WK4 - Lecture 19 - Drug Overdose PDF

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: DRUG OVERDOSE AND TOXICITY Objectives  Recognize and explain actions of specific CNS – stimulant and CNS- depressant agents  Recognize signs and symptoms of toxicity of common drugs of abuse  Determine suggested treatment modaliti...

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: DRUG OVERDOSE AND TOXICITY Objectives  Recognize and explain actions of specific CNS – stimulant and CNS- depressant agents  Recognize signs and symptoms of toxicity of common drugs of abuse  Determine suggested treatment modalities for patient experiencing drug toxicity from specific CNS- stimulants and CNS- depressants Drug Overdose  CNS Stimulant  Amphetamines  Cocaine Amphetamines  Central nervous system STIMULANT  Examples might be:  Ritalin  Adderall  Phentermine (weight loss)  Methamphetamine  Amphetamines  Activate sympathetic nervous system  Fight or flight response  increased heart rate  pupil dilation  decreased digestion  Prevent reuptake of excitatory neurotransmitters  Constant excitatory state Signs and Symptoms: Amphetamine Toxicity  Euphoria  Tachycardia  Restlessness  Hypertension  Talkativeness  Chest pains  Anxiety  Heart palpitations  Possible coma or MI  Agitation  Confusion  Flushing  Diaphoresis (sweating) Clinical  Meth mouth  Rampant caries Cocaine  CNS STIMULANT  Potent vasoconstrictor  Used medically as a local anesthetic for some procedures (nasal surgeries)  Also a street drug  Dopamine reuptake inhibitor  “Happy” drug  Feelings of euphoria Signs and Symptoms: Cocaine Toxicity  Anxiety  Seizures  Agitation  Hallucinations  Hyperthermia  Cerebral hemorrhage  Chest pain  Ventricular fibrillation  Tachycardia  MI  Hypertension  CVA  Arrhythmias  Dyspnea  Emergency Management: Amphetamine & Cocaine Toxicity  Contact EMS  Position: comfortable  C-A-B, as needed  Monitor vital signs  Benzodiazepine (by trained professional only)  Attempt to cool skin by spraying lukewarm water or a tepid sponge to skin with air fans  Do not give emetic (vomit causing) agent  vomiting can induce seizures Emergency Management: Amphetamine & Cocaine Toxicity  In hospital:  Administrationof activated charcoal to prevent systemic absorption of the drugs Black powder that combines with water to form a slurry (active charcoal prevents the absorption of the drug in GI) Drug Overdose  CNS Depressants  Opioids  Benzodiazepine Opioids CNS DEPRESSANT  Derived from poppy plant  Natural source: morphine and codeine  Synthetic source: heroin, oxycodone, fentanyl, methadone  Routes of administration: oral, smoking, and IV Opiates and Opioids  Mechanism of action:  bind with specific opioid receptors in CNS and spinal cord to produce drug’s effects  Sedation  Euphoria  Reduction in pain perception  Inhibits gastrointestinal motility – constipation  Signs and Symptoms: Opioid Toxicity  Lethargy  Flaccid muscles  Pupil constriction  Lack of response to  Shallow respirations external stimulation  Hypotension  Severe overdose can  Hypothermia lead to coma, respiratory depression,  Bradycardia and death Benzodiazepines  Used for reduction of anxiety, anticonvulsant properties, and muscle relaxant properties  Usually delivered orally – can be IM or IV  Examples:  Valium  Xanax  Ativan Benzodiazepines  Enhancement of inhibitory neurotransmitter GABA in CNS  Produces  Sedation  Antianxiety  Signs and Symptoms: Benzodiazepine Toxicity  Lethargy  Slurred speech  Ataxia (loss muscle coordination)  Mental confusion  Coma and respiratory arrest may occur; usually in combination with other CNS depressants Emergency Management: Opioid & Benzodiazepine Toxicity  Contact EMS immediately  Patient: supine  C-A-B, as needed  Administer Naloxone Spray (Narcan)  ONE spray in one nostril  Another dose every 2-3 minutes until patient response or EMS arrives  *Naloxone will only reverse the effects of opioid https://nida.nih.gov/publications/drugfacts/naloxone#:~:text=Naloxone%20can%20quickly%20restore%20normal,treatment%2 0for%20opioid%20use%20disorder.  Administer O2 4-6L/minute  Monitor vital signs  External warming measures  Do not induce vomiting – possible obstructed airway References Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall  https://nida.nih.gov/publications/drugfacts/naloxone#:~:text=Naloxone%20can% 20quickly%20restore%20normal,treatment%20for%20opioid%20use%20disorder.