| Cholinergic |
Insecticides (e.g. organophosphates) physostigmine, neostigmine, pyridostigmine, pilocarpine, nerve agents (e.g. Sarin) |
Muscarinic: Defecation, Urination, Miosis, Bradycardia, Bronchosecretions, Emesis, Lacrimation, Salivation, Sweating (DUMBBELSS)
Nicotinic: Mydriasis, Tachycardia, Weakness, Hypertension, Fasciculations (MTWtHF) |
Atropine (with pralidoxime if organophosphate poisoning) |
| Anticholinergic |
Antihistamines, antipsychotics, antidepressants (TCAs), anti-parkinsons, atropine, scopolamine |
Hyperthermia, dry skin, mydriasis, delirium, hallucinations, tachycardia, urinary retention, seizures (“Hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter”) |
Supportive care, consider physostigmine with toxicology |
| Sympathomimetic |
Cocaine, amphetamines, bath salts, synthetic cannabinoids, sedative/hyponotic withdrawal, pseudoephedrine, caffeine |
Hyperthermia, mydrasis, diaphoresis, tachycardia, arrythmias, hypertension, seizures |
None, supportive care; benzodiazepines as needed* |
| Opioid |
Morphine, heroin, hydromorphone, fentanyl |
Miosis, hypoventilation, somnolence, comatose, bradycardia, hypotension |
Naloxone |
| Sedative-hypnotic |
Benzos, barbiturates, alcohol, zolpidem |
CNS depression, confusion, stupor, coma |
None, supportive care only |
| Hallucinogenic |
Phencyclidine, LSD, MDMA “Ecstasy” |
Hallucinations, depersonalization, agitation, mydriasis (usually), tachycardia, hypertension, nystagmus |
None, supportive care only |
| Serotonin syndrome |
SSRIs, SNRIs, MOAIs |
Hyperreflexia, myoclonus, diaphoresis, flushing, diarrhea, hyperthermia, tachycardia, confusion, agitation, coma |
Supportive care; benzodiazepines as needed*; contact toxicology prior to using cyproheptadine |
| *for treatment of seizures, tachycardia, hypertension, agitation, and hyperthermia |
