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USMLE > Drug Intoxication Withdrawal > Flashcards

Drug Intoxication Withdrawal Flashcards

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USMLE® Step 1 flashcards
1
Q

Depressant intoxication

A 
Mood elevation
Decreased anxiety
Sedation
Behavioral disinhibition
Respiratory depression
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2
Q

Depressant withdrawal

A

Anxiety
Tremor
Seizures
Insomnia

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3
Q

Depressant examples (4)

A

Alcohol
Opioids (morphine, heroin, methadone)
Barbiturates
Benzodiazepines

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4
Q

Intoxication causing emotional liability, slurred speech, ataxia, coma, blackouts? Associated lab values?

A

Alcohol intoxication
Serum gamma-glutamyltransferase (GTT) = sensitive indicator of alcohol use
2 AST : 1 ALT

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5
Q

Alcohol withdrawal

Mild? Severe?

A 
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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6
Q

Treatment for delirium tremens associated with alcohol withdrawal?

A

Benzodiazepines

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7
Q

Intoxication causing euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (PINPOINT PUPILS), seizures (overdoes)
Treatment?

A

Opioid intoxication (morphine, heroin, methadone)

Treatment = naloxone, naltrexone

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8
Q

Treatment for opioid intoxication

A 
Naloxone = emergency overdose
Naltrexone = maintenance
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9
Q

Withdrawal causing sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” sx)
Treatment?

A

Opioid withdrawal (morphine, heroin, methadone)

Treatment = long term support, methadone, buprenorphine

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10
Q

Treatment for opioid withdrawal

A

Long term support
Methadone
Buprenorphine

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11
Q

Which has a lower safety margin - barbiturates or benzos?

A 
Barbiturates = low safety margin
Benzodiazepines = greater safety margin
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12
Q

Intoxication causing marked respiratory depression?

Treatment?

A

Barbiturate intoxication

Treatment = sx management (assist respiration, increase BP)

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13
Q

Withdrawal causing delirium, life-threatening cardiovascular collapse?

A

Barbiturate withdrawal

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14
Q

Intoxication causing ataxia, minor respiratory depression?

Treatment?

A

Benzo intoxication

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

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15
Q

Drug for benzo overdose?

A

Flumazenil = competitive antagonist

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16
Q

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

A

Benzo withdrawal

Can be triggered by reversal with flumazenil

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17
Q

Stimulant intoxication

A 
Mood elevation
Psychomotor agitation
Insomnia
Cardiac arrhythmias
Tachycardia
Anxiety
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18
Q

Stimulant withdrawal

A

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

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19
Q

Stimulant examples (4)

A

Amphetamines
Cocaine
Caffeine
Nicotine

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20
Q

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

A

Amphetamine intoxication

Severe = cardiac arrest, seizure

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21
Q

Pupillary constriction

A

Opioid intoxication

22
Q

Pupillary dilation

A

Amphetamine and cocaine intoxication

23
Q

Withdrawal causing anhedonia, increased appetite, hypersomnolence, existential crisis?

A

Amphetamine withdrawal

24
Q

Intoxication causing impaired judgment, PUPILLARY DILATION, hallucinations (tactile), paranoid ideations, angina, sudden cardiac death?
Treatment?

A

Cocaine intoxication

Treatment = benzos

25
Q

Treatment for cocaine intoxication?

A

Benzodiazepines

26
Q

Withdrawal causing hypersomnolence, malaise, severe psychological craving, depression/suicidality?

A

Cocaine withdrawal

27
Q

Caffeine intoxication?

A

Restlessness
Increased diuresis
Muscle twitching

28
Q

Caffeine withdrawal?

A

Lack of concentration

Headache

29
Q

Nicotine intoxication?

A

Restlessness

30
Q

Nicotine withdrawal?

Treatment?

A

Irritability, anxiety, craving

Treatment = nicotine patch, gum, or lozenges; bupropion/varenicline

31
Q

Treatment for nicotine withdrawal?

A

Nicotine patch, gum, lozenges
Bupropion (Wellbutrin) = NE/Da reuptake inhibitor; NE/Da releasing agent
Varenicline (Chantix) = nicotine receptor partial agonist

32
Q

Hallucinogen examples (3)

A

PCP = Phencyclidine (angel dust)
LSD = Lysergic acid diethylamide
Marijuana (cannabinoid)

33
Q

Intoxication causing belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures?
Treatment?

A

PCP intox

Treatment = benzos, rapid-acting antipsychotic

34
Q

Treatment for PCP intoxication?

A

Benzodiazepines

Rapid-acting antipsychotic

35
Q

Withdrawal causing depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep?

A

PCP withdrawal

36
Q

Intoxication causing perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks?

A

LSD intox

37
Q

LSD withdrawal?

A

NONE

38
Q

Intoxication causing euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations?

A

Marijuana intoxication

39
Q

Prescription form of marijuana?

Two clinical uses?

A

Dronabinol (tetrahydrocannabinol isomer) = used as antiemetic (chemo) and appetite stimulant (AIDs)

40
Q

Withdrawal causing irritability, depression, insomnia, nausea, anorexia?

A

Marijuana withdrawal

Most sx peak in 48 hours and last for 5-7 days

41
Q

How long is marijuana detectable in urine?

A

4-10 days

42
Q

Treatment for heroin addiction?

A

Methadone
Naloxone + buprenorphine
Naltrexone

43
Q

Methadone for heroin addiction

A

Long acting oral opiate

Used for heroin detoxification or long-term maintenance

44
Q

Naloxone + buprenorphine for heroin addiction

A

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)

45
Q

Naltrexone for heroin addiction

A

Long-acting opioid antagonist used for relapse prevention once detoxified (maintenance)

46
Q

Alcoholism treatment

A

Disulfiram = condition patient to abstain from alcohol use
Naltrexone
Supportive care
Alcoholic anonymous and other peer support groups

47
Q

Mechanism of action of disulfiram?

A

Inhibits acetaldehyde dehydrogenase

Acetaldehyde builds up immediately when alcohol is consumed = causes unpleasant hangover effects

48
Q

Delirium tremens (DTs)
Symptoms?
Treatment?

A

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

49
Q

Delirium tremens symptoms in order of appearance (3)

A

Autonomic system hyperactivity = tachycardia, tremors, anxiety, seizures
Psychotic symptoms = hallucinations, delusions
Confusion

50
Q

When do delirium tremens symptoms peak?

A

2-5 days after last alcoholic drink

USMLE (38 decks)

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