OP Prehospital Treatment
- Wear PPE and notify the ED early.
- Decontaminate the patient as soon as possible.
- Provide supportive care with ABC management.
- Establish IV/ IO access and administer IV fluids.
- Atropine is used as a muscarinic receptor antagonist.
Carbon Monoxide Poisoning
- Carbon monoxide (CO) is odorless, colorless, and tasteless.
- CO has a 220 times greater affinity for hemoglobin than oxygen.
- Sources include petrol-powered pumps, outdoor heaters, generators used indoors, gas stoves (including caravans), outdoor cookers with charcoal beads.
- Patients may be asymptomatic until they become unconscious.
- Headache often precedes hypoxic signs.
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Description
Explore the critical conditions of Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome. Understand the causes, symptoms, and risk factors associated with these potentially life-threatening reactions to medications. This quiz delves into the pharmacological mechanisms and clinical manifestations to enhance your knowledge in mental health treatment.
