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toxodromes [2026/06/30 17:31] – [Sympathomimetic] Scott Larsontoxodromes [2026/06/30 17:54] (current) – Scott Larson
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 ====Anticholinergic====  ====Anticholinergic==== 
 This occurs when drugs block the action of acetylcholine in the parasympathetic nervous system.  This occurs when drugs block the action of acetylcholine in the parasympathetic nervous system. 
- +  * Common Agents 
-• Common Agents: Atropine, antihistamines, tricyclic antidepressants (TCAs), and plants like Jimson weed.  +    * Atropine 
-• Key Symptoms: Delirium, hallucinations, confusion, and muscle twitching. Often summarized by the classic mnemonic: "Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone."  +    * Antihistamines 
-• Vital Signs & Exam: Tachycardia, hyperthermia, dilated pupils, flushed (red) skin, and notably dry skin and mucous membranes (no sweating).+    * Tricyclic antidepressants (TCAs) 
 +    * Plants like Jimson weed.  
 +  * Key Symptoms 
 +    * Delirium, hallucinations, confusion 
 +    * Muscle twitching.  
 +    * Classic mnemonic: **"Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone."**  
 +  * Vital Signs & Exam:  
 +    * Tachycardia 
 +    * Hyperthermia 
 +    * Dry skin and mucous membranes (no sweating) 
 +  * Eye Findings: [[drugs_cause_miosis|Miosis]] 
  
 ====Cholinergic==== ====Cholinergic====
 This toxidrome is caused by overstimulation of parasympathetic nerves due to an excess of acetylcholine.  This toxidrome is caused by overstimulation of parasympathetic nerves due to an excess of acetylcholine. 
- +  * Common Agents 
-• Common Agents: Organophosphates (pesticides), nerve agents (e.g., Sarin), and certain medications like physostigmine.  +    * Organophosphates (pesticides) 
-• Key Symptoms: Often remembered with the mnemonic SLUDGE: Salivation, Lacrimation (tearing), Urination, Diarrhea, Gastrointestinal cramps, and Emesis (vomiting). Severe cases cause pinpoint pupils, muscle fasciculations, and respiratory distress.  +    * nerve agents (e.g., Sarin) 
-• Vital Signs & Exam: Profuse bodily secretions, constricted pupils, and potentially a slow heart rate (bradycardia).  +    * Meds like physostigmine.  
 +  * Key Symptoms: 
 +    * Mnemonic **"SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal cramps, and Emesis"**  
 +    * Severe cases cause pinpoint pupils, muscle fasciculations, and respiratory distress.  
 +  * Vital Signs & Exam:  
 +    * Profuse bodily secretions 
 +    * Bradycardia 
 +  * Eye Findings: [[drugs_cause_miosis|Miosis]]   
 + 
  
 ====Opioid==== ====Opioid====
 This toxidrome suppresses the central nervous system, mainly through the activation of mu-opioid receptors.  This toxidrome suppresses the central nervous system, mainly through the activation of mu-opioid receptors. 
  
-• Common Agents: Morphine, heroin, fentanyl, oxycodone, and codeine.  +  * Common Agents 
-• Key Symptoms: CNS depression ranging from extreme drowsiness to unresponsiveness or coma.  +    * Opioids: Morphine, heroin, fentanyl, oxycodone, and codeine 
-• Vital Signs & Exam: Severely depressed respiratory rate (bradypnea), constricted (pinpoint) pupils, low blood pressure (hypotension), and low body temperature. +  * Key Symptoms:  
 +    * CNS depression ranging from extreme drowsiness to unresponsiveness or coma.  
 +  * Vital Signs & Exam:  
 +    * Bradypnea 
 +    * Hypotension 
 +    * Hypothermia 
 +  * Eye Findings: [[drugs_cause_miosis|Miosis]] 
  
 ====Sedative-Hypnotic==== ====Sedative-Hypnotic====
 This syndrome results from the enhancement of GABA receptors, which generally slows down brain activity.  This syndrome results from the enhancement of GABA receptors, which generally slows down brain activity. 
- +  * Common Agents: 
-• Common Agents: Benzodiazepines (e.g., Valium, Xanax), barbiturates, ethanol (alcohol), and sleeping aids (Z-drugs).  +    * Benzodiazepines (e.g., Valium, Xanax) 
-• Key Symptoms: Drowsiness, slurred speech, confusion, and ataxia (loss of coordination).  +    * Barbiturates,  
-• Vital Signs & Exam: Depressed breathing, decreased reflexes (hyporeflexia), and low blood pressure. Unlike opioids, pinpoint pupils are generally not a feature of this toxidrome.+    * Ethanol 
 +    * Sleeping aids (Z-drugs) 
 +  * Key Symptoms 
 +    * Drowsiness, slurred speech, confusion, and ataxia 
 +  * Vital Signs & Exam:  
 +    * Depressed breathing 
 +    * Hyporeflexia 
 +    * Hypotension 
 +  * Eye findings: generally not a feature of this toxidrome.
  
