Drug of Abuse

Question 1

opioid toxicity s/s

Answer 1

triad
-pinpoint pupils (constricted)
-respiratory depression
-decreased LOC –> coma

-reverse acute attack with Naloxone (Narcan)

Question 2

opioid dependence and abstinence s/s

Answer 2

s/s:
-yawning, rhinorrhea (snot), sweating
-then anorexia, irritability & agitation, tremor
-violent sneezing, muscle spasm, kicking, nvd, abd cramps
-can last 7-10 days and chronically suffer

Question 3

opioids overdose (detox and long term manage)

Answer 3

detox with
-methadone substitution: oral opioid w long duration –> stabilize then gradually decrease
-clonidine-assisted withdrawal: centrally-acting alpha2 –> suppress abstinence s/s

long term manage opioid addiction
-methadone: maintenance and suppressive therapy
-Buprenorphine: suppress craving of heroin (low abuse potential)

Question 4

cocaine overdose and withdrawal

Answer 4

-is a psychostimulant –> MOA: produce euphoria (incr activation dopamine)
-overdose is frequent
-mild: agitation, dizzy, tremor, blurred vision
-severe: hyperpyrexia, convulsions, dysryhthmias (most worrying), stroke
-others: angina, anxiety, hallucination

=> give naloxone or benzo (for agitation, seizures)

Question 5

alcohol abuse s/s

Answer 5

-MOA: GABA (CNS depressant) and 5HT3 (dopamine receptors)
-low dose: alter thinking, lower inhibitions
-high doses: reflex and consciousness impaired (no driving, operating heavy machinery)

-acute side effects: wernickes encephalopathy (confusion, nystagmus, abnorm ocular movements) –> reverse with thiamine
-chronic side effects: Korsakoff’s psychosis (polyneuropathy, cant short to long term memory) –> NOT reversible
==> affect all body systems

Question 6

alcohol withdrawal

Answer 6

-due to chronic use –> physical dependence and tolerance
-mild withdrawal s/s: sleep disturbed, weakness, nausea, tremors, anxiety
-severe s/s: hallucinations, intense tremors, seizures, increase BP/HR/Temp –> CV collapse and death

-screen with CIWA

==> 1st: give benzo: Lorazepam (Ativan)
==> **after withdrawal s/s: **
-give disulfiram (antabuse): discourages drinking by causing severe rxn
-give Naltrexone (revia): blocks good effects of alc, decreases craving

Question 7

alcohol contraindicated meds

Answer 7

-CNS depressants: worsen CNS depress
-NSAIDS: increase GI bleed, gastritis, kidney impair
-acetaminophen: liver toxic
-disulfiram: pt get super sick
-antihypertensives: drop BP
-some abx like Metronidazole