Toxic Dose Overview and Clinical Presentations
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Questions and Answers

Amantadine enhances the release of which neurotransmitter and prevents its reuptake?

  • Acetylcholine
  • GABA
  • Serotonin
  • Dopamine (correct)

    • Why is dialysis not effective in eliminating amantadine?

  • Due to its large volume of distribution (correct)
  • Because of its rapid clearance
  • Because of its high degree of protein binding
  • Due to its low molecular weight

    • Which of the following is NOT a clinical presentation of amantadine toxicity?

  • Delirium
  • Agitation
  • Visual hallucinations
  • Hypothermia (correct)

    • What is the typical treatment approach for amantadine toxicity?

    <p>Supportive care and emergency measures</p> Signup and view all the answers

    What is the significance of serum levels above 1.5mg/L in amantadine toxicity?

    <p>Associated with toxicity</p> Signup and view all the answers

    Which group of patients is more prone to developing toxic intoxication with therapeutic doses of amantadine?

    <p>Elderly patients with renal insufficiency</p> Signup and view all the answers

    What is a possible complication of amantadine withdrawal?

    <p>Rigidity</p> Signup and view all the answers

    What is a characteristic anticholinergic manifestation of amantadine toxicity?

    <p>Dry mouth</p> Signup and view all the answers

    What laboratory study is useful in evaluating amantadine toxicity?

    <p>Electrolytes and ECG monitoring</p> Signup and view all the answers

    What is the minimum toxic dose of quinine in adults?

    <p>3-4 g</p> Signup and view all the answers

    What is the fatal dose of quinine in children?

    <p>1 g</p> Signup and view all the answers

    What is cinchonism?

    <p>A group of symptoms including tinnitus, deafness, vertigo, headache, and visual disturbances</p> Signup and view all the answers

    When does retinal toxicity typically occur after quinine ingestion?

    <p>9-10 hours</p> Signup and view all the answers

    What is the purpose of a stellate ganglion block?

    <p>To treat quinine-induced blindness</p> Signup and view all the answers

    What is the recommended dose of hypertonic sodium bicarbonate for cardiotoxicity?

    <p>1-2meq/kg rapid IV bolus</p> Signup and view all the answers

    What is the common feature of severe quinine intoxication?

    <p>Ataxia, obtundation, and convulsions</p> Signup and view all the answers

    What is the laboratory study that is NOT mentioned in the content?

    <p>Liver function tests</p> Signup and view all the answers

    What is the purpose of decontamination in quinine overdose?

    <p>To reduce the absorption of quinine</p> Signup and view all the answers

    What is the name of the enzyme that helps protect red blood cells from destruction?

    <p>Glucose-6-phosphate dehydrogenase</p> Signup and view all the answers

    What is a common side effect of primaquine and quinacrine intoxication?

    <p>Methemoglobinemia</p> Signup and view all the answers

    What is the therapeutic dose of chloroquine phosphate for malaria prophylaxis?

    <p>500 mg once a week</p> Signup and view all the answers

    What is the estimated lethal dose of chloroquine for adults?

    <p>30-50 mg/kg</p> Signup and view all the answers

    What is a common laboratory study used to evaluate chloroquine toxicity?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic symptom of mild to moderate chloroquine overdose?

    <p>Neuromuscular excitability</p> Signup and view all the answers

    What is a complication of chloroquine use in G6PD-deficient patients?

    <p>Hemolytic anemia</p> Signup and view all the answers

    What is a side effect of mefloquine use?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic laboratory finding in primaquine or quinacrine intoxication?

    <p>Free plasma hemoglobin</p> Signup and view all the answers

    What is the therapeutic range for the drug mentioned in the text?

    <p>50-300 mg/d</p> Signup and view all the answers

    What is the primary mechanism of action for methylene blue in the treatment of methemoglobinemia?

    <p>It reduces the heme group from methemoglobin to hemoglobin.</p> Signup and view all the answers

    Which of the following is a characteristic of sulfhemoglobinemia?

    <p>It results in a greenish discoloration of the blood.</p> Signup and view all the answers

    What is the primary treatment for the condition mentioned in the text?

    <p>Supportive care and decontamination.</p> Signup and view all the answers

    What is a characteristic of hemolysis in the context of the provided text?

    <p>It may be caused by depletion of intracellular glutathione.</p> Signup and view all the answers

    Which of the following is a potential complication of the condition discussed in the text?

    <p>Cyanosis.</p> Signup and view all the answers

    What is the significance of Heinz bodies in the context of the text?

