Tricyclic antidepressants salicylates

Examples of the application of HPLC to the analysis of (a) acetaminophen, salicylic acid, and caffeine (b) chlorinated pesticides (c) tricyclic antidepressants and (d) peptides. (Chromatograms courtesy of Alltech Associates, Inc. Deerfield, IL). 

Sodium bicarbonate administration for cardiac arrest is controversial because there are few clinical data supporting its use, and it may have some detrimental effects. Sodium bicarbonate can be used in special circumstances (i.e., underlying metabolic acidosis, hyperkalemia, salicylate overdose, or tricyclic antidepressant overdose). The dosage should be guided by laboratory analysis if possible. 

Physostigmine salicylate Antilirium) Anticholinergics (including tricyclic antidepressants)... 

Amiodarone Benzodiazepines Chloramphenicol Cimetidine Disulfiram Ethanol (acute ingestion) Fluconazole Isoniazid Metronidazole Miconazole Omeprazole Phenacemide Phenylbutazone Succinimides Sulfonamides Trimethoprim Valproic acid Salicylates Tricyclic antidepressants Valproic acid... 

Drugs that may affect valproic acid include carbamazepine, charcoal, chlorpromazine, cholestyramine, cimetidine, erythromycin, ethosuximide, felbamate, lamotrigine, phenytoin, rifampin, and salicylates. Drugs that may be affected by valproic acid include carbamazepine, clonazepam, diazepam, ethosuximide, lamotrigine, phenobarbital, phenytoin, tolbutamide, tricyclic antidepressants, warfarin, and zidovudine. 

Forced diuresis is occasionally useful. It may cause volume overload or electrolyte disturbances. Forced diuresis is useful for phenobarbital, bromides, lithium, salicylate, or amphetamines overdoses. Do not use for tricyclic antidepressants, sedative-hypnotics, or highly protein-bound medications. The most common agents employed are furosemide and osmotic diuretics with mannitol. 

Some toxicants that affect body temperature are shown in Figure 6.11. Among those that increase body temperature are benzadrine, cocaine, sodium fluoroacetate, tricyclic antidepressants, hexachlorobenzene, and salicylates (aspirin). In addition to phenobarbital and ethanol, toxicants that decrease body temperature include phenothiazine, clonidine, glutethimide, and haloperidol. 

The gastrointestinal tract responds to a number of toxic substances, usually by pain, vomiting, or paralytic ileus (see Intestines, Section 6.4.5). Severe gastrointestinal pain is symptomatic of poisoning by arsenic or iron. Both of these substances can cause vomiting, as can acids, bases, fluorides, salicylates, and theophyllin. Paralytic ileus can result from ingestion of narcotic analgesics, tricyclic antidepressants, and clonidine. 

Both accidental and intentional overdose are relatively frequent and pose difficult management problems. Particular concern has been expressed for children, either because they gain access to parents tablets or have been treated for enuresis. During one year a Melbourne hospital admitted 35 children poisoned with tricyclic antidepressants (147). In 1979 it was reported that tricyclic antidepressants had replaced salicylates as the most common cause of accidental death in English children under the age of five. Concern was expressed about this (148), and Swiss federal statistics raised similar worries (149). 

Electrochemical detectors can be used in the oxidative mode for a wide range of drugs, including cannabinoids, haloperidol, morphine, paracetamol, phenothiazines, salicylic acid, and tricyclic antidepressants. Operation in the reductive mode is more difficult as dissolved oxygen must be removed from the eluent (K. Bratin et al, J. liq. Chromat., 1981,, 1777-1795). Reductive applications include chloramphenicol and benzodiazepines. 

Physostigmine sulfate and physostigmine salicylate (Antilirium) are cholinesterase inhibitors that are indicated as antidotes to poisoning from substances possessing anticholinergic properties such as imipramine, a tricyclic antidepressant. In addition, it has been used in open-angle glaucoma. 

B. Toxicodynamics Toxicodynamics is a term used to denote the injurious effects of toxins, ie, their pharmacodynamics. A knowledge of toxicodynamics can be useful in the diagnosis and management of poisoning. For example, hypertension and tachycardia are typically seen in overdoses with amphetamines, cocaine, and antimuscarinic drugs. Hypotension with bradycardia occurs with overdoses of calcium channel blockers, beta-blockers, and sedative-hypnotics. Hypotension with tachycardia occurs with tricyclic antidepressants, phenothiazines, and theophylline. Hyperthermia is most frequently a result of overdose of drugs with antimuscarinic actions, the salicylates, or sympathomimetics. Hypothermia is more likely to occur with toxic doses of ethanol and other CNS depressants. Increased respiratory rate is often a feature of... 

Monoamine oxidase inhibitors Phencyclidine Tricyclic antidepressants Increased metabolic rate Dinitrophenol and pentachlorophenol Salicylates Thyroid hormone... 

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