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So my toxicology professor told us that the best drugs to commit suicide with would be Tricyclic Antidepressants. I'm trying to figure out, why is it these over CNS depressants?
So my toxicology professor told us that the best drugs to commit suicide with would be Tricyclic Antidepressants. I'm trying to figure out, why is it these over CNS depressants?
physostigmine....Relatively quick, very effective. Not so peaceful until you get through the anticholinergic psychosis though.
But we do have an antidote. It covers two mechanisms for reversing toxicity. What is it and what are the mechanisms?
Not my first choice. Or fourth.
in my experience working within a tox service at a level 1 trauma hospital, activated charcoal is rarely used for several reasons but mostly due its risk for aspiration and lack of accurate information about actual timeline of ingestion to presentation (unless it is witnessed)...Activated charcoal if it's early enough, NaBicarb for acidosis, lidocaine for arrythmia, and dopamine for heart block or hypotension.
Supposedly due to CNS depression, it can take longer to digest.in my experience working within a tox service at a level 1 trauma hospital, activated charcoal is rarely used for several reasons but mostly due its risk for aspiration and lack of accurate information about actual timeline of ingestion to presentation (unless it is witnessed)...
in my experience working within a tox service at a level 1 trauma hospital, activated charcoal is rarely used for several reasons but mostly due its risk for aspiration and lack of accurate information about actual timeline of ingestion to presentation (unless it is witnessed)...
Supposedly due to CNS depression, it can take longer to digest.
How does altered mental status affect absorption
Here is an interesting article to consider when discussing the treatment of TCA overdose... It was published by the group I worked with and seems to offer a promising treatment modality for the future. I know its a case report but there are many more where this came from but are simply unpublished as of yet.
Clin Toxicol (Phila). 2009 Apr;47(4):303-7.
High dose insulin in toxic cardiogenic shock.
Holger JS, Engebretsen KM, Marini JJ.
Department of Emergency Medicine, Regions Hospital, St. Paul, MN 55101, USA.
Abstract
OBJECTIVE: To report the successful use of high dose insulin (HDI) in previously unreported insulin dosing ranges in a patient with severe myocardial toxicity due to an amitriptyline and citalopram overdose.
CASE REPORT: A 65-year-old female presented in respiratory arrest, which was followed by bradycardic pulseless electrical activity after ingesting multiple medications. After a prolonged resuscitation, the patient was maintained only on infusions of norepinephrine (40 mcg/min), vasopressin (4 units/h), insulin (80 units/h), and sodium bicarbonate. Due to a deteriorating clinical condition and limited prognosis, the insulin infusion was titrated incrementally upwards to 600 units/h (6 units/kg/h) over a 5 h time period while simultaneously completely weaning off both vasopressors. She developed brisk pulses and warm extremities, and her cardiac output nearly tripled. After 2 days of stabilization the insulin was slowly tapered, and the patient recovered.
DISCUSSION: HDI as a single cardiovascular agent significantly improved clinical and cardiovascular parameters after the failure of vasopressor therapy in severe cardiovascular toxicity. Higher doses of insulin than previously recommended may be needed in toxic poisonings when severe myocardial depression is present.
So my toxicology professor told us that the best drugs to commit suicide with would be Tricyclic Antidepressants. I'm trying to figure out, why is it these over CNS depressants?
I don't know anything about that. Maybe drunk people? Tricyclics are highly lipophilic, so please, enlighten me. The source specifically talked about delayed gastric emptying.How does altered mental status affect absorption
:I don't know anything about that. Maybe drunk people? Tricyclics are highly lipophilic, so please, enlighten me. The source specifically talked about delayed gastric emptying.
Anticholenergic properties leading to delayed gastric emptying and CNS depression are similar descriptors... in my mind. Loli think njac was attempting to point out that AMS does not directly affect absorption and was responding to your comment: "Supposedly due to CNS depression, it can take longer to digest."
what is supposedly due to CNS depression? how does CNS depression increase "digestion time"? does the term "digestion" refer to absorption or metabolism?
not sure what you were going for there ...
I don't know anything about that. Maybe drunk people? Tricyclics are highly lipophilic, so please, enlighten me. The source specifically talked about delayed gastric emptying.
Anticholenergic properties leading to delayed gastric emptying and CNS depression are similar descriptors... in my mind. Lol
It just shows that I suck at being a woman. I can't get anything across. My manipulation skills are too weak. Lol!ahhh, i am beginning to follow you now... typical woman, expecting you to read her mind haha jk
It just shows that I suck at being a woman. I can't get anything across. My manipulation skills are too weak. Lol!
Well. If being a woman meant saving money and being thrifty, then I'd be top notch. But no. Today, it's about spending, not saving, and preferably, it's about spending someone else's money. Oh well... Maybe next lifetimeoh come on now, don't be so hard on yourself
Cyanide is still the best.
On 2nd thought, maybe this thread should be deleted...
Why? It's a legit discussion about pharmacy.
Certainly, a discussion of toxicology is interesting and potentially educational for SDN members, and I initially contributed to this thread in that spirit. But we have an uncommon knowledge of poisons, and I don't think it's appropriate for us to be using our professional knowledge to discuss the most effective way to kill yourself on the internet.
I keep thinking about this. Does norepi displace TCAs?Why is norepi preferable to bicarb in tca-associated hypotension, particularly if pt on tca chronically?
I keep thinking about this. Does norepi displace TCAs?
Ok. I'll pull the package insert when I get to work on a few things... if they're still attached to the bottles!Nope! But something else does.
LOL! Reminds me of that time on another forum where I posted a formula of how to create really cool purple crystals. Anyone who had common sense would have known not to do it (ammonia and bleach were some of the reagents), but apparently some turd actually did it and came back to the forum bitching.
Ok. I'll pull the package insert when I get to work on a few things... if they're still attached to the bottles!
I had planned on looking in the pharmacology and toxicology sections...These aren't answers youll find in package inserts...
Only took 2 hours to drive the 11 miles home from my offsite rotation!
that's part of it. But it's particularly in patients with chronic TCA use.
What about TCA's mechanism as an antidepressant would make it more amenable to exogenous Norepinephrine than Dopamine?
Ok my point about NE depletion was answered, but again, why NE over DA? Physiologically/Mechanistically?
Ok my point about NE depletion was answered, but again, why NE over DA? Physiologically/Mechanistically?
Well I'm going off the top of my head, but I'm giving a lecture on TCA-toxicity next week at a top-10 pharmacy school. I don't mind if the youngins are looking things up.
let a resident take a crack at this case:
Patients die of TCA OD due to arrhythmia and seizures.
my guess is phenytoin, takes care of the arrhythmia and seizure problem.
Phenytoin has a narrow therapeutic window and there is a possibility it can interact with TCAs?NO.
But why?