Drug misuse Flashcards
Drug use over a year
9.4% of the adult population
2883 drug misuse deaths
25,429 hospital admissions
North east england
Relation between social deprivation and drug misuse
large correlation between the 2
What is most common cause of death from drug overdose
Accidental poisonning
What drug causes most drug death s
Opioids - heroin, morphine
Harm from drug misuse
Death rate
Compromised employment & education
Financial hardship
Effects on personal relationships, families and children
Homelessness
Criminal behaviour such as theft, prostitution, drug dealing and violence
STIs eg HIV, hepatitis
What determines psychological dependence
Dopamine pathway in nucleus accumbens - deltafosB expression
Acute withdrawal features
seen in drugs targeting GABA receptor eg benzos or GHB tremor, sweating, anxiety, irritability, nausea and vomiting, abdominal pain, headache and seizures. A
What drugs cause seizures and arrhythmias
Sodium channel blockers eg cocaine
Types of drugs tests
Immunoassays
liquid chromatography-tandem mass spectrometry (gold standard but days to weeks)
How reliable are immunoassays
not very -
false positives and negatives very common
Why are toxidromes useful
immunoassays often unreliable - group symptoms so know how to treat
Features of stimulant toxicity
tachycardia
HPTN
Dilated pupils
Sweating
Convulsions
Agitation
Synthetic cannabis features
reduced consciousness or agitation
confusion + paranoia
metabolic/resp acidosis
tachy or brady
less common - convulsions, renal impairment
Sedative toxidrome features
Reduced consciousness
Hypoventialtion
Possible bradycardia
Differentiate between opioid and benzo as different treatment
Why are constricted pupils not neccesarily relable for opiate toxicity
mixed overdoses
When is flumenazil CI in voerdose
If cause of sedation not soely due to benzos
Hallucinogenic
visual, auditory, tactile hallucinations agitation, confusion, mild to mod stimulant features
Dissociative toxidrome features
neuropsychiatric features incl out of body experiences, agitation, analgesia, drowsy, nystagmus, ataxia, coma, convulsions, mild stim features
Poppers/organic nitrates toxidrome
Hypotension
Vasodilation
Methaemoglobinaemia (apparent cyanosis)
Sev - convulsions, coma, CV collapse
When can discharge patient whos taken drugs
4 hours asymptomatic
Classical opioid toxidrome
Reduced GCS
Reduced ventilation eg reduced resp rate, meiosis (pinpoint pupils)
Sev - T2 resp failure, resp arrest, aspiration pneumonia
Starting dose of naloxone, how continue to give and what goal
400 microgram IV
Escalate doses at 1 minute intervals aiming for GCS above 10 and RR above 10
What is problem with naloxone half life
Its short - opioid toxicity can reoccur once naloxone effecs ‘wear off’
Features of overdose more significant of opioids
Needle tracks
Piloerection
MEIOSIS
Bradycardia (relative)
N+V, ileus
Rhabdomyolysis
Pulmonary oedema
Features of GHB/related drugs specific to them
CNS depressnat
Urinary incontinence
Hypersalivation
Headache
Amnesia
Seizures
Brady arrhythmia
N/V
Tremor, myoclonus
General features of depressant toxidrome
Hypothermia
Sedation
Confusion
Coma
Hypotension
Resp depression
Ataxia
Reduced muscle tone/reflexes
Resp failure
Aspiration pneumonia
Toxidrome stimulant drugs
Euphoria, sweating, hyperthermia, anorexia
Mydriasis, agitation/psychosis, confusion, trismus, seizures
Tachycardia, hypertension, arrhythmias
Tremor, rhabdomyolysis
Hyponatremia, metabolic acidosis
What ECG change does cocaine cause
Widened QRS comples - arrhtyhmias, seizures
Coroanry artery spams - raised ST
Sodium channel blocker
Receptors targeted by stimulants
inhibit or even reverse catecholamine reuptake transporters on the pre-synaptic membrane of CNS neurones, more specifically at the dopamine reuptake transporter (DAT) the serotonin reuptake transporter (SERT) and the noradrenaline reuptake transporter (NET
Which receptor are drugs more active at that are ass with greater toxicity and mortality
SERT
What receptors are targeted by opioids
G protein couple - mu1, 2 and kappa
mu1 - analgesia
mu 2 - resp depress
kappa - sedation
How does cannabis cause a high
Delta9-THC, partial agonist at CB1 CB2 cannabinoid receptors
What systems does cannabis inhibit
GABAergic, glutamatergic, cholinergic, dopaminergic and serotoninergic systems.
What do CB1 receptors target
motor activity
Thinking
Motor coordination
Appetite
Short term memory
Pain perception
Immune cells
CB2 receptors target
Wider than CB1 - influence most of body
Severe comps of synthetic cannabis
acute kidney injury, seizures, metabolic or respiratory acidosis, psychosis, acute coronary syndrome, arrhythmia or death.
Synthetic cannabis toxidrome
A history of smoking or vaping
Cardiovascular dysfunction, typically tachycardia and hypertension but occasionally bradycardia
Neuropsychiatric dysfunction including reduced GSCS or agitation, panic or hallucinations
Gastrointestinal disturbance usually nausea and vomiting
What receptor causes hallucinations
2a serotonin receptors in CNS
glutamine and dopamine may be involved
Effects of hallucinogens
Duration 30 mins to days
Cause trauma, accidents, injury secondarily
mild to mod temp increase and BP, generally low mortality
Common hallucinogenic drugs
LSD, NBOMe drugs and Psilocybin containing mushrooms (‘magic mushrooms’) shown below.
What does nitrous oxide work on
NMDA receptor - dosccoaitive anaesthetic action
Hypoxic asphyxia
What can compressed nitrous oxide use cause
Pneumothorax, mucosal injuryk cold injuries to ksin and mucosa
What can chronic nitrous oxide use cause
Neurological dysfunction due to B12 depletion
Clinical effects of laughing gas
euphoria and analgesia but hypoxia, reduction in GCS, arrhythmia and death are reported.
Early effects of solvents
Euphoria, Excitement, Ataxia, Tremor, Visual disturbances, Vomiting, Chest tightness, ventricular arrhythmias - sudden cardia death
What do poppers cause and how
enhanced sexual pleasure, altered perceptions of reality and feelings of warmth. these effects are probably mediated through vasodilation and reflex tachycardia - hypotension and dizziness
Severe cases of poppers
metabolic acidosis, seizures, cardiovascular collapse and death may occu
How to treat methaemoglobinaemia
Methylene blue if severe - end organ ischaemia or v high methaemoglobin conc found
What can be dangerous in MDMA
High temperatures - need aggressive cooling
What treat broad QRS complex tachycardia from cocaine with
IV sodium bicarbonate
Benzos
