Drug Intoxications and Withdrawal

Question 1

Alcohol Intoxication

Answer 1

• Emotional lability, slurred speech, ataxia, coma, blackouts
• Serum gamma-glutamyltransferase (GGT) = sensitive indicator of alcohol use
• AST&raquo_space; ALT

Question 2

Alcohol Withdrawal

Answer 2

• Mild: anxiety, tremor, seizures, insomnia

- Severe: autonomic hyperactivity, delirium tremens (5-15% mortality rate)

Question 3

Delirium Tremens

Answer 3

• Peaks 2-4 d after last drink
• Autonomic hyperactivity –> tachy, tremors, anxiety, seizures
• Occurs in hospital (2-4 d post-surgery) in alcoholics
• Rx: benzodiazepines

Question 4

Alcoholic Hallucinosis

Answer 4

• Visual hallucinations 12-48 hrs after last drink

- Rx: benzodiazepines (chlordiazepoxide, lorazepam, diazepam)

Question 5

Opioid Intoxication (Heroin)

Answer 5

• Euphoria, RESPIRATORY AND CNS DEPRESSION, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures
• Most common cause of drug OD death
• Rx: naloxone, naltrexone

Question 6

Opioid Withdrawal (Heroin)

Answer 6

• Sweating, dilated pupils, piloerection, fever, rinorrhea, YAWNING, LACRIMATION nausea, stomach cramps, diarrhea (“flu-like sx”)
• Rx: long-term support, methadone, buprenorphine

Question 7

Barbiturate Intoxication

Answer 7

• Marked respiratory depression
• Rx: sx management (assist respiration, increased BP)
• Low safety margin

Question 8

Barbiturate Withdrawal

Answer 8

• Delirium, life-threatening CV collapse

Question 9

Benzodiazepine Intoxication

Answer 9

• Greater safety margin
• Ataxia, minor respiratory depression
• Rx: flumazenil (benzo R antagonist, but rarely used because it causes seizures)

Question 10

Benzodiazepine Withdrawal

Answer 10

• Sleep disturbances, depression, rebound anxiety, seizure

Question 11

Amphetamine Intoxication

Answer 11

• Euphoria, grandiosity, pupillary dilation, prolonged wakefulness & attention, HTN, TACHY, anorexia, paranoia, fever
• Severe –> cardiac arrest, seizures
• Rx: benzos for agitation and seizure
• Presents similarly to paranoid schizophrenia

Question 12

Stimulant Withdrawal

Answer 12

Post-use “crash” –> depression, lethargy, increased appetite, sleep disturbance, vivid nightmares

Question 13

Cocaine Intoxication

Answer 13

• Impaired judgement, pupillary dilation, hallucination (TACTILE), paranoid ideations, ANGINA, SUDDEN CARDIAC DEATH
• Rx: alpha blockers, benzos
• BETA BLOCKERS NOT RECOMMENDED

Question 14

Caffeine Intoxication

Answer 14

• Restlessness, diuresis, muscle twitching

Question 15

Caffeine Withdrawal

Answer 15

• HA, difficulty concentrating, flu-like sx

Question 16

Nicotine Intoxication

Answer 16

Restlessness

Question 17

Nicotine Withdrawal

Answer 17

• Irritability, anxiety, restlessness, difficulty concentrating
• Rx: nicotine patch, bupropion/varenicline

Question 18

Phencyclidine Intoxication
(NMDA R antagonist)
“Angel Dust”

Answer 18

• Violence, impulsivity, psychomotor agitation, NYSTAGMUS, tachycardia, HTN, analgesia, psychosis, delirium, seizures, DISORIENTATION/DETACHMENT
• Trauma is most common complication
• Rx: Benzodiazepines, rapid-acting antipsychotic

Question 19

Lysergic Acid Diethylamide Intoxication

Answer 19

• Perceptual distortion (VISUAL, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

Question 20

Marijuana Intoxication

Answer 20

• Euphoria, anxiety, paranoid delusions, PERCEPTION OF SLOWED TIME, impaired judgement, social withdrawal, INCREASED APPETITE, dry mouth, CONJUNCTIVAL INJECTION, hallucinations

Question 21

Marijuana Withdrawal

Answer 21

• Irritability, anxiety, depression, insomnia, restlessness, decreased appetite
• Can detect in urine for 1 mo

Question 22

MDMA (Ecstasy) Intoxication

Answer 22

• Hallucinogenic stimulant –> euphoria, disinhibition, hyperactivity
• Life-threatening effects: HTN, tachy, hyperthermia, hyponatremia, 5HT syndrome

Question 23

MDMA (Ecstasy) Withdrawal

Answer 23

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