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Psychiatry > Drug Intoxication and withdrawal > Flashcards

Drug Intoxication and withdrawal Flashcards

1
Q

Depressants

A

Alcohol
Opioids
Barbs and Benzos

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2
Q

Depressants- general intox S&S

A 
Mood elevation
Decreased anxiety
Sedation
Behavioral disinhibition
Respiratory depression
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3
Q

Depressants- withdrawal

A

Anxiety
Tremor
Seizure
Insomnia

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4
Q

Alcohol- intox

A

Emotional lability
Slurred speech
Coma
Blackouts

AST&raquo_space; ALT (AST is 2X ALT)

GGT is a sensitive indicator of alcohol use

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5
Q

Alcohol- withdrawal

A

Mild: anxiety, tremor, seizures, insomnia
SEVERE: autonomic hyperactivity and delirium tremens (hallucinations) –> tx with benzos

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6
Q

Opioids- intox

A

Miosis
Respiratory depression (and CNS)
Constipation

Tx: Naloxone (acute reversal) and naltrexone (longer term management of opioid AND ALCOHOL overdose)

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7
Q

Opioid- withdrawal

A 
Mydriasis
Tachycardia
Sweating
Piloerection
Fever
Rhinorrhea
Nausea, stomach cramps
Diarrhea ("flu-like symptoms")

LACRIMATION AND YAWNING- characteristic of heroin overdose

Less likely to have seizures with withdrawal (unlike alcohol and benzos)

Tx: long-term support, methadone, bupernorphine
NOT NALOXONE!!! This will make it worse

In neonates will see similar symptoms + hypertonia, irritability, and jittery movements

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8
Q

Barbs- intox and withdrawal

A

Intox: low safety margin, respiratory depression

Withdrawal: delirium, life-threatening cardiac complications

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9
Q

Benzos- intox and withdrawal

A

intox: bigger safety margin; respiratory depression
Tx: flumazenil –> but this can precipitate seizures

withdrawal: sleep disturbance, depression, rebound anxiety, and seizures

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10
Q

Stimulants

A

amphetamines
cocaine
caffeine
nicotine

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11
Q

Stimulants- general intox symptoms

A 
Mood elevation
Psychomotor agitation
Insomnia
Cardiac arrythmias
Tachycardia
Anxiety
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12
Q

Stimulants- general withdrawal symptoms

A 
Overuse "crash"
Depression
Lethargy
Increased appetite
Sleep disturbance
Nightmares
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13
Q

Amphetamines- intox

A

Mechanism: Increase RELEASE of catecholamines and reuptake inhibitor

Euphoria, grandiosity, PUPILARY DILATION (due to increased sympathetic response)

Tx: benzos (spec. for agitation and seizures)

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14
Q

Cocaine- intox

A

Prevents reuptake of catecholamines (like SSRIs, SNRIs, and TCADs)

Symp overstimulation: Sweating, tachy, high BP, hyperactivity
Impaired judgement
Pupillary dilation
Hallucinations (tactile- cocaine crawlies)
Angina
Sudden cardiac death
Atrophy of intranasal septum (with nasal abuse)

Tx: alpha blockers, benzos

DONT give beta blockers as this will make NE specifically go after the vasculature and unopposedly VASOCONSTRICT

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15
Q

Cocaine- withdrawal

A

Hypersomnolence
Irritability
Depression

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16
Q

Caffeine- intox

A

restlessness, increased diuresis, muscle twitching

17
Q

Caffeine- withdrawal

A

Headache, difficulty concentrating, flu-like symptoms

18
Q

Nicotine- intox

A

restlessness

19
Q

Nicotine- withdrawal

A

irritability, anxiety, restlessness, difficulty concentrating

Tx: nicotine patch, gum, lozenges; buproprion/ varenicline

20
Q

Hallucinogens

A

Phencyclidine
LSD
Marijuana
MDMA (ecstasy)

21
Q

Phencyclidine

A 
VIOLENCE
Impulsivity
Psychomotor agitation
NYSTAGMUS
Delirium
Seizures
Tachy

(like cocaine abuse + violence + hallucinations and seizures)

22
Q

LSD

A 
Hallucinations
Anxiety or depression
Delusions
Depersonalization
Paranoia
Nausea
Dilated pupils
Euphoria

(different than cocaine abuse b/c these patients have NORMAL HR and BP) –> they also don’t have intense thirst as seen in folks who have anticholinergic symptoms

23
Q

Marijuana

A

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, increased appetite, dry mouth, CONJUNCTIVAL INJECTION, hallucinations

Dronabinol- pharmaceutical form –> used in AIDS pts (to increase eating) and for patients taking chemo (anti-emetic)

Detectable in urine for up to 1 month

24
Q

MDMA (ecstasy)- intox

A

Hallucinogenic stimulant
Euphoria, disinhibition, hyperactivity

Life threatening effects: HTN, tacky, hyperthermia, hyponatremia, serotonin syndrome

25
Q

MDMA (ecstasy)- withdrawal

A

Depression, fatigue, change in appetite, difficulty concentrating, and anxiety

26
Q

Delirium tremens

A

Life-threatening alcohol WITHDRAWAL syndrome that peaks 2-4 days after last drink

Characterized by autonomic hyperactivity –> tachy, tremors, anxiety, and seizures

27
Q

Alcoholic hallucinosis

A

DIFFERENT THAN DELIRIUM TREMENS!!

distinct condition characterized by VISUAL hallucinations 12-48 hours after last drink

Tx: benzodiazepines

Psychiatry (4 decks)

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