    <p>They are a potential indicator of hemolysis.</p> Signup and view all the answers

    What is the recommended prehospital treatment for the condition mentioned in the text?

    <p>Administering activated charcoal and inducing emesis.</p> Signup and view all the answers

    Which of the following statements accurately describes the condition's effect on oxyhemoglobin saturation?

    <p>It results in a significant decrease in oxyhemoglobin saturation.</p> Signup and view all the answers

    Which of the following is a possible symptom of an acute overdose of a drug mentioned in the content?

    <p>Diarrhea</p> Signup and view all the answers

    What drug is commonly used to treat methemoglobinemia caused by dapsone overdose?

    <p>Methylene blue</p> Signup and view all the answers

    Which of the following enzymes is inhibited by trimethoprim?

    <p>Dihydrofolate reductase</p> Signup and view all the answers

    Which of the following drugs is indicated for the treatment of leprosy?

    <p>Dapsone</p> Signup and view all the answers

    Which of the following statements about dapsone is TRUE?

    <p>It can cause methemoglobinemia, even at therapeutic doses.</p> Signup and view all the answers

    Which of the following drugs inhibits the enzyme dihydropteroate synthase?

    <p>Sulfonamides</p> Signup and view all the answers

    What is the recommended treatment for a patient who has overdosed on dapsone and is experiencing methemoglobinemia?

    <p>Administer methylene blue intravenously.</p> Signup and view all the answers

    What is the primary reason why leucovorin is administered in cases of drug overdose?

    <p>To restore normal folate levels.</p> Signup and view all the answers

    Which of the following statements regarding the toxic dose of drugs mentioned in the content is TRUE?

    <p>Life-threatening reactions can occur at subtherapeutic doses.</p> Signup and view all the answers

    Study Notes

    Toxic Dose Overview

    • Toxic doses vary significantly among individuals, highlighting the need for caution.
    • Leucovorin, a folic acid analog, is administered intravenously post-overdose to restore normal folate levels.
    • Life-threatening reactions can occur even at subtherapeutic doses in sensitive individuals.

    Clinical Presentations of Overdose

    • Acute overdose symptoms typically include nausea, vomiting, and diarrhea.
    • Dapsone overdose requires methylene blue for treating symptomatic methemoglobinemia.
    • Chronic dapsone use can lead to methemoglobin levels of 5-8%, with life-threatening doses exceeding 1.4g.
    • Sulfhemoglobinemia, a rare condition, results in excess sulfhemoglobin in the blood, causing cyanosis and unresponsiveness to methylene blue.

    Diagnostic Considerations

    • Diagnosis relies on patient history and clinical symptoms; specific drug levels are often not available.
    • For toxic doses, serum levels greater than 1.5 mg/L indicate potential poisoning.
    • Additional lab tests include electrolytes, BUN, creatinine, and ECG monitoring.

    Treatment Approaches

    • Emergency care includes administering activated charcoal and supportive measures.
    • Methylene blue is pivotal for methemoglobinemia.
    • Antidotes are mostly unavailable for other toxicities.

    Mechanism of Toxicity

    • Amantadine enhances dopamine release and inhibits its reuptake, affecting both peripheral and central nervous systems.
    • High degrees of protein binding in certain drugs hinder their removal by hemodialysis.

    Clinical Manifestations of Amantadine Toxicity

    • Symptoms may include agitation, hallucinations, tremors, slurred speech, and dysautonomia.
    • Withdrawal can precipitate hyperthermia and rigidity.

    Additional Toxicity Discussion

    • Quinine overdose can induce mild symptoms like nausea and severe reactions including respiratory arrest and cardiotoxicity.
    • Symptoms of quinine-induced blindness appear 9-10 hours post-ingestion, accompanied by retinal toxicity.

    Diagnosis and Treatment for Quinine Overdose

    • Diagnosis through history and symptoms; drug levels can be checked, although not often readily available.
    • Treatment involves hypertonic sodium bicarbonate for cardiotoxicity and activated charcoal for decontamination.

    Specific Drug Information

    • Primaquine and quinacrine overdoses lead to gastrointestinal upset, methemoglobinemia, and potential severe hemolysis.
    • Chloroquine has a therapeutic range with risks of severe toxicity at doses above 30-50 mg/kg in adults, with reported pediatric fatalities at 300 mg.

    General Precautions and Measures

    • Emergency interventions are critical in cases of suspected toxicity.
    • Regular monitoring of electrolyte levels and other relevant laboratory parameters is essential for patient safety and effective management.

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    Description

    Learn about toxic doses, their variations, and clinical presentations of overdose, including symptoms and treatment options.

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