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Drugs Flashcards

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1
Q

legal limit for intoxication in most states?
at what BAL do more than 50% of adults show obvious signs of intoxication?
coma in novice drinker?
respiratory depression?

A

legal limit: 0.08-0.1mg%,
obvious: 0.15mg%,
coma: 0.3mg%,
resp depression: 0.4mg%

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2
Q

what can alcohol do to acid base?

A

methanol, ethanol, and ethylene glycol can cause metabolic acidosis with increase anion gap

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3
Q

what should be given to patients with altered mental status from alcohol?

A

thiamine, glucose, naloxone

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4
Q

should you do GI lavage for ETOH OD?

A

it has no role in ETOH OD but may be used in mixed ETOH OD

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5
Q

4 things for alcohol dependence

A
  1. AA
  2. disulfiram
  3. psychotherapy and SSRI
  4. naltrexone- opioid antagonist, helps reduce cravings for ETPH
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6
Q

3 parts of wernicke’s

A
  1. ataxia
  2. confusion
  3. eye abnrmalities- nystagmus, gaze palsies
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7
Q

3 parts of korsakoffs

A
  1. impaired recent memory
  2. anterograde amneisa
  3. confabulation
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8
Q

ddx of cocaine? how to test

A

ddx: methamphetamine and PCP
test: urine (3 days or more)

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9
Q

how to treat cocaine intoxications

A
  1. for severe agitation benzos
  2. for severe agitation or psychosis: haloperidol
  3. symptomatic support- HTN, arrythmias
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10
Q

benzo vs. barbiturate mechanism. have together?

A

benzo increase the frequency of chloride channel opening while barb increase duration of chloride channel opening. together they are synergistic and can lead to respiratory depression

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11
Q

gamma-hydroxy-butyrate

A

GHB- grevious bodily harm. dose specific CNS depressant-> memory loss, respiratory distress, and coma. commonly used as date rape drug.

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12
Q

how to treat barbiturate OD? benzo OD?

A

barb OD: alkalinize urine with sodium bicarb to enhance renal excretion.
benzo: flumazanil.
both are supportive care- improve respiratory status and control hypotension

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13
Q

merepidine + MAOI

A

even though merepidine is an opioid, can lead to serotonin syndrome

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14
Q

.classic triad of opioid OD

A

respiratory depression, altered mental status, miosis. RAM

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15
Q

withdrawal from opiates. deadly?

A

dysphoria, lacrimation, rhinorhea, sweating, weakness, piloerection, vomiting/nausea, dialted pupils, muscle ache. can treat with clonidine and/or bupernorphine. detox with methadone tapered over 7 days. NOT DEADLY but uncomfortable. opiate OD can be deadly from respiratory depression.

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16
Q

caffeine withdrawal

A

resolve with 1 week. headache, nausea/drowsiness, anxiety, depression

17
Q

smoking during pregnancy->

A

low birth weight and persistent pulmonary HTN in newborn

18
Q

4 ways to treat nicotine withdrawal

A
  1. couseling
  2. nicotine replacement therapy
  3. zyban- antidepressant that helps reduce cravings
  4. clonidine
19
Q

MDMA sxs? can MDMA be detected in urine tox screens?

A

HTN, tachycardia, hyperthermia, serotonin syndrome, hyponatremia, death. not detected by routine tox screens.

20
Q

treatment for TCA OD

A

sodium bicarbonate

21
Q

acid-base of methanol, ethanol, ethylene glycol

A

all can cause metabolic acidosis with increased anion gap

22
Q

when do the earliest sxs of ETOH withdrawal appear after last drink

A

6-24 hours. irritable/insomnia. fever, disorientation, seizure, or hallucinations.

23
Q

what does cocaine intoxication do to BP and respiration.

A

can increase OR decrease BP. it can cause respiratory depression

24
Q

how can cocaine intox-> death

A

secondary to cardiac arrythmia, seizure, cerebrovascular accident, or respiratory depression

25
Q

how to treat cocaine intoxication

A

moderate agitation: benzos.
for severe agitation or psychosis: haloperidol.
symptomatic support: control HTN, arrythmias

26
Q

how to treat cocaine dependence

A
  1. psychotherapy, group therapy
  2. TCAs
  3. dopamine agonists (amantidine, bromocriptine)
27
Q

can opiate + MAOI-> serotonin syndrome

A

yes- merepidine (demerol)

28
Q

what percent of demented pts have a treatable and reversible cause of dementia

A

15%

29
Q

which 2 opioids come up negative on a tox screen

A

methadone and oxycodone

30
Q

when do generalized tonic clonic seizure happen after last drink

A

between 6 and 48 hrs with peak at 13-24 hours

31
Q

acamprosate?

A

structurally similar to GAVA. thought to inhibit the glutamatergic system. should be start post detox for relapse prevention in pts who have stopped drinking.

32
Q

topiramate in alchol

A

anticonvulsant that potentiates GABA and inhibits glutamate receptors. reduced cravings for alachol

33
Q

how can MDMA cause death

A

OD an cause hyerthermia, deydration, rhabdo-> kidney failure

34
Q

which drug withdrawal has the highest mortality

A

barbiturate

35
Q

what is the most common cause of death from street heroin use

A

infection secondary to needle sharing

36
Q

how can opiate intoxication kill you? other sxs?

A

respiratory depression. can also cause nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constirction

37
Q

suboxone

A

buprenorphine+naloxone

38
Q

what is issue with naltrexone

A

compliance is an issue- it is a good choice for highly motivated pts

39
Q

can inhalants be deadly?

A

yes- secondary to respiratory depression or cardiac arrythmia

Psych (7 decks)

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