Chapter 101- Drug abuse Flashcards
Specific findings of drug use (5)
Dental caries Madarosis Scarring Tattooing Staining
Most widely used psychoactive substance in the world
Caffeine
Recurrent use of illegal drugs or the misuse of nonprescription or prescription drugs that results in negative consequences
Drug abuse
Characterized by physiologic dependence and inability to consistently abstain from the drug
Drug addiction
With the exception of caffeine, ___ is the most widely used drug in the world
Cannabis
Second most commonly used drug worldwide
Amphetamine
Cause the highest negative health impact
Opiates
‘The gateway drug’ is the most commonly used illicit drug
Marijuana
Central role in many neuropsychiatric conditions, including substance addiction
Dopaminergic neural pathways
Protective factors for drug use
Religiosity
Strong family support
Gold standard for diagnosis of most legal and illegal agents
Drug testing
Result of venous thrombosis with subsequenr scarring and pigmentation of the veins
Track marks
The most common site for track marks
Medial vein in the antecubital fossa of nondominant arm
Lack of track marks precludes IV drug use.
True or False
False, does not
Most common drugs associated with track marks
Cocaine
Heroin
Method of injecting intradermally or subcutaneously leaving irregular leukodermic atrophic scars that are irreversible
Skin popping
Lobular panniculitis can be induced by sclerosants such as ___ and diluents such as ___
Pentazocine
Talc
Most common disease for which users are admitted to the hospital
Skin and soft tissue infections
Overdose is the usual acute complication seen in the population.
True or False
False, sepsis
Skin popping has a ___fold greater risk of infection when compared to IV injection
5
Blood cultures are often negative in SSTIs.
True or False
True
Most frequently cultured organism
#1 Staphylococcus aureus #2 group A B hemolytic Streptococcus #3 Rikinella corrodens
Classic signs of anaerobic infection such as free air bubbles on radiograph or foul smell may not be present.
True or False
True
___, added to heroin, increases the risk of tetanus
Quinine
___ is ideal for the growth of botulism due to high water content
Black tar heroin
Diagnostic test of choice for botulism
Standard mouse bioassay of serum
Treatment of botulism
Antitoxin + high dose penicillIn + surgical debridement
___ has been reported among IV heroin users who ised lemon juice to dissolve the heroin
Disseminated candidiasis
___ can be achieved through the use of inhalants
Euphoria and delirium
Perioral or perinasal dermatitis in perioral or perinasal area associated with use of inhalants
Huffer’s rash
Helpful clue to inhalant-induced dermatitis
Yellow crust due to nitrates
Other terms for cocaine
C Coke Snow Flake Blow
Sympathomimetic that causes tachycardia, HPN, and mydriasis from Erythroxylum coca
Cocaine
Free base form of cocaine processed with ammonia or sodium bicarbonate
Crack
Nasal verrucae that can develop in cocaine users
Snorter’s warts
___ antibodies are found in patients with cocaine-induced midline destructive lesions
Anti human neutrophil elastase antibodies
Cocaine has been implicated in the ff:
8
Unmask or cause scleroderma, Raynaud phenomenon SJS, AGEP Urticarial vasculitis, Churg Strauss, necrotizing granulomatous vasculitis Buerger disease Halitosis Lip smacking Formication Madarosis Palmar hyperkeratosis
Common adulterant added to cocaine that can cause neutropeni, agranulocytosis, and vasculitis
Levamisole
Distinctive retiform purpura on the ears with or without lesions elsewhere (nose, cheeks, extremities)
Levamisole-induced necrosis syndrome (LINES)
Half life of levamisole
5-6 hours
High titers of __ are present in 70% of cases
Perinuclear antineutrophil antibodies and anti-MPO antibodies
Other terms for heroin
H
Junk
Ska
Smack
Opiate, synthesized from morphine that causes miosis, respiratory depression
Heroin
A heroin user may inject up to __ times a day
4
Heroin users can develop ___, esp on genitals and on their face
High pruritus
Heroin causes:
Urticaria Puffy hand syndrome Penile ulcers, necrotizing cellulitis of scrotum FDE, TEN Pemphigus vegetans Necrolytic migratory erythema Acanthosis nigricans
Alternatives to heroin
Tripelennamine with pentazocine (Ts and blues)
Induce a sense of euphoria and enhance senosry perception via effects on multiple neurochemical pathways; pimples and widespread guttate psoriasis
3,4- methylenedioxymethamphetamine (MDMA)
Induce euphoria and aphrodisiac, and a ‘reversible coma’ and short term memory loss
Gamma hydroxybutyrate
Liquid X
Liquid Ecstacy
Fantasy
It causes euphoria, increased energy, anxiety, aggression, hallucinations, and severe withdrawal.
