Which toxidrome increases heart rate, blood pressure, and agitation?

• A. Cholinergic Toxidrome
• B. Anticholinergic Toxidrome
• C. Sympathomimetic
• D. Opioid Toxidrome

Answer: (C)

The main idea here is recognizing patterns of toxidromes by the combination of vital signs and mental state. A sympathomimetic toxidrome produces overt sympathetic “fight-or-flight” effects: the heart speeds up (tachycardia), blood pressure rises (hypertension), and the person is agitated or anxious. This happens because these agents either release stored catecholamines or directly activate adrenergic receptors, mainly increasing beta1 activity in the heart to raise rate and contractility and alpha1 activity in vessels to raise pressure, with central nervous system stimulation driving agitation. Substances like cocaine, amphetamines, or pseudoephedrine fit this pattern, often with sweating as well.

Cholinergic toxidrome, in contrast, tends to involve excessive secretions and slowed heart rate, along with miosis and bronchorrhea. Anticholinergic toxidrome causes dry skin, hyperthermia, mydriasis, urinary retention, and delirium, but sweating is typically reduced. Opioid toxidrome shows pinpoint pupils, slowed breathing, and reduced consciousness, not the tachycardia and hypertension described.

So the described triad—increased heart rate, increased blood pressure, and agitation—most consistently points to a sympathomimetic toxidrome.