Page 1060 - Basic _ Clinical Pharmacology ( PDFDrive )

1046 SECTION IX Toxicology

The cause of this activation is not fully understood, but the effects hypotension and tachycardia. Phenobarbital is preferred over
can be ameliorated by β blockers (see below). Cardiac arrhythmias phenytoin for convulsions; most anticonvulsants are ineffective.
include atrial tachycardias, premature ventricular contractions, and Hemodialysis is indicated for serum concentrations >100 mg/L
ventricular tachycardia. In severe poisoning (eg, acute overdose and for intractable seizures in patients with lower levels.
with serum level >100 mg/L), seizures often occur and are usually
resistant to common anticonvulsants. Toxicity may be delayed in
onset for many hours after ingestion of sustained-release tablet REFERENCES
formulations. Dart RD (editor): Medical Toxicology, 3rd ed. Lippincott Williams & Wilkins,
General supportive care should be provided. Aggressive gut 2004.
decontamination should be carried out using repeated doses of Goldfrank LR et al (editors): Goldfrank’s Toxicologic Emergencies, 10th ed.
McGraw-Hill, 2015.
activated charcoal and whole bowel irrigation. Propranolol or Olson KR et al (editors): Poisoning & Drug Overdose, 6th ed. McGraw-Hill, 2011.
other β blockers (eg, esmolol) are useful antidotes for β-mediated POISINDEX. (Revised Quarterly.) Thomson/Micromedex.

C ASE STUD Y ANSWER

Overdose of bupropion can cause seizures that are often more potent central nervous system depressant may be used.
recurrent or prolonged. Drug-induced seizures are treated To prevent ingested drugs and poisons from being absorbed
with an intravenous benzodiazepine such as lorazepam or systemically, a slurry of activated charcoal is often given
diazepam. If this is not effective, phenobarbital or another orally or by nasogastric tube.