Methamphetamine Meth Speed Chalk Ice Crystal Glass Crank
Signs of methamphetamine abuse (5)
Intense pruritus Body odor Weight loss Premature aging Hyperhidrosis
Consists of numerous dental caries and enamel erosions satrting at the gum line due to xerostomia, bruxism, and poor dental hygiene
Meth mouth
Treatment for narcolepsy
Amphetamine and methylphenidate
Found in ergot, alter one’s sense of time and sensory perception
Lysergic acid diethylamide
Mushrooms
Main cutaneous side effect of LSD
Dry mouth
Psychoactive compounds of LSD
Psilocybin
Psilocin
Clonazepam can cause (2)
Morbiliform hypersensitivity eruptions
Erythema multiforme
Other names for cannabis
Marijuana
Mary Jane
Pot
Weed
Psychoactive chemical compund of marijuana
9- tetrahydrocannabinol
For cannabis, oral consumption effects starts later than inhalation but can lasy as long as ___
6 hours
Serious vascular complication that can occur with chronic use of cannabis. It presents as peripheral ischemia of the lower limbs
Cannabis arteritis
Cannabis arteritis may be due to combine vasocontrictive effects of THC and
Arsenic
Difference of cannabis arteritis vs atherosclerosis
Cannabis arteritis: occlusion below the knee
Atherosclerosis: calcified plaques in iliofemoral areas
Treatment for cannabis arteritis
Low dose aspirin (81mg)
If severe, iloprost (2mkday)
Expand volume of drug to increase distribution
Diluent
Enhance the effects of main active ingredient or facilitate administration of drug
Adulterants
An adulterant in heroin which causes cardiac events
Clenbuterol
Combination of areca nut, betel elaf, slaked lime
Betel quid
Main stimulant of betel
Psychoactive alkaloid
Brownish red discoloration of buccal mucosa associated with irregular desquamation due to betel use
Chewer’s mucosa
Prodrome of oral dysethesia followed by palpable vertical fibrous bands that may require surgical interventions associated with betel use
Oral submucous fibrosis
Oral carcinoma can occur on the ff areas (2) due to betel use
Buccal areas of tongue
Labial mucosa
Synthetic opioid ten times more potent than heroin
Desomorphine
Krokodil
Drug of abuse in Russia that is highly addictive and causes scaly green black changes in users which also involves muscle and cartilaginous tissue
Desomorphine
Krokodil
Common cutaneous signs of alcohol abuse (3)
Spider angiomata
Palmar erythema
Telangiectasia
Latent congenital nevi that presents in the setting of alcohol-induced hyperestrogenism, often in C3-C4 distribution, as thread-like collections of fine telangiectasias
Nevoid telangiectasia
Systemic jaundice is seen when serum bilirubin levels reach greater than ___
2.5mg/dl
Classic nail change ‘Terry’s nails’ seen in liver cirrhosis is described as
Proximal nail: nontranslucent white
Distal nail: pink
Terry’s nails present in ___ of patients with alcoholic cirrhosis
80%
Hallmark cutaneous condition associated with alcohol abuse
Porphyria cutanea tarda
More than __ chemicals m found in tobacco smoke are known to be carcinogenic
70
Use of tobacco incites/worsens the ff conditions (4)
Psoriasis
Hidradenitis suppurativa
Subacute and chronic cutaneous lupus erythematosus
Smokers should not use __ due to high risk of lung cancer
B carotene supplements
Uniform keratosis of the hard palate with multiple umbilicated erythematous papules that are the inflamed orifices of minor salivary glands
Leukokeratosis nicotinica palati (nicotine stomatitis, smoker’s palate)
Homogenous white plaque that affects the anterior 2/3 of dorsal tongue
Leukokeratosis nicotinica glossae
Legally prescribed opioids that can produce analgesia
Hydrocodone
Oxycodone
Morphine
Codeine
Most common side effect of prescription opioids
CNS depression
Side effects may not reverse upon discontinuation of anabolic steroids.
True or False
True
Systemic side effects associated with anabolic steroid use
Hepatic enzyme elevation
Jaundice
HPN
Lipid abnormalities
Most common drug that cause madarosis
Cocaine
Heroin
Methamphetamine
Most common drugs that cause vasculitis
Cocaine
Levamisole
Cannabis
Tobacco
Most common drugs that cause Formication
Methamphetamine
Cocaine
Heroin
Alcohol
Most common drugs that cause acne
MDMA
Methamphetamine
Anabolic steroids
Cannabis