Barbituates
Enhance activity of GABA, in higher doses, allow Cl influx even if GABA not bound
The picture of a barb overdose is just like benzos but with a much greater chance of resp depression. Coma with normal vitals except decreased RR.
People were dying until Scandanavian method, intubate them and then let them wake up.
To hasten elimination, consider alkalinization of urine or charcoal hemoperfusion, but very rarely are these indicated due to the benign course so long as supportive care is available
Withdrawl-seizures, autonomic dysfunction. Give 30 mg of Phenobarb for each 100 mg of short acting, in divided doses then taper.
Can sometimes see barb blisters-blisters on non-dependant portions of body
Suicide drug of choice overseas, take overdose of barbs and then tape a garbage bag over your head to really do the job
Benzodiazepines
Mild hypothermia, mild hypotension, mild reduction in HR, CNS depression, mild resp depression
Use Flumazenil only after conscious sedation in patients well screened.
.2 mg over 30 seconds
flumaz seizure risk may be exaggerated ann emerg med Volume 51, Issue 4, Page 473 (April 2008)
but maybe not…
and
- (PMID: 22766408)
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GHB
Gamma-Hydroxybutyrate (GHB, Grievious Bodily Harm)
Also precursors gamma-butyrolactone (GBL) and butanediol (BD)
Potent CNS depressant
Increases dopamine concentrations in cortex. binds to GABA, and specific binding to a receptor which causes CNS depressant effect
Patients may cycle between periods of apnea and agitation with hyperventilation
Non-symptomatic bradycardia is common
Amnesia and Hypotonia
Somnolence, euphoria, dizziness and hallucinations (by acting as gaba in substantia nigra)
Doesnt cause seizure activity, but can cause clonic movements
Can cause symptomatic bradycardia. High doses can result in resp depression and coma
GBL is a precursor that gets metabolized to GHB and is much more potent
If resistant to high dose benzos, can use small doses of pentobarbital (1-2 mg/kg q 30-60 minutes) (Ann Emerg Med 38:6)
give benzos for withdrawl from GHB
best review (Acad Emerg Med 2002;9(7):730)
5-MEO-DMT
hallucinogen available over the net
hypotonicity leading to seizures
Non-Barb, Non-Benzo
Ambien
Partially reversible c flumazenil
Chloral Hydrate
used as knockout drops, first popularized by bar owner Mickey Finn Potentiates ETOH effects by preventing breakdown
Can have corrosive GI effects
Odor of Pears
Can use B-Blockers if Ventricular dysrhythmias
Still used as a sedative for peds and elderly as less paradoxical excitement effects
Ethchlorvynol (Placidyl)
pulmonary edema (NCPE), can cause bullae as well, decontam, supportive care
Glutethimide
cyclic coma
Meprobamate
Soma, give ac
Methaqualone
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