Toxin Induced Altered Level of Consciousness Causes

Aka: Toxin Induced Altered Level of Consciousness Causes, Drug Induced Altered Level of Consciousness Causes

1. See Also
   1. Dementia
   2. Delirium
   3. Altered Level of Consciousness
2. Risk factors: Medication induced Altered Level of Consciousness
   1. Age over 60 years old
3. Medications: Neuro-Psychopharmacologic Agents
   1. Anticholinergics (e.g. Atropine)
      1. See Anticholinergic Medications
      2. See Anticholinergic Toxicity
   2. Anticonvulsants
      1. Delirium or Confusion
      2. Cognitive Impairment
      3. Amnesia
   3. Barbiturates
      1. Delirium or Confusion
      2. Incoordination
      3. Barbiturate withdrawal related signs
   4. Benzodiazepines (esp. high dose longer acting agents)
      1. Cognitive Impairment
      2. Amnesia
      3. Sedation
      4. Pseudo-Dementia
      5. Incoordination
      6. Benzodiazepine Withdrawal (e.g. Delirium)
         1. Higher risk with shorter acting Benzodiazepines
   5. Tricyclic Antidepressants (e.g. Elavil, Doxepin)
      1. Delirium
      2. Confusion
      3. Impaired Memory
   6. Selective Serotonin Reuptake Inhibitors (SSRIs)
      1. Decreased concentration
      2. Confusion associated with SIADH
   7. Antipsychotics
      1. Effects
         1. Delirium or confusion
         2. Cognitive Impairment
         3. Amnesia
      2. High risk
         1. Chlorpromazine
         2. Thioridazine
         3. Clozapine
      3. Low risk
         1. Risperidone
   8. Lithium
      1. Organic brain syndrome
   9. Zolpidem (Ambien)
      1. Memory Impairment
      2. Hallucinations
4. Medications: Analgesics
   1. Salicylate Poisoning
   2. NSAIDs (especially Indomethacin)
      1. Delirium or confusion
      2. Cognitive Impairment
      3. Delirium
   3. Narcotic Analgesics (esp. Demerol, Fentanyl Patch)
      1. Delirium or confusion
      2. Cognitive Impairment
5. Medications: Drugs of Abuse and Toxins
   1. See Cholinergic Toxicity (e.g. Organophosphate Poisoning)
   2. Alcohol
   3. Opiates (See Analgesics above)
   4. Hallucinogens (LSD, PCP, Cocaine)
   5. Carbon Monoxide
   6. Cyanide
   7. Heavy metals
6. Medications: CardioPulmonary agents
   1. Beta Blockers
      1. Confusion
      2. Cognitive Impairment
   2. Calcium Channel Blockers
      1. Cognitive decline
   3. Acetazolamide (Diamox)
      1. Confusion
   4. Digoxin
      1. Confusion or Delirium
   5. Disopyramide (Norpace)
      1. Psychosis (Anticholinergic related)
   6. Ethacrynic Acid
      1. Confusion
   7. Nitroprusside
      1. Confusion or Delirium
   8. Procainamide
      1. Delirium
   9. Quinidine
      1. Confusion
      2. Psychosis
   10. Theophylline
       1. Psychosis
7. Medications: Infectious Disease Agents
   1. Beta lactam antibiotics
      1. Confusion
   2. Fluoroquinolones
      1. Neurologic stimulation
      2. Confusion
   3. Acyclovir
      1. Confusion
   4. Mefloquine
      1. Confusion
      2. Psychosis
   5. Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
      1. Delirium
      2. Psychosis
8. Medications: Antihistamines
   1. See Anticholinergic Medications
   2. See Anticholinergic Toxicity
   3. H1 blocker
      1. Effects
         1. Decreased attention
         2. Decreased Concentration
      2. High risk: Sedating Antihistamine
      3. Low risk: Fexofenadine, Loratadine
   4. H2 Blocker (esp. Cimetidine)
      1. Delirium or confusion
9. Medications: Miscellaneous
   1. Corticosteroids (Prednisone at doses above 60 mg)
      1. Confusion of Delirium
      2. Memory Impairment
   2. Baclofen
      1. Psychosis
   3. Cyclobenzaprine (Flexeril)
      1. Delirium or confusion
   4. Cyclosporine
      1. Confusion
   5. Fenfluramine
      1. Confusion
   6. Interferon alpha
      1. Confusion
      2. Memory Impairment
   7. Omeprazole (Prilosec)
      1. Confusion
      2. Agitation
      3. Memory Impairment
10. References
    1. Gray (1999) Drug Saf 21:101 [PubMed]
    2. Moore (1999) Drugs Aging 15:15 [PubMed]