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Drug Intox and Withdrawal Flashcards

1
Q

Depressant intoxication nonspecific effects?

A

Mood elevation, decrease anxiety, sedation, behavioral disinhibition, respiratory depression

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2
Q

Depressant withdrawal non specific effects?

A

anxiety, tremor, seizures, insomnia

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3
Q

Alcohol intox?

A

Emotional lability, slurred speech, ataxia, coma, blackouts. Serum GGT is an indicator of use. AST = 2xALT

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4
Q

Alcohol withdrawal?

A

Milder: similar to other depressants
Severe: autonomic hyperactivity and DT’s

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5
Q

Treatment for alcohol withdrawal?

A

Time

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6
Q

Treatment for DTs?

A

Benzodiazepines

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7
Q

Opiod intox?

A

Euphoria, resp and CNS depression, decreased gag reflex, pupillary CONSTRICTION (pinpoint), seizures

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8
Q

Treatment for Opiod intox?

A

Naloxone/Naltrexone

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9
Q

Opiod withdrawal?

A

Sweating, dilated pupils, piloerection (“cold turkey”), fever rhinorrhea, yawning, nausea, stomach cramps, diarrhea (FLS).

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10
Q

Opiod withdrawal treatment?

A

Long term support, methadone, buprenorphine

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11
Q

Barbituate intox?

A

Low safety margin, rest depression (esp w/ alcohol)

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12
Q

Barb intox tx?

A

Symptomatic management (assist respiration, increase BP)

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13
Q

Barb withdrawal?

A

delirium, life threatening cardiovascular collapse

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14
Q

Benzodiazepine intox?

A

Greater safety margin, ataxia, minor reap depression

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15
Q

Benzo intox tx?

A

Supportive care, Flumazenil* (competitive benzo antagonist)

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16
Q

Benzo withdrawal?

A

Sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reversal with fumazenil)

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17
Q

Nonspecific stimulant intox?

A

Mood elevation, psychomotor agitation, insomnia, cardia arrhythmias, tachycardia, anxiety (hyperexcited)

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18
Q

Nonspecific stimulant withdrawal?

A

Post-use “crash”, depression, lethargy, weight gain, h/a

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19
Q

MOA Amphetamines?

A

Release of catecholamine stores

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20
Q

Amphetamine intox?

A

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoid, fever

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21
Q

Severe amphetamine intox?

A

Cardiac arrest/seizure

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22
Q

Amphetamine withdrawal?

A

Anhedonia, increased appetite, hyper somnolence, existential crisis

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23
Q

Cocaine MOA?

A

Block reuptake of NE, 5-HT, Dopamine

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24
Q

Cocaine intox?

A

Impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudde cardiac death

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25
Cocaine intox treatment?
Benzos
26
Cocaine withdrawal?
Hypersomnolence, malaise, severe psychological craving, depression/suicidality
27
What are caffeine and nicotine CI'd in?
MI b/c arrhythmia
28
Caffeine intox?
restlessess, diuresis, muscle twitching
29
Caffeine withdrawal?
Lack of concentration, h/a
30
Nicotine intox?
Restlessness (DIT: premature atrial/ventricular contractions)
31
Nicotine withdrawal?
Irritability, anxiety, craving.
32
Nicotine withdrawal tx?
Nicotine patch, gum, or lozenges; Or Buproprion/Vernicline
33
What is the treatment to prevent relapse for alcoholics? (DIT)
1) AA 2) Disulfram -> you'll get sick if you drink it 3) Topiramate -> antiseizure 4) Naltrexone 5) Acamprosite
34
PCP intoxication?
Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, VERTICAL AND HORIZONTAL NYSTAGMUS, tachycardia, homicidality, psychosis, delirium, seizures
35
MOA PCP?
Inhibit reuptake of dopamine and serotonin (some NE too)
36
Tx PCP intox?
Benzodiazepines and rapid acting antipsychotics (Haloperidol)
37
PCP Withdrawal?
Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep; violence here too
38
What receptors does LSD work on in CNS?
5-HT
39
LSD Intox?
Perceptual distortion (visual/auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks (+/- pupillary dilation), "pleasurable psychosis"
40
LSD withdrawal?
None, but intox can happen randomly again
41
Marijuana intox?
Euphoria, anxiety, paranoid delusions, slowed time, impaired judgement, social withdrawal, appetite, dry mouth, conjunctival injection, hallucinations
42
What is prescription form of Marijuana? Use?
Dronabinol (THC isomer): Antiemetic post chemo and apetite stimulant in AIDS patients
43
What are teens at increased risk for with mary J?
Schizophrenia
44
Marijuana withdrawal?
Irritability, depression, insomnia, nausea, anorexia. Most Sx peak in 48 hrs and last 5-7 days, you can detect in urine for 4-10 days. No tx.
45
What are users at high risk for in heroin addiction?
Hepatitis, abscesses, overdose, hemorrhoids, AIDS, RS endocarditis (Tricuspid valve = S. Epi/S. Aureus). Look for track marks.
46
Treatments for heroin addiction? (3)
Methadone - long acting oral opiate (detox or long term maintenance) Naloxone + Buprenorphine = Suboxone - partial agonist (long acting, fewer w/d symptoms than methadone) Naltrexone - Long acting opiod antagonist for relapse prevention once detox'd
47
What is notable about naloxone?
It is not active orally so withdrawal symptoms only occur if injected = lowers abuse potential
48
What is alcoholism?
Physiologic tolerance and dependence with symptoms of withdrawal when intake is interrupted
49
What are the complications of being an alcoholic?
Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy
50
Treatment of alcoholic?
Disulfram, naltrexone, supportive, AA + support groups
51
When treating an alcoholic what should you correct?
Mg 2+, thiamine, glucose
52
What is wernicke-korsakoff syndrome?
Caused by thiamine (B1) deficiency; Triad of confusion, ophthalmoplegia and ataxia (Wernicke) and may progress to irreversible memory loss, confabulation, personality change (Korsakoff) Periventricular hemorrhage/necrosis of mamillary body association
53
Tx of W-K?
IV Vitamin B1
54
What is mallory weiss syndrome?
Longitudinal partial thickness tear at GEJ from vomiting, often presents with hematemesis, these are painful. (EV's are painless w/ alcoholic cirrhosis --> hypertension)
55
What are DT's?
Life threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
56
What are the symptoms in order of appearance in DT's?
Autonomic system hyperactivity --> psychotic symptoms --> confusion
57
DT treatment?
benzos or simply alcohol
58
Homeless man undergoes emergency surgery and doctor elects to monitor him for another 24 hours (It has already been 36 hours). 12 hours later he starts becoming hyperactive, hallucinating, and confused. What is treatment?
Benzodiazepenes (Probably chlordiazepoxide, but any will probably do for our purposes)
59
What should you warn alcoholic patients of?
Acetaminophen toxicity (they should probably avoid, but 4g/day max)
60
Screen for alcoholics?
CAGE (Cut back, annoyed, guilt, eye opener) (FOR PCM: Eye opener might as well be saying 4/4)

First Aid Facts (20 decks)

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