Drug Intoxication Withdrawal Flashcards
Depressant intoxication
Mood elevation Decreased anxiety Sedation Behavioral disinhibition Respiratory depression
Depressant withdrawal
Anxiety
Tremor
Seizures
Insomnia
Depressant examples (4)
Alcohol
Opioids (morphine, heroin, methadone)
Barbiturates
Benzodiazepines
Intoxication causing emotional liability, slurred speech, ataxia, coma, blackouts? Associated lab values?
Alcohol intoxication
Serum gamma-glutamyltransferase (GTT) = sensitive indicator of alcohol use
2 AST : 1 ALT
Alcohol withdrawal
Mild? Severe?
Mild = sx similar to other depressants (anxiety, tremor, seizures, insomnia) Severe = autonomic hyperactivity and delirium tremens (5-15% mortality rate) --> tx with benzos
Treatment for delirium tremens associated with alcohol withdrawal?
Benzodiazepines
Intoxication causing euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (PINPOINT PUPILS), seizures (overdoes)
Treatment?
Opioid intoxication (morphine, heroin, methadone)
Treatment = naloxone, naltrexone
Treatment for opioid intoxication
Naloxone = emergency overdose Naltrexone = maintenance
Withdrawal causing sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” sx)
Treatment?
Opioid withdrawal (morphine, heroin, methadone)
Treatment = long term support, methadone, buprenorphine
Treatment for opioid withdrawal
Long term support
Methadone
Buprenorphine
Which has a lower safety margin - barbiturates or benzos?
Barbiturates = low safety margin Benzodiazepines = greater safety margin
Intoxication causing marked respiratory depression?
Treatment?
Barbiturate intoxication
Treatment = sx management (assist respiration, increase BP)
Withdrawal causing delirium, life-threatening cardiovascular collapse?
Barbiturate withdrawal
Intoxication causing ataxia, minor respiratory depression?
Treatment?
Benzo intoxication
Treatment = supportive care; consider FLUMAZENIL (competitive benzo antagonist)
Drug for benzo overdose?
Flumazenil = competitive antagonist
Withdrawal causing sleep disturbance, depression, rebound anxiety, seizure?
Benzo withdrawal
Can be triggered by reversal with flumazenil
Stimulant intoxication
Mood elevation Psychomotor agitation Insomnia Cardiac arrhythmias Tachycardia Anxiety
Stimulant withdrawal
Post-use “crash” = depression, lethargy, weight gain, headache
Stimulant examples (4)
Amphetamines
Cocaine
Caffeine
Nicotine
Intoxication causing euphoria, grandiosity, PUPILLARY DILATION, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever?
Severe effects?
Amphetamine intoxication
Severe = cardiac arrest, seizure
Pupillary constriction
Opioid intoxication
Pupillary dilation
Amphetamine and cocaine intoxication
Withdrawal causing anhedonia, increased appetite, hypersomnolence, existential crisis?
Amphetamine withdrawal
Intoxication causing impaired judgment, PUPILLARY DILATION, hallucinations (tactile), paranoid ideations, angina, sudden cardiac death?
Treatment?
Cocaine intoxication
Treatment = benzos
Treatment for cocaine intoxication?
Benzodiazepines
Withdrawal causing hypersomnolence, malaise, severe psychological craving, depression/suicidality?
Cocaine withdrawal
Caffeine intoxication?
Restlessness
Increased diuresis
Muscle twitching
Caffeine withdrawal?
Lack of concentration
Headache
Nicotine intoxication?
Restlessness
Nicotine withdrawal?
Treatment?
Irritability, anxiety, craving
Treatment = nicotine patch, gum, or lozenges; bupropion/varenicline
Treatment for nicotine withdrawal?
Nicotine patch, gum, lozenges
Bupropion (Wellbutrin) = NE/Da reuptake inhibitor; NE/Da releasing agent
Varenicline (Chantix) = nicotine receptor partial agonist
Hallucinogen examples (3)
PCP = Phencyclidine (angel dust)
LSD = Lysergic acid diethylamide
Marijuana (cannabinoid)
Intoxication causing belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures?
Treatment?
PCP intox
Treatment = benzos, rapid-acting antipsychotic
Treatment for PCP intoxication?
Benzodiazepines
Rapid-acting antipsychotic
Withdrawal causing depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep?
PCP withdrawal
Intoxication causing perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks?
LSD intox
LSD withdrawal?
NONE
Intoxication causing euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations?
Marijuana intoxication
Prescription form of marijuana?
Two clinical uses?
Dronabinol (tetrahydrocannabinol isomer) = used as antiemetic (chemo) and appetite stimulant (AIDs)
Withdrawal causing irritability, depression, insomnia, nausea, anorexia?
Marijuana withdrawal
Most sx peak in 48 hours and last for 5-7 days
How long is marijuana detectable in urine?
4-10 days
Treatment for heroin addiction?
Methadone
Naloxone + buprenorphine
Naltrexone
Methadone for heroin addiction
Long acting oral opiate
Used for heroin detoxification or long-term maintenance
Naloxone + buprenorphine for heroin addiction
Partial agonist; long acting with fewer withdrawal symptoms than methadone
Naloxone is NOT active when taken orally so withdrawal symptoms occur only if injected (lower abuse potential)
Naltrexone for heroin addiction
Long-acting opioid antagonist used for relapse prevention once detoxified (maintenance)
Alcoholism treatment
Disulfiram = condition patient to abstain from alcohol use
Naltrexone
Supportive care
Alcoholic anonymous and other peer support groups
Mechanism of action of disulfiram?
Inhibits acetaldehyde dehydrogenase
Acetaldehyde builds up immediately when alcohol is consumed = causes unpleasant hangover effects
Delirium tremens (DTs)
Symptoms?
Treatment?
Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
Symptoms in order of appearance:
—Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures)
—Psychotic symptoms (hallucinations, delusions)
—Confusion
Treatment = benzodiazepines
Delirium tremens symptoms in order of appearance (3)
Autonomic system hyperactivity = tachycardia, tremors, anxiety, seizures
Psychotic symptoms = hallucinations, delusions
Confusion
When do delirium tremens symptoms peak?
2-5 days after last alcoholic drink
