tox test 2 sympathomimetics

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coal
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242172
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tox test 2 sympathomimetics
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2013-10-22 16:46:22
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tox test 2 sympathomimetics
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  1. neurotransmitter working on preganglionic sympathetic neurons
    acetycholine
  2. neurotransmitter working on the postganglionic sympathetic neurons
    NE except in sweat glands
  3. SNS stimulation results in increased what 7
    • blood pressure
    • bronchial airway tone
    • cardiac contraction
    • carbohydrate and fatty acid metabolism
    • mood
    • psychomotor activity
    • vasomotor tone
  4. sympathomimetic toxidrome
    • diaphoresis
    • hyperthermia
    • hypertension
    • mydriasis
    • altered mental status
    • tachycardia
    • cardiac dysrhythmias
    • hyperactive bowel sounds
    • seizures
  5. sympathomimetic MOA
    alpha adrenergic stimulation and inhibit neurotransmitter reuptake
  6. amphetamine elimination
    • weak bases (pKa between 8.8 & 10.4)
    • elimination is urine pH dependent
    • 30% are excreted unchanges
  7. what hormone is released in conjunction with MDMA and what are the effects
    cortisol - increased body temperature and thermal stress
  8. what is aggregation toxicitiy
    when you are around a crowd and you take the same levels of an amphetamine the effects are intensified
  9. 5 acute complications of amphetamines
    • cerebrovascular accidents
    • severe hypothermia
    • renal complications
    • cardiac complications
    • hyponatremia
  10. 6 chronic complications of amphetamine
    • significantly changed brain functions
    • reduced motor performance & impaired verbal
    • psychological dependence
    • cardiac complications
    • psychiatric illnesses
    • sleep disturbances
  11. amphetamine toxicity Tx
    • ABC's
    • GI decontamination
    •   1-2h = gastric lavage followed by AC
    •   > 2 h AC alone
    • altered mental status & seizures = benzos
    •   if unresponsive to benzos = haloperidol
  12. Tx of amphetamine tox w/ acute mental disturbances or seizures
    • benzos
    • if unresponsive to them = haloperidol
  13. Tx of amphetamine tox w/ hyperthemia
    • < 39 C = rapid crystalloid fluid (20ml/kg)
    • > 39 C = mist/sprays, fans, ice placement
  14. Tx of amphetamine tox w/ cardiovascular complications
    • IV benzos
    • sodium nitroprusside (malignant cases)
    • avoid beta blockers
    • acute = diuretics, ACEI
  15. what is the most common complaint at the ER cocaine tox
    chest pain
  16. cocaine withdrawal S&S
    • dysphoria
    • depression
    • sleepiness, fatigue
    • cocaine craving
    • bradycardia
  17. Tx of cocaine tox of
    agitation
    hyperthermia
    blood pressure
    dysrhythmias
    myocardial ischemia
    refractory pain
    neurologic complications
    rhabdo
    • agitation - benzos
    • hyperthermia - cooling measures
    • blood pressure - benzo, phentolamine, nitro
    • dysrhythmia
    •  hemo stable = benzo, CCB, adenosine
    •  hemo unstable = cardioverted
    • myocardial ischemia = benzo, ASA, nitro
    • refractory pain = MS, nitro (phentolamine or
    •                          verapamil if unresponsive)
    • neurologic comp. = benzo
    • rhabdo = hydration, mannitol, Na HCO3
  18. mechanism for bronchodilation
    • PDE-4 inhibition
    • A1 antagonism
  19. increased gastric secretion mechanism
    PDE4 inhibition
  20. headache, vomiting mechanism
    • PDE4 inhibition
    • catecholamine release
  21. diuresis mechanism
    A1 antagonism
  22. tachycardia mechanism
    • A1 antagonism
    • catecholamine release
    • PDE 3 inhibition
  23. hypotension mechanism
    B2 adrenergic agonism
  24. CNS excitation mechanism
    • A1 antagonism
    • catecholamine release

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