Drug Intoxications and Withdrawal Flashcards
Alcohol Intoxication
- Emotional lability, slurred speech, ataxia, coma, blackouts
- Serum gamma-glutamyltransferase (GGT) = sensitive indicator of alcohol use
- AST»_space; ALT
Alcohol Withdrawal
- Mild: anxiety, tremor, seizures, insomnia
- Severe: autonomic hyperactivity, delirium tremens (5-15% mortality rate)
Delirium Tremens
- 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
Alcoholic Hallucinosis
- Visual hallucinations 12-48 hrs after last drink
- Rx: benzodiazepines (chlordiazepoxide, lorazepam, diazepam)
Opioid Intoxication (Heroin)
- Euphoria, RESPIRATORY AND CNS DEPRESSION, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures
- Most common cause of drug OD death
- Rx: naloxone, naltrexone
Opioid Withdrawal (Heroin)
- Sweating, dilated pupils, piloerection, fever, rinorrhea, YAWNING, LACRIMATION nausea, stomach cramps, diarrhea (“flu-like sx”)
- Rx: long-term support, methadone, buprenorphine
Barbiturate Intoxication
- Marked respiratory depression
- Rx: sx management (assist respiration, increased BP)
- Low safety margin
Barbiturate Withdrawal
- Delirium, life-threatening CV collapse
Benzodiazepine Intoxication
- Greater safety margin
- Ataxia, minor respiratory depression
- Rx: flumazenil (benzo R antagonist, but rarely used because it causes seizures)
Benzodiazepine Withdrawal
- Sleep disturbances, depression, rebound anxiety, seizure
Amphetamine Intoxication
- 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
Stimulant Withdrawal
Post-use “crash” –> depression, lethargy, increased appetite, sleep disturbance, vivid nightmares
Cocaine Intoxication
- Impaired judgement, pupillary dilation, hallucination (TACTILE), paranoid ideations, ANGINA, SUDDEN CARDIAC DEATH
- Rx: alpha blockers, benzos
- BETA BLOCKERS NOT RECOMMENDED
Caffeine Intoxication
- Restlessness, diuresis, muscle twitching
Caffeine Withdrawal
- HA, difficulty concentrating, flu-like sx
Nicotine Intoxication
Restlessness
Nicotine Withdrawal
- Irritability, anxiety, restlessness, difficulty concentrating
- Rx: nicotine patch, bupropion/varenicline
Phencyclidine Intoxication
(NMDA R antagonist)
“Angel Dust”
- Violence, impulsivity, psychomotor agitation, NYSTAGMUS, tachycardia, HTN, analgesia, psychosis, delirium, seizures, DISORIENTATION/DETACHMENT
- Trauma is most common complication
- Rx: Benzodiazepines, rapid-acting antipsychotic
Lysergic Acid Diethylamide Intoxication
- Perceptual distortion (VISUAL, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks
Marijuana Intoxication
- Euphoria, anxiety, paranoid delusions, PERCEPTION OF SLOWED TIME, impaired judgement, social withdrawal, INCREASED APPETITE, dry mouth, CONJUNCTIVAL INJECTION, hallucinations
Marijuana Withdrawal
- Irritability, anxiety, depression, insomnia, restlessness, decreased appetite
- Can detect in urine for 1 mo
MDMA (Ecstasy) Intoxication
- Hallucinogenic stimulant –> euphoria, disinhibition, hyperactivity
- Life-threatening effects: HTN, tachy, hyperthermia, hyponatremia, 5HT syndrome
MDMA (Ecstasy) Withdrawal
Depression, fatigue, change in appetite, difficulty concentrating, anxiety
