0071643192.pdf

TOXICOLOGY

■ Sodium nitroprusside or phentolamine, if severely hypertensive
■ Avoid:
■ β-Blockers (→unopposedα-adrenergic stimulation)
■ All indirect sympathomimetics (dopamine)

COMPLICATIONS

■ Serotonin syndrome
■ Sequelae of hypertensive emergency
■ Rhabdomyolysis

Newer Antidepressants

Heterogeneous group of newer medications that block dopamine, norepi-
nephrine, and serotonin CNS reuptake to varying degrees.

Common examples and toxicities are listed in Table 6.6.

ANTIBIOTICS AND ANTIRETROVIRALS

Most antibiotics and antivirals are associated with adverse drug effects (eg,
allergic reactions) or complications from chronic therapy.

This section is limited to medications that are associated with severe toxicity
in overdose.

Isoniazid

Isoniazid is one of the first-line agents used to treat tuberculosis (TB).

Chronic use is associated with peripheral neuropathy, hepatitis, drug-induced
systemic lupus erythematosus (SLE).

MECHANISM/TOXICITY

■ Reduction of vitamin B 6 in brain →↓γ-aminobutyric acid (GABA) pro-
duction→seizures.

TABLE 6.6. Toxicity Related to Newer Antidepressants

MEDICATION MAJORTOXICITY

Bupropion (Wellbutrin) Seizures (hallmark of toxicity)

Mirtazapine (Remeron) Hypotension

Serotonin syndrome

Trazadone (Desyrel) Similar to SSRIs

Serotonin syndrome

Hypotension

Venlafaxine (Effexor) CNS sedation

Serotonin syndrome

Seizing patient refractory to

standard therapy? Consider

INH toxicity.