Drugs Flashcards
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?
legal limit: 0.08-0.1mg%,
obvious: 0.15mg%,
coma: 0.3mg%,
resp depression: 0.4mg%
what can alcohol do to acid base?
methanol, ethanol, and ethylene glycol can cause metabolic acidosis with increase anion gap
what should be given to patients with altered mental status from alcohol?
thiamine, glucose, naloxone
should you do GI lavage for ETOH OD?
it has no role in ETOH OD but may be used in mixed ETOH OD
4 things for alcohol dependence
- AA
- disulfiram
- psychotherapy and SSRI
- naltrexone- opioid antagonist, helps reduce cravings for ETPH
3 parts of wernicke’s
- ataxia
- confusion
- eye abnrmalities- nystagmus, gaze palsies
3 parts of korsakoffs
- impaired recent memory
- anterograde amneisa
- confabulation
ddx of cocaine? how to test
ddx: methamphetamine and PCP
test: urine (3 days or more)
how to treat cocaine intoxications
- for severe agitation benzos
- for severe agitation or psychosis: haloperidol
- symptomatic support- HTN, arrythmias
benzo vs. barbiturate mechanism. have together?
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
gamma-hydroxy-butyrate
GHB- grevious bodily harm. dose specific CNS depressant-> memory loss, respiratory distress, and coma. commonly used as date rape drug.
how to treat barbiturate OD? benzo OD?
barb OD: alkalinize urine with sodium bicarb to enhance renal excretion.
benzo: flumazanil.
both are supportive care- improve respiratory status and control hypotension
merepidine + MAOI
even though merepidine is an opioid, can lead to serotonin syndrome
.classic triad of opioid OD
respiratory depression, altered mental status, miosis. RAM
withdrawal from opiates. deadly?
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.
caffeine withdrawal
resolve with 1 week. headache, nausea/drowsiness, anxiety, depression
smoking during pregnancy->
low birth weight and persistent pulmonary HTN in newborn
4 ways to treat nicotine withdrawal
- couseling
- nicotine replacement therapy
- zyban- antidepressant that helps reduce cravings
- clonidine
MDMA sxs? can MDMA be detected in urine tox screens?
HTN, tachycardia, hyperthermia, serotonin syndrome, hyponatremia, death. not detected by routine tox screens.
treatment for TCA OD
sodium bicarbonate
acid-base of methanol, ethanol, ethylene glycol
all can cause metabolic acidosis with increased anion gap
when do the earliest sxs of ETOH withdrawal appear after last drink
6-24 hours. irritable/insomnia. fever, disorientation, seizure, or hallucinations.
what does cocaine intoxication do to BP and respiration.
can increase OR decrease BP. it can cause respiratory depression
how can cocaine intox-> death
secondary to cardiac arrythmia, seizure, cerebrovascular accident, or respiratory depression
how to treat cocaine intoxication
moderate agitation: benzos.
for severe agitation or psychosis: haloperidol.
symptomatic support: control HTN, arrythmias
how to treat cocaine dependence
- psychotherapy, group therapy
- TCAs
- dopamine agonists (amantidine, bromocriptine)
can opiate + MAOI-> serotonin syndrome
yes- merepidine (demerol)
what percent of demented pts have a treatable and reversible cause of dementia
15%
which 2 opioids come up negative on a tox screen
methadone and oxycodone
when do generalized tonic clonic seizure happen after last drink
between 6 and 48 hrs with peak at 13-24 hours
acamprosate?
structurally similar to GAVA. thought to inhibit the glutamatergic system. should be start post detox for relapse prevention in pts who have stopped drinking.
topiramate in alchol
anticonvulsant that potentiates GABA and inhibits glutamate receptors. reduced cravings for alachol
how can MDMA cause death
OD an cause hyerthermia, deydration, rhabdo-> kidney failure
which drug withdrawal has the highest mortality
barbiturate
what is the most common cause of death from street heroin use
infection secondary to needle sharing
how can opiate intoxication kill you? other sxs?
respiratory depression. can also cause nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constirction
suboxone
buprenorphine+naloxone
what is issue with naltrexone
compliance is an issue- it is a good choice for highly motivated pts
can inhalants be deadly?
yes- secondary to respiratory depression or cardiac arrythmia
