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- Discussion:
- anticholinergic crisis in w/ antidepressant overdose presents as:
- mydriasis, blurred vision, urinary retension, dry mucous membranes,
constipation, ileus, sinus tachycardia, hyperthermia or hypothermia,
confusion, agitation, and hallucinations;
- acidosis potentiates TCA toxicity;
- respiratory acidosis is treated w/ intubation and hyperventilation;
- drug interactions:
- anesthetic agents:
- combination of halothane, pancuronium, & tricyclic antidepressants,
can cause severe ventricular arrhythmias;
- interaction w/ neuroleptic agents,
- combination of drugs should be especially avoided in the elderly;
- least potent antipsychotics (Chlorpromazine & Thioridazine tend to
be most sedating and to have most anticholinergic effects;
- use of such drugs in combination w/ antidepressant that also has
high anticholinergic activity may cause toxic anticholinergic
reactions, including delirium;
- autonomic side effects are also relatively frequent w/ less
potent neuroleptics, & resultant hypotensive episodes may
predispose to falls, myocardial infarction, or CVA;

Original Text by Clifford R. Wheeless, III, MD.