Addiction and Overdose Flashcards
What are the effects of cocaine?
Stimulant and euphoriant
Increased alertness and energy
Increased confidence and impaired judgement
Lessens appetite and desire for sleep
How long does cocaine stay in the body?
approx 30 minutes
What are the side effects of cocaine use?
Palpitations
Psychosis
HTN
Both tachycardia and bradycardia
Mydriasis
Rhabdomylosis
Coronary artery spasm
What are the withdrawl signs of cocaine?
Depression
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia
How is cocaine toxicity managed?
Benzodiazepines, first line
Benzodiazepine + GTN, if chest pain
Benzodiazepine + sodium nitroprusside, if HTN
B blockers are contraindicated due to risk of coronary vasospasm
How long does amphetamine stay in the body?
Approx few hours
What are side effects of amphetamine?
Amphetamine psychosis in heavy chronic use
Toxic confusion occasionally with convulsions and death
Give examples of opiates
Opium
Morphine
Heroin (Diamorphine)
Methadone
Codeine
Dihydrocodein
What are the effects of opiates?
Analgesia
Drowsiness and sleep
Euphoria/Intense pleasure
Respiratory depression
Cough reflex depression
Bradycardia and hypotension
Lowering body temperature
Pupillary constriction
Constipation
What are the side effects of opiates?
N&V
Headache
Phlebitis
Anorexia
Constipation
What are the withdrawl signs of opiates?
Craving
Insomnia
Yawning
Muscle pain and cramps
Increased salivary, nasal and lacrimal secretions
Dilated pupils
Piloerection
What are the effects of ecstacy?
Relaxed euphoric state without hallucinations
Euphoria followed by a feeling of calm
Increased sociability
Inability to distinguish between what is and isn’t desirable
How long do the effects of ecstacy last?
2-4 hours
How quick do the effects of ecstacy come on?
20 minutes
What are the side effects of ecstacy?
Nausea and dry mouth
Increased blood pressure and temperature
Dehydration risk
Large doses can cause anxiety and panic
Drug induced psychosis
Liver and brain cell damage
What are the effects of cannabis?
Relaxing or stimulating
Euphoriant
Increases sociability and hilarity
Increases appetite
Changes in time perception,
Synaesthesia (merging of sense)
What are the side effects of cannabis?
Respiratory problems
Toxic confusion
Exacerbation of major mental illness
Cannabis psychosis
Anxiety and panic
Hallucinatory activity
What is the most toxic substance known to man?
Botulinium
What is the general management principals in toxicology?
ABCDE
IV fluids for hypotension
IV lorazepam if fitting
Decomtamination with activated charcoal
- Within 1 hour of overdose
- 50g
- Mostly effective against drugs that are toxic in low doses, such as CCB or TCA
- Not safe to give if drowsy, due to aspiration risk
Targeted investigations
Specific antidotes
What are the methods of active elimination?
Multiple doses of activated charcoal
Whole bowel irrigation to empty bowel quickly
Urinary alkalinization to enhance urinary excretion of weak acids by IV sodium bicarbonate
Haemodialysis
How does apsirin overdose present?
Tinnitus
N&V
Confusion
Dehydration
Initial respiratory alkalosis and later metabolic acidosis
How is aspirin overdose managed?
Gastric lavage
Activated charcoal if ingestion less than an hour ago
IV fluids
Alkaline diuresis with IV sodium bicarbonate
Dialysis may be needed if blood levels are high
How does opioid overdose present?
CNS and respiratory depression
Miosis
Apnoea
(Urinary retention, constipation)
How is opioid overdose managed?
Ventilation
Opioid antagonost/400mcg Naloxone
Opioid replacment therapy with methadone
Give features of paracetamol overdose
N&V
Pallor
Sweating
ALT and AST in 10,000s
Describe the process of paracetamol overdose
Less than 75mg/kg no risk of toxicity
More than 150mg/kg high risk of toxicity
Blood level at 4 hours dictates management
Hepato-toxicity occurs at 8 hours
Often asymptomatic in first 24 hours
If delayed presentation, uncertain timings or staggered overdose over an hour, start NAC before blood level
How is paracetamol overdose managed?
Activated charcoal if ingested < 1 hour ago
N-Acetyl Cysteine (NAC) infusion
Liver transplant
How is CCB overdose managed?
Calcium chloride
How is benzodiazepine overdose managed?
Flumazenil
Give features of b blocker overdose
Bradycardia
Hypotension
Heart failure
Syncope
How is b blocker overdose managed?
If bradycardic, IV atropine
In resistant cases glucagon may be used
Haemodialysis is not useful
Give features of tricyclic overdose
Early features
- Dry mouth
- Dilated pupils
- Agitation
- Tachycardia
- Blurred vision
Severe poisoning
- Seizures and QT prolongation and QRS widening
- Arrythmia
- Metabolic acidosis
- Coma
How is tricyclic overdose managed?
IV bicarbonate, first line therapy for hypotension or arrhytmias
