118b - Substance Intoxication and Withdrawal Flashcards
List some of the symptoms of stimulant withdrawal
-
Depression, dyspohria
- High risk of suicidality
- Appetite stimulation, cravings
- Fatigue
- Sedation, slowing
- Irritability
A patient is experiencing alcohol withdrawl 24 hours after their last drink
What symptoms might they be experiencing?
- ANS hyperactivity
- Seizures
- Hallucinations
Key here is that the stages of withdrawal overlap
List some of the signs of opioid withdrawal
Every orifice is open and excreting things (kind of like cholinergic toxicity)
- Vomiting, diarrhea
- Sweating
- Tearing
- Pupil dilation
- Tremor, restlessness
- Anxiety/irritability
- Piloerection
Which receptors are acted on by cannabinoids?
What are the effects?
- CB1
- CNS effects: analgesia, psychoactive, GI
- THC is a partial agonist
- CBD is an antagonist
- CB2
- Immune tissue
How should alcohol withdrawal seizures be managed?
Usually generalized tonic-clonic seizures
- Benzos or barbituates acutely
- Phenytoin (anticonvulsants) is less effective in alcohol withdrawal seizures
List some of the findings of opioid intoxication
Which one is most consistently found?
- Meiosis (constricted pupils) - very consistent finding w/opioid intoxication
- Euphoria, mood changes
- Respiratory depression
- Constipation, dry mouth, flushing
- Impaired reflexes
What is the difference between cannabis sativa adn cannabis indica?
- Sativa = more THC
- Energizing -> productive, creative
- Indica = more CBD
- Relaxing, anxiolytic
List 2 commonly used illicit stimulants
Cocaine
Methamphetamine
What are the risk factors for delirium tremens?
Risk factors:
- Sustained alcohol use (chronic drinking)
- Prior history of delirium tremens
- Age 30+
- Concurrent medical illness
- Withdrawal begins while still intoxicated
Note: 95% of people who experience alcohol withdrawal DO NOT have delirium tremens
Which illicit substance is most likely to cause serotonin syndrome?
MDMA (aka molly, ecstacy)
What pathophysiologic changes occur with prolonged drinking?
- Downregulation of GABAa receptors
- Alcohol stimulates GABAa receptors;
constant stimulation -> downregulation
- Alcohol stimulates GABAa receptors;
- Upregulation of NMDA receptors
- Alcohol inhibits the NMDA receptor;
constant block -> upregulation
- Alcohol inhibits the NMDA receptor;
In alcohol withdrawal, when does delirium tremens typically occur?
3-5 days after last drink
May be 7-8 days for heavy drinkiers
95% of people who experience alcohol withdrawal WILL NOT have delirium tremens
List some of the symptosm of MDMA intoxication
- Euphoria
- Sense of connectedness
- Enhanced visual, tactile senses
- Extroversion
- Well-being
- Negative effects
- Nausea, bruxism, motor restlessness
- Serotonin syndrome possible
What is cannabinoid hyperemisis syndrome?
When does it occur?
- Recurrent nausea and vomiting
- Dehydration
- Relief with hot showers
Usually happens when stopping after years of daily use
How do synthetic cannabinoids differ from cannabis?
- More potent (full agonist on CB1)
- Longer acting
- Structurally different from THC
- Not detected on urine drug screen
