sedative-hypnotics, lithium tox

GABA like sleep aids

zolpidem, zaleplon, eszopiclone

warnings = BEERS fall risk in elderly, hallucinations, confusion, withdrawal, rebound insomnia

benzo toxicity

• cns dep, sedation, resp dep, withdrawal

• propylene glycol (solvent used in iv lorazepam, diazepam) causes hyperosm, anion gap, metabolic acidosis, AKI, sepsis like syndrome

• treatment = hemodialysis

propylene glycol toxicity

solvent used in iv lorazepam, diazepam

causes hyperosm, anion gap, metabolic acidosis, AKI, sepsis like syndrom

melatonin sleep aids

ramelton, tasimelteon

ade = drowsiness, dizziness, fatigue, headache

antihistamine

diphenhydramine, doxylamine, hydroxyzine

BEERS drowsiness, seizures, mydriasis, tachycardia, hyperthermia, urinary retention, no bowel sounds, hallucinations

bolus sedatives

etomidate, ketamine, propofol

continuous sedatives

propofol, dexmedetomidine

BEERS drugs

zolpidem, diphenhydramine, lithium***

lithium

anticholinergic toxicity

high bp, hr, body temp

delirium, mydriasis pupil size

no bowel movements, urinary retention, dry skin

(TCA, antihistamine)

cholinergic toxicity********

high rr

depressed mental status

diarrhea, polyuria, sweating

(insecticides)

ethanol, benzo, sleep aid toxicity

low bp, hr, rr, body temp

agitated and depressed mental status

no bowel movements, hyporeflexia, ataxia

opioid toxicity

low bp, hr, rr, body temp

depressed mental status, pinpoint pupil size

no bowel movements, hyporeflexia

mydriasis

large pupil size

miosis

pinpoint pupil size

sympathomimetic toxicity

high bp, hr, rr, body temp

agitated, mydriasis pupil size, sweating

increase bowel movements, tremors, seizures

ethanol and sedative withdrawal toxicity

high bp, hr, rr, body temp

agitated and hallucinations, mydriasis pupil size, sweating

increase bowel movements, tremors, seizures

opioid withdrawal toxicity

high bp, hr

anxious, mydriasis pupil size, sweating

increase bowel movements, runny nose, vom/diarr

activated charcoal does not work for

alcohol, lithium, cyanide, hydrocarbons

po NAC, small ingestion, benzo tox

z sleep aid antidote

flumazenil (better than use in benzos, no seizure risk)

enhance lithium elimination

diuresis, dialysis, sodium polystyene sulfonate