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errors and drugs > Drug misuse > Flashcards

Drug misuse Flashcards

1
Q

Drug use over a year

A

9.4% of the adult population
2883 drug misuse deaths
25,429 hospital admissions
North east england

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2
Q

Relation between social deprivation and drug misuse

A

large correlation between the 2

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3
Q

What is most common cause of death from drug overdose

A

Accidental poisonning

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4
Q

What drug causes most drug death s

A

Opioids - heroin, morphine

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5
Q

Harm from drug misuse

A

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

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6
Q

What determines psychological dependence

A

Dopamine pathway in nucleus accumbens - deltafosB expression

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7
Q

Acute withdrawal features

A

seen in drugs targeting GABA receptor eg benzos or GHB tremor, sweating, anxiety, irritability, nausea and vomiting, abdominal pain, headache and seizures. A

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8
Q

What drugs cause seizures and arrhythmias

A

Sodium channel blockers eg cocaine

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9
Q

Types of drugs tests

A

Immunoassays
liquid chromatography-tandem mass spectrometry (gold standard but days to weeks)

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10
Q

How reliable are immunoassays

A

not very -
false positives and negatives very common

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11
Q

Why are toxidromes useful

A

immunoassays often unreliable - group symptoms so know how to treat

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12
Q

Features of stimulant toxicity

A

tachycardia
HPTN
Dilated pupils
Sweating
Convulsions
Agitation

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13
Q

Synthetic cannabis features

A

reduced consciousness or agitation
confusion + paranoia
metabolic/resp acidosis
tachy or brady
less common - convulsions, renal impairment

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14
Q

Sedative toxidrome features

A

Reduced consciousness
Hypoventialtion
Possible bradycardia
Differentiate between opioid and benzo as different treatment

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15
Q

Why are constricted pupils not neccesarily relable for opiate toxicity

A

mixed overdoses

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16
Q

When is flumenazil CI in voerdose

A

If cause of sedation not soely due to benzos

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17
Q

Hallucinogenic

A

visual, auditory, tactile hallucinations agitation, confusion, mild to mod stimulant features

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18
Q

Dissociative toxidrome features

A

neuropsychiatric features incl out of body experiences, agitation, analgesia, drowsy, nystagmus, ataxia, coma, convulsions, mild stim features

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19
Q

Poppers/organic nitrates toxidrome

A

Hypotension
Vasodilation
Methaemoglobinaemia (apparent cyanosis)
Sev - convulsions, coma, CV collapse

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20
Q

When can discharge patient whos taken drugs

A

4 hours asymptomatic

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21
Q

Classical opioid toxidrome

A

Reduced GCS
Reduced ventilation eg reduced resp rate, meiosis (pinpoint pupils)
Sev - T2 resp failure, resp arrest, aspiration pneumonia

22
Q

Starting dose of naloxone, how continue to give and what goal

A

400 microgram IV
Escalate doses at 1 minute intervals aiming for GCS above 10 and RR above 10

23
Q

What is problem with naloxone half life

A

Its short - opioid toxicity can reoccur once naloxone effecs ‘wear off’

24
Q

Features of overdose more significant of opioids

A

Needle tracks
Piloerection
MEIOSIS
Bradycardia (relative)
N+V, ileus
Rhabdomyolysis
Pulmonary oedema

25
Q

Features of GHB/related drugs specific to them

A

CNS depressnat
Urinary incontinence
Hypersalivation
Headache
Amnesia
Seizures
Brady arrhythmia
N/V
Tremor, myoclonus

26
Q

General features of depressant toxidrome

A

Hypothermia
Sedation
Confusion
Coma
Hypotension
Resp depression
Ataxia
Reduced muscle tone/reflexes
Resp failure
Aspiration pneumonia

27
Q

Toxidrome stimulant drugs

A

Euphoria, sweating, hyperthermia, anorexia
Mydriasis, agitation/psychosis, confusion, trismus, seizures
Tachycardia, hypertension, arrhythmias
Tremor, rhabdomyolysis
Hyponatremia, metabolic acidosis

28
Q

What ECG change does cocaine cause

A

Widened QRS comples - arrhtyhmias, seizures
Coroanry artery spams - raised ST
Sodium channel blocker

29
Q

Receptors targeted by stimulants

A

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

30
Q

Which receptor are drugs more active at that are ass with greater toxicity and mortality

A

SERT

31
Q

What receptors are targeted by opioids

A

G protein couple - mu1, 2 and kappa
mu1 - analgesia
mu 2 - resp depress
kappa - sedation

32
Q

How does cannabis cause a high

A

Delta9-THC, partial agonist at CB1 CB2 cannabinoid receptors

33
Q

What systems does cannabis inhibit

A

GABAergic, glutamatergic, cholinergic, dopaminergic and serotoninergic systems.

34
Q

What do CB1 receptors target

A

motor activity
Thinking
Motor coordination
Appetite
Short term memory
Pain perception
Immune cells

35
Q

CB2 receptors target

A

Wider than CB1 - influence most of body

36
Q

Severe comps of synthetic cannabis

A

acute kidney injury, seizures, metabolic or respiratory acidosis, psychosis, acute coronary syndrome, arrhythmia or death.

37
Q

Synthetic cannabis toxidrome

A

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

38
Q

What receptor causes hallucinations

A

2a serotonin receptors in CNS
glutamine and dopamine may be involved

39
Q

Effects of hallucinogens

A

Duration 30 mins to days
Cause trauma, accidents, injury secondarily
mild to mod temp increase and BP, generally low mortality

40
Q

Common hallucinogenic drugs

A

LSD, NBOMe drugs and Psilocybin containing mushrooms (‘magic mushrooms’) shown below.

41
Q

What does nitrous oxide work on

A

NMDA receptor - dosccoaitive anaesthetic action
Hypoxic asphyxia

42
Q

What can compressed nitrous oxide use cause

A

Pneumothorax, mucosal injuryk cold injuries to ksin and mucosa

43
Q

What can chronic nitrous oxide use cause

A

Neurological dysfunction due to B12 depletion

44
Q

Clinical effects of laughing gas

A

euphoria and analgesia but hypoxia, reduction in GCS, arrhythmia and death are reported.

45
Q

Early effects of solvents

A

Euphoria, Excitement, Ataxia, Tremor, Visual disturbances, Vomiting, Chest tightness, ventricular arrhythmias - sudden cardia death

46
Q

What do poppers cause and how

A

enhanced sexual pleasure, altered perceptions of reality and feelings of warmth. these effects are probably mediated through vasodilation and reflex tachycardia - hypotension and dizziness

47
Q

Severe cases of poppers

A

metabolic acidosis, seizures, cardiovascular collapse and death may occu

48
Q

How to treat methaemoglobinaemia

A

Methylene blue if severe - end organ ischaemia or v high methaemoglobin conc found

49
Q

What can be dangerous in MDMA

A

High temperatures - need aggressive cooling

50
Q

What treat broad QRS complex tachycardia from cocaine with

A

IV sodium bicarbonate
Benzos

errors and drugs (8 decks)

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