Drug Intox and Withdrawal

Question 1

Depressant intoxication nonspecific effects?

Answer 1

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

Question 2

Depressant withdrawal non specific effects?

Answer 2

anxiety, tremor, seizures, insomnia

Question 3

Alcohol intox?

Answer 3

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

Question 4

Alcohol withdrawal?

Answer 4

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

Question 5

Treatment for alcohol withdrawal?

Answer 5

Time

Question 6

Treatment for DTs?

Answer 6

Benzodiazepines

Question 7

Opiod intox?

Answer 7

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

Question 8

Treatment for Opiod intox?

Answer 8

Naloxone/Naltrexone

Question 9

Opiod withdrawal?

Answer 9

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

Question 10

Opiod withdrawal treatment?

Answer 10

Long term support, methadone, buprenorphine

Question 11

Barbituate intox?

Answer 11

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

Question 12

Barb intox tx?

Answer 12

Symptomatic management (assist respiration, increase BP)

Question 13

Barb withdrawal?

Answer 13

delirium, life threatening cardiovascular collapse

Question 14

Benzodiazepine intox?

Answer 14

Greater safety margin, ataxia, minor reap depression

Question 15

Benzo intox tx?

Answer 15

Supportive care, Flumazenil* (competitive benzo antagonist)

Question 16

Benzo withdrawal?

Answer 16

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

Question 17

Nonspecific stimulant intox?

Answer 17

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

Question 18

Nonspecific stimulant withdrawal?

Answer 18

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

Question 19

MOA Amphetamines?

Answer 19

Release of catecholamine stores

Question 20

Amphetamine intox?

Answer 20

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

Question 21

Severe amphetamine intox?

Answer 21

Cardiac arrest/seizure

Question 22

Amphetamine withdrawal?

Answer 22

Anhedonia, increased appetite, hyper somnolence, existential crisis

Question 23

Cocaine MOA?

Answer 23

Block reuptake of NE, 5-HT, Dopamine

Question 24

Cocaine intox?

Answer 24

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

Question 25

Cocaine intox treatment?

Answer 25

Benzos

Question 26

Cocaine withdrawal?

Answer 26

Hypersomnolence, malaise, severe psychological craving, depression/suicidality

Question 27

What are caffeine and nicotine CI’d in?

Answer 27

MI b/c arrhythmia

Question 28

Caffeine intox?

Answer 28

restlessess, diuresis, muscle twitching

Question 29

Caffeine withdrawal?

Answer 29

Lack of concentration, h/a

Question 30

Nicotine intox?

Answer 30

Restlessness (DIT: premature atrial/ventricular contractions)

Question 31

Nicotine withdrawal?

Answer 31

Irritability, anxiety, craving.

Question 32

Nicotine withdrawal tx?

Answer 32

Nicotine patch, gum, or lozenges; Or Buproprion/Vernicline

Question 33

What is the treatment to prevent relapse for alcoholics? (DIT)

Answer 33

1) AA
2) Disulfram -> you’ll get sick if you drink it
3) Topiramate -> antiseizure
4) Naltrexone
5) Acamprosite

Question 34

PCP intoxication?

Answer 34

Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, VERTICAL AND HORIZONTAL NYSTAGMUS, tachycardia, homicidality, psychosis, delirium, seizures

Question 35

MOA PCP?

Answer 35

Inhibit reuptake of dopamine and serotonin (some NE too)

Question 36

Tx PCP intox?

Answer 36

Benzodiazepines and rapid acting antipsychotics (Haloperidol)

Question 37

PCP Withdrawal?

Answer 37

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep; violence here too

Question 38

What receptors does LSD work on in CNS?

Answer 38

5-HT

Question 39

LSD Intox?

Answer 39

Perceptual distortion (visual/auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks (+/- pupillary dilation), “pleasurable psychosis”

Question 40

LSD withdrawal?

Answer 40

None, but intox can happen randomly again

Question 41

Marijuana intox?

Answer 41

Euphoria, anxiety, paranoid delusions, slowed time, impaired judgement, social withdrawal, appetite, dry mouth, conjunctival injection, hallucinations

Question 42

What is prescription form of Marijuana? Use?

Answer 42

Dronabinol (THC isomer): Antiemetic post chemo and apetite stimulant in AIDS patients

Question 43

What are teens at increased risk for with mary J?

Answer 43

Schizophrenia

Question 44

Marijuana withdrawal?

Answer 44

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.

Question 45

What are users at high risk for in heroin addiction?

Answer 45

Hepatitis, abscesses, overdose, hemorrhoids, AIDS, RS endocarditis (Tricuspid valve = S. Epi/S. Aureus). Look for track marks.

Question 46

Treatments for heroin addiction? (3)

Answer 46

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

Question 47

What is notable about naloxone?

Answer 47

It is not active orally so withdrawal symptoms only occur if injected = lowers abuse potential

Question 48

What is alcoholism?

Answer 48

Physiologic tolerance and dependence with symptoms of withdrawal when intake is interrupted

Question 49

What are the complications of being an alcoholic?

Answer 49

Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

Question 50

Treatment of alcoholic?

Answer 50

Disulfram, naltrexone, supportive, AA + support groups

Question 51

When treating an alcoholic what should you correct?

Answer 51

Mg 2+, thiamine, glucose

Question 52

What is wernicke-korsakoff syndrome?

Answer 52

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

Question 53

Tx of W-K?

Answer 53

IV Vitamin B1

Question 54

What is mallory weiss syndrome?

Answer 54

Longitudinal partial thickness tear at GEJ from vomiting, often presents with hematemesis, these are painful. (EV’s are painless w/ alcoholic cirrhosis –> hypertension)

Question 55

What are DT’s?

Answer 55

Life threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink

Question 56

What are the symptoms in order of appearance in DT’s?

Answer 56

Autonomic system hyperactivity –> psychotic symptoms –> confusion

Question 57

DT treatment?

Answer 57

benzos or simply alcohol

Question 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?

Answer 58

Benzodiazepenes (Probably chlordiazepoxide, but any will probably do for our purposes)

Question 59

What should you warn alcoholic patients of?

Answer 59

Acetaminophen toxicity (they should probably avoid, but 4g/day max)

Question 60

Screen for alcoholics?

Answer 60

CAGE (Cut back, annoyed, guilt, eye opener) (FOR PCM: Eye opener might as well be saying 4/4)