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Pharmacology

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CNS Part- 2

Question
37 out of 42
 

A woman has consumed several tabs of Amitriptyline. All of the following can be used as a part of her management except (AIPG 2009)


A Sodium barbiturate to treat lactic acidosis

B Gastric lavage

C Use Atropine as an antidote

D Diazepam for seizure control

Ans. C Use Atropine as an antidote

(Ref: BG Katzung, Basic & Clinical Pharmacology’ 11th Edition’ 2010; pp-113-14)

Antidepressant drugs:

Typical and atypical

Typical: TCA, SSRI, MAOI

TCA: Acts by inhibiting reuptake of NA and serotonin

Toxicity:

A. Cardiovascular toxicity:

Arrhythmias: due to blocking of sodium channels. Aggravated by acidosis, hypoxiA. Can result in QT prolongation, TDP. Also tachyarrhythmia due to hypotension

Hypotension: because of blocking alpha receptor, M/C cause of immediate death in toxicity. Aggravated by acidosis, hypoxia

B. Anticholinergic side effects:

Altered mental status, hyperthermia, urinary retention, paralytic ileus, dryness of eyes and mouth

C. CNS toxicity:

Altered mental status due to anticholinergic action can result in:

Delirium, psychosis,, lethargy, myoclonus and seizures

D. Pulmonary toxicity:

Acute lung injury (ARDS) due to aspiration, Hypotension, coma

Management:

a. GIT decontamination by gastric lavage, active charcoal is added to enhance the action

b. Sodium bicarbonate (i.v.): to control pH, which will control arrhythmias

c. Antiarrhythmic drugs: magnesium sulphate for TDP and lidocaine for other arrhythmias

d. Isotonic saline: to control hypotension

e. Anti epileptic drugs: BZD, propofol are preferred agents to control seizures induced by TCA.

f. There is no role of atropine, as it is a anticholinergic drug, which will further aggravate the toxicity

CNS Part- 2 Flashcard List

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