Pediatric emergency medicine trisk 3081 3081
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (105.93 KB, 1 trang )
Selective serotonin reuptake inhibitors (SSRIs) commonly produce
CNS depression in overdose, and may lead to serotonin syndrome.
Overdose is generally well tolerated with isolated SSRI ingestions.
Monoamine oxidase inhibitors are highly toxic, which may manifest as a
result of food-drug interactions, drug-drug interactions, or MAOI
overdose.
MAOI toxicity produces hypertension, hyperpyrexia, skeletal muscle
rigidity, cardiac arrhythmias, myoclonus, seizures, rhabdomyolysis, and
death. Patients should be observed for at least 24 hours after
concerning exposure.
Current Evidence. Besides the tricyclic antidepressants, numerous mood
elevating agents are prescribed. The chemical structure of these agents and their
profile of toxicity are diverse. Major groupings of nontricyclic antidepressants
include (i) the selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram,
fluoxetine, sertraline), (ii) the monoamine oxidase inhibitors (MAOIs; e.g.,
phenelzine, tranylcypromine), and (iii) other atypical antidepressants (e.g.,
bupropion, venlafaxine).
SSRIs most commonly produce CNS depression in overdose. Seizures may
occur after large ingestions. Life-threatening events from acute overdose are rare.
The serotonin syndrome, manifested by the triad of autonomic instability,
neuromuscular changes (myoclonus, rigidity especially in the lower extremities),
and altered mental status, is potentially lethal. Citalopram and its enantiomer
escitalopram cause both QTc interval prolongation and seizure activity that are
thought to be dose related. Bupropion, prescribed for both depression and in
smoking-cessation programs, prevents reuptake of biogenic amines, is highly
epileptogenic, and in large overdose, may cause QRS widening and lifethreatening cardiotoxicity. Bupropion’s amphetamine nucleus accounts for the
positive toxicology screens seen in patients with therapeutic use as well as in
overdose settings. The α-adrenergic antagonism of trazodone may lead to
hypotension.
The MAOIs, although pharmacologically effective and therapeutically
important, are some of the most toxic medications known. Acute single overdoses
of as little as 6 mg/kg have been associated with a fatal outcome. In addition,
because of their irreversible inhibition of the enzyme monoamine oxidase, which
is responsible for the degradation of most biogenic amines, MAOIs possess
several important interactions with foods and other medications that can lead to
