Drug of abuse - French

Question 1

A patient arrives in the ED with rapid, shallow breathing, pinpoint pupils, tachycardia, cyanosis, and pulmonary edema. What drugs (class, examples) are implicated?

What is the proper treatment (antidote)?

What is the bichemical mode of action of this class of drug

Answer 1

Opiates (hydrocodone, oxycodone, heroin, morphine)

Naloxone

Mu receptor agonist

Question 2

Grandma Maggie has been popping oxycodone for a month, at high dose for her pain. She is admitted for a hip fracture. After 24 hours in the hopsital, you notice she is diaphoretic, agitated, and tachycardic. She complains of bowel discomfort and diarrhea.

What can you give gran-gran to make her feel better?

Answer 2

Opioid withdrawal can be treated with

–> clonidine (alpha adrenergic agonist) to offset the sympathetic overactivity

and/or

–> methadone (cross-reactivity will bring her down more slowly).

Question 3

What should you give Timmy, the recovering heroin addict, to prevent relapse?

Answer 3

Buprehorphine –> partial mu agonist with low abuse potential and low risk of overdose

**can be mixed with naloxone (not absorbed through gut) to prevent crushing/IV injection

OR

Naltrexone–> opioid receptor antagonist (wont reduce craving but blocks reinforcing actions of heroin)

Question 4

Jennifer overdosed on her benzodiazepine prescription. She is hypotensive and unresponsive, with shallow breathing. You treat her immediately and save her life. What did you do?

What is the mode of action of benzodiazepines?

Answer 4

Supportive therapy (respiratory), gastric lavage, Flumanezil (antidote).

facilitate GABA
inhibit Glu-NMDA

Question 5

Two days after her admission, you are checking in on Jennifer, who overdosed on her benzos, when you notice that she seems anxious. She isn’t eating, hasn’t slept, and admits to vomiting twice that morning. What should you do?

If you do nothing, what is the most severe possible consequence?

Answer 5

Start a taper regimen of buspirone or benzodiazepines to avoid withdrawal symptoms.

Grand mal seizures, psychosis.

Question 6

Jorge arrives at the ED. He is tachycardic, febrile, diaphoretic, and manic. He is clutching his chest. What are some common CNS simulants that might cause these symptoms?

What is the most serious overdose risk, and how should Jorge be treated?

Answer 6

Methamphetamine, cocaine.

Lavage, supportive care, manage fever.

Most serious outcome is cardiac arrest (arrhythmias common)

Question 7

Jorge, he of the meth overdose, has a massive seizure before you can start treatment. What should you immediately give him?

What if he had become psychotic?

Answer 7

Diazepam

Psychosis–> haloperidol

Question 8

You stabilize Jorge (meth overdose), and check his BP. it is 220/150.
What should you give him?
What should you NOT give him?

Answer 8

Phentolamine.

Don’t give BetaBlockers (unnopposed alpha stimulation)

Question 9

What differentiates cocaine from amphetamines at a biochemical level?

Answer 9

Cocaine–> inhibit monoamine reuptake

Amphetamines–> stimulate monoamine release

Question 10

Do stimulants produce dependance?

Answer 10

Arguable. Lack of physiologic symptoms. Psychologic dependance does occur.

Question 11

A 5 y/o girl drank some insecticide and now has excessive diarrhea, drooling, miosis, and a weak pulse. You are about to administer ____ for presumed organophosphate poisoning, but recall that nicotine can also be an ingredient in insecticides.

Answer 11

Organophosphates - atropine

Nicotine - Gastric lavage/charcoal, respiratory assistance.

Question 12

Nicotine is a _____.

Answer 12

Nicotinic cholinergic agonist

Question 13

To help Frank Jr. stop smoking, what txs can be used? (3)

Answer 13

NIcotine patch, taper.

Buproprion

Varenicline - partial nicotine agonist. Blocks nicotine effect if they start smoking again.

Question 14

Your cousin calls you from the Nevada ED. Her fiance ate mushrooms at burning man, which caused him to become extremely anxious, depressed, and have hallucinations of “dark figures” chasing him.

What other drug in this category would cause similar symptoms?

What is the biochemical mode of action of this class of durgs?

What can you offer as possible treatment?

Answer 14

Indoleamines: Psilocybin. LSD.

partial agonist at 5HT-2 serotonin receptors

Benzodiazepines can relieve some anxiety.

Question 15

Another cousin went to an EDM show and took a pill. At first, he felt a great sense of “unity with everyone there, and the nature, man”, but rapidly became confused, anxious, with paranoid hallucinations. Upon admission to the ED he was hyperthermic (104F) and developed rhabdomyolysis.

What might he have taken?

What can he be given?

Answer 15

Phenylethylamine: Mescaline (peyote), MDMA

Benzos for anxiety, haloperidol for psychosis.

Supportive care.

Question 16

What is the mode of action of phenylethylamine drugs (MDMA, mescaline)?

Answer 16

Partial 5HT-agonist

PLUS

Dopamine releasing

Question 17

You got carried away one night and took some PCP. Whoops. Being a huge nerd, you know the mechanism of this drug. What is it?

What other drugs are in the same category?

Answer 17

Dissociative anesthetic: antagonist at NMDA-type glutamate receptors

Ketamine
Dextromethorphan (100x therapeutic dose of cough suppressant)

Question 18

What symptoms should you expect after your PCP ingestion?

Answer 18

Lower doses–> euphoria and heightened emotionality,

Intermediate doses –> increased talkativeness, feelings of unreality, and changes in body image

Higher doses associated with hostile or bizarre behavior.

Question 19

Hopefully you didn’t overdose on the PCP. It’s easy to do. What would happen?

Answer 19

delirium, increased respirations, hypertension, tachycardia, hyperpyrexia, muscle rigidity (rhabdomyolysis risk) and increased deep tendon reflexes, stereotypies, and a blank stare. Death from respiratory or cardiac complications.

Trauma is common because you might get VIOLENT you filthy animal.