drug abuse: presentation and treatment

Question 1

cause constricted pupils

Answer 1

opoids, nicotine (usually), sympatholytic agents

Question 2

cause dilated pupils

Answer 2

sympathomimetic agents, amphetamine and derivatives, cocaine, LSD

Question 3

cause horizontal nystagmus

Answer 3

barbiturates, ethanol, carbamazepine, phenytoin, scorpion venom

Question 4

causes horizontal and vertical nystagmus

Answer 4

PCP

Question 5

alcohol effects

Answer 5

CV and respiratory depression, relaxation of smooth muscle (vasodilation, hypothermia, increased gastric flow); relaxes uterine smooth muscle

Question 6

insomnia, tremor, anxiety; seizures, N/V, arrhythmia

Answer 6

alcohol withdrawal

Question 7

cause disulfiram like effects

Answer 7

sulfonylureas, cefotetan, ketoconazole, procarbazine

Question 8

alcohol interactions

Answer 8

increase tox of acetaminophen, increased risk of bleeding with NSAIDs and anticoagulants; increased risk of hypoglycemia with diabetic medicine; increased risk of teratogenicity via changes in metabolism

Question 9

heroine effects

Answer 9

IV: after injection - rush; euphoria, dry mouth warm sensation
later: “on the nod” - drowsy state

Question 10

acute opiate intoxication

Answer 10

shallow and slow respirations, pupillary mitosis, bradycardia, hypothermia, stupor or coma - death from CV or respiratory collapse
seizures with mixed intoxication

Question 11

methodone unique effect

Answer 11

QT prolongation

Question 12

goal of naloxone administration

Answer 12

reverse respiratory depression

Question 13

marijuana intoxication

Answer 13

2 cardinal signs: increased HR, reddened eyes
cognitive dysfunction, changes in perception, and reaction time impairment;
panic and paranoia uncommon except in psychotic patients

Question 14

marijuana mechanism

Answer 14

binds presynaptic CB1 receptors and prevents the release of GABA or glutamate; this leads to disinhibition of DA neurons in the VTA and to the feeling of euphoria

Question 15

cause rhabdomyolysis

Answer 15

amphetamines and derivatives, clozapine, lithium, cocaine, MAOIs, PCP

Question 16

rhabdomyolysis treatment

Answer 16

hydration to avoid renal failure, alkalinize urine with sodium bicarb to prevent myoglobin deposition in renal tubules

Question 17

cocaine mechanism

Answer 17

inhibits the DAT, prevents reuptake of DA - decreasing DA clearance from the synaptic cleft and causing an increase in extracellular DA conc.

Question 18

amphetamine mechanism

Answer 18

competitively inhibits VMAT causing the free concentration of DA in the presynaptic terminal to rise and the DAT reverses its pumping to expel the DA into the synaptic cleft

Question 19

used to decrease cravings in alcoholics

Answer 19

naloxone

Question 20

acts by increasing the non-vesicular release of DA from DA neurons

Answer 20

amphetamine

Question 21

zero order kinetics

Answer 21

ethanol, phenytoin, high dose aspirin

Question 22

heroin addiction detox

Answer 22

buprenorphine first then naltrexone

Question 23

delirium tremens associated with

Answer 23

hyperadrenergic state - alcohol intoxication; also causes visual hallucinations

Question 24

can be lethal when used with an opoid

Answer 24

alcohol

Question 25

hippuric acid positive urine

Answer 25

inhaled hydrocarbons

Question 26

treatment for cocaine or amphetamine intoxication

Answer 26

benzo for anxiety, nitroglycerin or phentolamine for HTN - do not give pure beta-blocker, give labatolol
adenosine or lidocaine for ventricular arrhythmia
alkalinize urine

Question 27

cocaine and amphetamine intoxication

Answer 27

dose-dependent increase in HR and P; increased arousal, vigilance, alertness,; sense of self-confidence and well-being (euphoria in high doses); dilated pupils

Question 28

MDMA, ephedrine, methcathinone, and derivatives intoxication symptoms

Answer 28

similar to cocaine or amphetamine: anxiety, tremulousness, tachycardia, hypertension diaphoresis, dilated pupils agitation, muscular hyperactivity, and psychosis;
muscle hyperreactivity may lead to metabolic acidosis and rhabdomyolysis
hyponatremia after MDMA

Question 29

PCP and ketamine mechanism

Answer 29

bind to different receptors in the CNS with varying degrees of affinity; an increasing concentration is necessary to achieve the various clinical effects; at lower doses, glutamate signaling is inhered by drugs like PCP; CV effects occur through increased sympathetic activity following inhibition of MAO

Question 30

PCP or ketamine intoxication

Answer 30

mild intoxication: lethargy euphoria, hallucinations, and occasionally bizarre or violent behavior; hyper salivation and lacrimation may occur, abrupt sings from quiet catatonia to loud or agitated behavior
severe intoxication: rapidly fluctuating behavior, vertical nystagmus, and sympathomimetic signs; pupils are sometimes paradoxically small

Question 31

LSD clinical features

Answer 31

mydriasis, tachycardia, anxiety, muscle tension

Question 32

Ssilocybin clinical features

Answer 32

mydriasis, tachycardia, anxiety, N/V; muscle tension

Question 33

Mescaline (peyote) clinical features

Answer 33

mydriasis, abdominal pain, N/V, dizziness, nystagmus, ataxia

Question 34

treatment of LSD OD

Answer 34

supportive, benzodiazepines, haloperidol for psychosis

Question 35

inhaled hydrocarbon presentation

Answer 35

confusion, ataxia, lethargy, headache, arrhythmias, syncope, coma, and respiratory arrest,
may cause hepatic and renal damage
skin or eye contact causes local irritation, burns, or corneal injury;