Alcohol + Drug Misuse Flashcards
Features of opioid intoxication?
Drowsiness
Confusion
Decreased respiratory rate
Decreased heart rate
Constricted pupils
“Track marks”
What are “track marks” in opioid intoxication?
Aka needle marks
If the intravenous route has been used; abscesses at injection sites; veins thrombosed and damaged causing difficulties with intravenous access
What are the features of opioid withdrawal?
Agitation
Anxiety and irritability
Muscle aches or cramps
Chills
Runny eyes
Runny nose
Sweating
Hypersalivation
Yawning
Insomnia
Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting
Dilated pupils
Piloerection
Increased heart rate and blood pressure
Dilated pupils
Piloerection
Increased heart rate and blood pressure
Are all features of opioid intoxication. True/false?
False
These are features of opioid withdrawal
What drugs can be used to help with opioid withdrawal?
Methadone: beware, may cause prolonged QTc
Lofexidine (alpha 2 receptor agonist)
Loperamide (for diarrhea)
Anti-emetics (for nausea)
Benzodiazepines (for agitation
What drug is administered immediately for opiate overdose?
Naloxone
What receptors do heroin act upon in the brain?
Opioid receptors
What are some features of alcohol intoxication?
Ataxic gait
Nausea and vomiting
Reduced GCS
Dysarthria (broken speech)
Impaired judgement
What is ataxic gait?
A failure of muscle coordination and is characterised by an irregular foot placement, wide base, and instability.
When do the effects of alcohol withdrawal typically become prominent?
Usually 12 hours after the last drink
Features of alcohol withdrawal?
Nausea and vomiting
Tremor
Sweating
Anxiety
Agitation
Headache
Clouding of consciousness
Prevention and treatment of alcohol withdrawal?
Short acting benzodiazepines such as chlordiazepoxide (Librium).
Oxazepam may be used if there is evidence of liver injury.
Supportive treatment for alcohol withdrawal?
Fluids, anti-emetics, and Pabrinex (to prevent Wernicke-Korsakoff’s syndrome.)
What is delirium tremens?
A life threatening medical emergency, and usually occurs at day 3 of alcohol withdrawal, and lasts 3 days
Features of delirium tremens?
Paranoid delusions, visual/auditory and classically haptic (tactile) hallucinations (sensation of crawling e.g. formication), and seizures.
Management for delirium tremens?
Oral lorazepam as first line, and if the oral route cannot be used for whatever reason, parenteral lorazepam or haloperidol.
What is wernicke-korsakoff syndrome?
A syndrome associated with chronic alcohol abuse that occurs due to B1 (thiamine) deficiency, resulting in mammillary body atrophy.
It is not exclusive to alcohol abuse, however, with any individual with severe nutritional deficiency at risk.
What is wernicke’s encephalopathy?
A reversible presentation (treated with high dose intravenous thiamine, e.g. Pabrinex)
Characterised by triad of ophthalmoparesis with nystagmus, ataxia and confusion
What vitamin is thiamine?
Vitamin B1
What is the classic tetrad (group of 4) symptoms for wernicke’s encephalopathy?
Confusion
Ataxia
Ophthalmoplegia: classically of the lacteral rectus, but can also be an internuclear ophthalmoplegia or upward-gaze defects
Nystagmus
What are some less classical features of Wernicke’s encephalopathy?
Urinary incontinence and hypothermia due to autonomic neuropathy therefore making normal pressure hydrocephalus a key differential/
What is korsakoff’s psychosis?
An irreversible manifestation of untreated Wernicke’s encephalopathy.
Triad of features for korsakoff’s psychosis?
Retrograde amnesia
Anterograde amnesia
Confabulation (create imaginary memories
Features of cannabis intoxication?
Drowsiness
Impaired memory
Slowed reflexes
Slowed motor skills
Conjunctival injection
Increased appetite
Paranoia and psychotic symptoms (contrast with cannabinoid associated schizophrenia, which has a more insidious onset, over many years)
Tachycardia
Dry mouth
Features of LSD intoxication?
Labile mood
Hallucinations
Increased blood pressure
Increased heart rate
Increased temperature
Sweating
Insomnia
Dry mouth
