Addiction, Overdoses + Toxicology

Question 1

Effect of chronic alcohol on body

Answer 1

Chronic alcohol consumption

• enhances GABA mediated inhibition in the CNS
• inhibits NMDA-type glutamate receptors

Question 2

Effect of alcohol withdrawal on body

Answer 2

Alcohol withdrawal

• decreases GABA
• increases NMDA-type glutamate receptors

Question 3

Alcohol withdrawal symptoms in 6-12 hours

Answer 3

tremor
sweating
tachycardia
anxiety

Question 4

Peak seizure time in alcohol withdrawal

Answer 4

36 hours

Question 5

Alcohol withdrawal symptoms in 48-72 hours

Answer 5

Delirium Tremens

coarse tremor
confusion 
delusions
hallucinations (A&V)
fever
tachycardia

Question 6

coarse tremor
confusion 
delusions
hallucinations (A&V)
fever
tachycardia

Answer 6

Delirium Tremens

Question 7

1st line for Alcohol withdrawal

Answer 7

Long acting benzodiazepines

• Chlordiazepoxide
• Diazepam
• Lorazepam (if hepatic failure)

Question 8

2nd line for Alcohol withdrawal

Answer 8

Carbamazepine

Question 9

How do you assess severity of alcohol withdrawal

Answer 9

Clinical Institute Withdrawal Assessment (CIWA-Ar)

Question 10

How do you identify alcohol withdrawal

Answer 10

CAGE Questionnaire

AUDIT Questionnaire

Question 11

2 medications to help alcohol abstinence

Answer 11

Disulfiram (Antabuse)

Acamprostate (Campral)

Question 12

MoA of Disulfiram

Answer 12

Acetaldehyde dehydrogenase inhibitor

• causes nausea, vomiting & flushing if you take with alcohol
• don’t give to frail patients

Question 13

MoA of Acamprostate

Answer 13

Stops cravings for alcohol

Question 14

2 medications to help opioid abstinence

Answer 14

Methadone (opioid mu receptor agonist)

Buprenorphine (mixed opioid agonist/antagonist)

Question 15

Biochemistry seen in Paracetamol overdose

Answer 15

Increased ALT
Increased AST

PTT is an indicator of liver failure

Question 16

Management of paracetamol overdose

Answer 16

N Acetylcysteine

Activated charcoal if < 1hr since ingestion

Question 17

Blue lines on gum
Abdo pain 
Peripheral neuropathy (motor)

Answer 17

Lead poisoning

Question 18

Management of lead poisoning

Answer 18

Dimercaptosucinic acid (DMSA)

Question 19

dehydration 
dilated pupils
hypotension 
tachycardia 
Prolonged QT

Answer 19

Tricyclic antidepressant overdose

Question 20

Management for tricyclic antidepressant overdose

Answer 20

IV Sodium bicarbonate

Question 21

Magnesium sulphate overdose can cause

Answer 21

Respiratory depression

Question 22

Management of magnesium sulphate overdose

Answer 22

Calcium gluconate

Question 23

High pyrexia + overdose

Answer 23

MDMA overdose

Question 24

Management of benzodiazepine overdose

Answer 24

Flumenazil

Question 25

Management of opioid overdose

Answer 25

Naloxone | - lasts 45 mins

Question 26

Management of cocaine overdose

Answer 26

Diazepam

Question 27

Management of heparin overdose

Answer 27

Protamine sulphate

Question 28

Management of beta-blocker overdose

Answer 28

Atropine | Glucagon

Question 29

Management of salicylate (aspirin) overdose

Answer 29

Alkalisation (IV bicarbonate) = 7.5-8 pH | Haemodialysis

Question 30

Mixed respiratory alkalosis + metabolic acidosis Hyperventilation Tinnitus

Answer 30

Salicylate (aspirin) overdose

Question 31

Management of lithium overdose

Answer 31

Haemodialysis

Question 32

Management of methanol overdose

Answer 32

Ethanol (competitive inhibitor)

Question 33

Management of warfarin overdose

Answer 33

Vit K | Prothrombin

Question 34

Management of cyanide overdose

Answer 34

Hydroxycoalbumin

Question 35

Management of organophosphates (insecticide) overdose

Answer 35

Atropine

Question 36

Management of lead overdose

Answer 36

Chelating agents: - Dimercaprol - Calcium edetate

Question 37

Management of iron overdose

Answer 37

Desferrioxamine

Question 38

Management of ethylene glycol (anti-freeze) overdose

Answer 38

Fomepizole Ethanol Haemodialysis

Question 39

Headache Nausea + vomiting Vertigo Confusion "Lives in a caravan"

Answer 39

Carbon Monoxide poisoning

Question 40

Investigations for Carbon Monoxide poisoning

Answer 40

Carboxyhaemoglobin levels = 10-30% Should be: <3% normal <10% smokers

Question 41

Management of carbon monoxide poisoning

Answer 41

O2 100%

Question 42

Confusion Green/yellow vision Nausea

Answer 42

Digoxin toxicity - predisposed by hypokalaemia

Question 43

Management of digoxin overdose

Answer 43

Digibind

Question 44

Management of LSD overdose

Answer 44

Lorazepam

Question 45

Management of local anaesthetic toxicity

Answer 45

IV 20% lipid emulsion

Question 46

``` Confusion Myoclonic jerks Vivid dreams Hallucinations Pin point pupils Respiratory depression ```

Answer 46

Opiod toxicity