Drug Intoxication Withdrawal Flashcards by Abby Frederickson

Depressant intoxication

Mood elevation
Decreased anxiety
Sedation
Behavioral disinhibition
Respiratory depression

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Depressant withdrawal

Anxiety
Tremor
Seizures
Insomnia

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Depressant examples (4)

Alcohol
Opioids (morphine, heroin, methadone)
Barbiturates
Benzodiazepines

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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

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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

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Treatment for delirium tremens associated with alcohol withdrawal?

Benzodiazepines

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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

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Treatment for opioid intoxication

Naloxone = emergency overdose
Naltrexone = maintenance

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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

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Treatment for opioid withdrawal

Long term support
Methadone
Buprenorphine

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Which has a lower safety margin - barbiturates or benzos?

Barbiturates = low safety margin
Benzodiazepines = greater safety margin

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Intoxication causing marked respiratory depression?

Treatment?

Barbiturate intoxication

Treatment = sx management (assist respiration, increase BP)

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Withdrawal causing delirium, life-threatening cardiovascular collapse?

Barbiturate withdrawal

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Intoxication causing ataxia, minor respiratory depression?

Treatment?

Benzo intoxication

Treatment = supportive care; consider FLUMAZENIL (competitive benzo antagonist)

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Drug for benzo overdose?

Flumazenil = competitive antagonist

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Withdrawal causing sleep disturbance, depression, rebound anxiety, seizure?

Benzo withdrawal

Can be triggered by reversal with flumazenil

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Stimulant intoxication

Mood elevation
Psychomotor agitation
Insomnia
Cardiac arrhythmias
Tachycardia
Anxiety

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Stimulant withdrawal

Post-use “crash” = depression, lethargy, weight gain, headache

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Stimulant examples (4)

Amphetamines
Cocaine
Caffeine
Nicotine

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Intoxication causing euphoria, grandiosity, PUPILLARY DILATION, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever?
Severe effects?

Amphetamine intoxication

Severe = cardiac arrest, seizure

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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