Antidepressant/Antipsychotic Toxicity

main antidepressant toxicity

TCA

TCA toxicity sign and symptoms

altered mental status
hypotension, tachycardia
anticholinergic symptoms
seizures
prolonged QRS

QRS > 100 msec

increase risk of seizures

QRS > 150 msec

increase risk of arrhythmias

what can QRS prolongation cause at any interval

metabolic acidosis

TCA assessment options

fluids
vasopressors
seizure management
sodium bicarb

TCA antidote

sodium bicarb

when is sodium bicarb indicated in TCA toxicity

QRS interval > 100
TCA induced arrhythmia/hypotension
metabolic acidosis

when to d/c sodium bicarb in TCA toxicity

QRS < 100
ECG normal
hemodynamically stable

TCA seizure management

BZDs
phenobarbital

antipsychotic signs and symptoms

NMS
EPS
QT/QRS prolongations
sedations
hypotension
tachycardia

EPS treatment

benztropine
diphenhydramine

NMS signs and symptoms

hyperpyrexia with altered status
lead pipe muscular rigidity
high fever

onset and duration of NMS

occurs 3-9 days after initation of drug
continues for 5-10 days

NMS treatment

BZDs
dantrolene
bromocriptine
d/c offending agent

serotonin syndrome signs and symptoms

altered mental status
autonomic instability
neuromuscular abnormalites
lower limbs effected

onset of serotonin syndrome

occurs rapidly ( ~6 hours)

serotonin syndrome treatment

BZDs
aggressive cooling
cyproheptadine
d/c offending agent