 ====Resources==== ====Resources====
  
-  - [[https://www.youtube.com/watch?v=0UjhK1pCqJk| Youtube link]] +  - [[https://www.youtube.com/watch?v=0UjhK1pCqJk| 
-  - [[https://www.jove.com/science-education/v/17274/toxidromes-clinical-features|Toxodrome clinical features]]+Poisoning and Toxidromes: Definitions, Types & Diagnosis – Emergency Medicine]]
   - [[https://iem-student.org/2024/11/29/toxidromes-2024/ |Toxidrome Review]]   - [[https://iem-student.org/2024/11/29/toxidromes-2024/ |Toxidrome Review]]
-  - [[https://www.rch.org.au/clinicalguide/guideline_index/Toxidromes_poisoning/ Toxidrome Poisioning Clinical Guide]] +  - [[https://www.rch.org.au/clinicalguide/guideline_index/Toxidromes_poisoning/ |Toxidrome Poisioning Clinical Guide]] 
-  - [[https://www.youtube.com/watch?v=qwSaFlFvFeA |Youtube link]] +  - [[https://www.youtube.com/watch?v=qwSaFlFvFeA | Toxicology And Toxidromes by EM Note]] 
-  - [[https://emspodcast.com/episode/toxidromes-demystified-master-the-art-of-identifying-drug-overdoses-when-you-dont-know-what-they-took/| Demystifying Toxodromes]] +  - [[https://adc.bmj.com/content/110/9/681 |Paediatric emergency medicine: Toxidromes and a general approach to poisoning Free. Robert J Hoffman and Andrea Nillas. Archives of Disease in Childhood. 2025; 110(9):681-686]]
-  - [[https://adc.bmj.com/content/110/9/681 | Link]]+
   - [[https://emergencycarebc.ca/clinical_resource/clinical-summary/common-toxidromes-diagnosis-treatment/ | Common Toxodromes]]   - [[https://emergencycarebc.ca/clinical_resource/clinical-summary/common-toxidromes-diagnosis-treatment/ | Common Toxodromes]]
-[9] https://emspodcast.com/episode/toxidromes/ +  - [[https://en.wikipedia.org/wiki/Toxidrome| Wikipedia:Toxidrome]] 
-[10] https://www.youtube.com/watch?v=4JE0owcG85I +  - [[https://foamed.ebmedicine.net/rapid-reference/toxidromes/|EbMedicine Rapid Reference: Toxidromes]] 
-[11] https://en.wikipedia.org/wiki/Toxidrome +  - [[https://chemm.hhs.gov/toxicsyndromes.htm|CHEMM Toxidromes]]
-[12] https://foamed.ebmedicine.net/rapid-reference/toxidromes/ +
-[13] https://chemm.hhs.gov/toxicsyndromes.htm +
-[14] https://www.youtube.com/watch?v=UAOK66qAoBg +
-[15] https://pmc.ncbi.nlm.nih.gov/articles/PMC12429776/ +
-[16] https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/toxidrome +
-[17] http://www.thegasmanhandbook.co.uk/toxidromes.html +
-[18] https://www.jems.com/patient-care/emergency-medical-care/common-poisoning-syndromes-to-know/ +
-[19] https://www.tldrpharmacy.com/content/a-pharmacist-friendly-introduction-to-toxicology +
-[20] https://hospitalhandbook.ucsf.edu/content/03-toxidromes +
-[21] https://www.lecturio.com/concepts/general-principles-of-toxidromes/ +
-[22] https://quizlet.com/study-guides/major-toxidromes-symptoms-drugs-and-identification-ea3f9aa1-fd53-45db-a6bd-1b55d8f148e1 +
-[23] https://pmc.ncbi.nlm.nih.gov/articles/PMC12429776/ +
-[24] https://floridapoisoncontrol.org/healthcare-professional/toxidromes/ +
  
 +{{tag>drugs}}