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Accidental overdose

Clinical Discipline(s)/Organ System(s)
Clinical Biochemistry, Clinical Pharmacology, Emergency Medicine
Progress Test Topic(s)
Seriously ill patient
Description
An 82 year old Māori man attends the Emergency Department feeling awful. He has recently had his medication list changed but he has been using both his old and new blister packs.
Applied Science for Medicine 
   - Principles of pharmacokinetics and pharmacodynamics; principles of drug absorption, transportation, metabolism and excretion
   - Mechanisms of interactions between medications
   - Pharmacology of calcium channel blockers, beta adrenoceptor blocking drugs, digoxin, opioids, aspirin, paracetamol, warfarin and tricyclic antidepressants
   - Effects at toxic dose of calcium channel blockers, beta adrenoceptor blocking drugs, digoxin, opioids, aspirin, paracetamol, warfarin and tricyclic antidepressants
Clinical and Communication Skills 
   - History and/or a collateral history from a patient who has taken an accidental overdose; consider deliberate self-harm
   - Examination of a patient who has taken an accidental overdose
   - Perform venepuncture, ECG
   - Obtain a patients medication list from different sources (e.g. pharmacy, GP) and review prescribed medicines
   - Differential diagnosis of accidental overdose
   - Generic management of an overdose
   - Interpret urine toxicology, drug levels,blood glucose level, full blood count, arterial blood gas, coagulation screen, digoxin level, ECG, chest X-ray
   - Indications for continuous cardiac monitoring
   - Common antidotes; especially cover paracetamol, warfarin, opioid and tricyclic antidepressant overdoses
   - Medication errors; management of polypharmacy
   - Role of the pharmacist in dispensing and medication reconciliation
   - Clinical toxicology; sources of help with overdoses
Personal and Professional Skills 
   - Consent: information and understanding
   - Patient education concerning appropriate medication use
   - Risk:benefit ratio of medications
   - Discuss prescribing decisions with colleagues
   - Role of the Accident Compensation Corporation
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing pharmaceutical profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ
Population Health 
   - Epidemiology of polypharmacy
Conditions to be considered relating to this scenario
Common
overdose (paracetamol; aspirin; beta-blockers; calcium channel blockers; digoxin; warfarin; opioids; tricyclic antidepressants), dementia, alcohol abuse/dependence