A woman consumes several tabs of Amitryptilline (case of amitryptiline poisoning). All of the following can be done except -

Ans. is 'd' i.e., Atropine as antidote o This question is straight forward and you can solve this one, even if you don't know the treatment of TCAs poisoning. As you all know that TCAs cause antichlolinergic side effects, atropine (an anticholinergic drug) cannot be used in TCAs poisoning. Treatment of TCAs Poisoning o Treatment of TCAs overdose includes: (i) Assessment and treatment ofABC: Airway protection should be done. (ii) Gastric lavage (gastric decontamination): Gastric lavage may be considered for potentially life threatening TCA overdoses only when it can be delivered within 1 hour of ingestion and the airway is protected. Activated charcol may reduce the absorption of TCAs. (iii) Alkalinization: The use of sodium bicarbonate in TCA poisoning has been shown to have beneficial effects. A lkalinization correct hypotension and arrhythmias. Sodium bicarbonate is indicated when: (i) pH < 7.1; (ii) RS > 0.16 seconds; (iii) QRS > 100 msec; (iv) Arrhythmias; (v) Hypotension. (iv) IVfluids: IV fluids are given for hypotension. In cases refractory to the use of IV fluids inotropic agents may be required. (v) Anticonvulsants: Seizures are usually self limited but where treatment is necessary benzodiazepines are the treatment of choice. (vi) Drug elimination: Tricyclic specific antibody fragments have been developed and their effectiveness at reversing cardiovasular toxicity in animals has been demonstrated by several studies. However, experimental work has shown that extremely large amounts are required and at present the use of Fab fragments is limited by cost and possibility of renal toxicity. Hemodialysis and hemoperfusion are not effective.