4. recreational drugs in A&E

Question 1

clinical features of alcohol withdrawal

Answer 1

increase pulse and BP
sweating
shaking
agitation
confused or hallucinating

Question 2

what is the pathophysiology behind alcohol withdrawal

Answer 2

alcohol potentiates GABA and is also an NMDA antagonist.

-inhibit Ca influx via NMDA glutamate receptors = reduce neuronal excitation

Question 3

Ddx for alcohol withdrawal

Answer 3

• aspiration pneumonia –> sepsis
• Wernicke-Korsakoff syndrome
• Central pontine myelinolysis

Question 4

what is an indication for delirium tremens

Answer 4

low chloride, Na and L

high ALT and GGT

Question 5

treatment for alcohol withdrawal

Answer 5

• Benzos (potentiate GABA)
• Pabrinex (mix of vitamins, including thiamine to prevent WKS)
• correct electrolytes slowly

Question 6

what is GHB/GBL

Answer 6

gamma hydroxybutyrate

gamma butylactone

Question 7

acute effects of GHB/GBL

Answer 7

euphoria
altered time perception
'G slouch and G dribble'
bradycardia
hypotension
respiratory depression

Question 8

MoA of GHB and GBL

Answer 8

• GHB= GABA analogue. binds to pre-synaptic GABA-b receptors (high doses bind to post-synaptic)
• decreases GABA release (high doses inhibit post synaptic neurone)

Question 9

treatment for GBH/GBL withdrawal

Answer 9

1. Benzos: diazepam 20mg, may need 80mg/24hr (max 300mg)
2. baclofen 20mg (GABA-B agonist)
3. anaesthetics e.g. propofol

Question 10

opioid presentation in A&E

Answer 10

unconscious?
hypotensive
bradycardia 
respiratory depression 
hypoxia
CONSTRICTED PUPILS
underweight
track marks

Question 11

treatment of opioid overdose

Answer 11

naloxone 400mg injection
high potency opioid antagonist (dont give a lot otherwise withdrawal)
60-90min half llife

Question 12

respiratory effects of opioid

Answer 12

opioid receptors in respiratory centres in brainstem and medulla.
slows respiration

Question 13

what is spice/SCRAs

Answer 13

synthetic cannabinoid receptor antagonists