Drugs and Alcohol Flashcards
What are the physical health risks of misusing cocaine?
CARDIAC: MI, dissection, coronary vasospasm, HTN, QT prolongation
NEURO: seizures, stroke (haemorrhagic or ischaemic), increased tone (rhabdomyolysis)
GI: ischaemic colitis
OTHER: DVT
How is cocaine toxicity managed?
Benzodiazepines (inc. for cocaine induced chest pain)
+/- GTN for chest pain
+/- sodium nitroprusside for HTN
How could someone presenting with MDMA/ecstasy toxicity present? Signs, symptoms, bloods?
Agitated, confused, ataxic
Tachycardic, hypertensive, pyrexic, dilated pupils
Rhabdomyolysis
Hyponatraemia
How could MDMA associated pyrexia be managed?
Dantrolene if supportive measures don’t work
What are the effects of LSD?
Hallucinogenic
- visual hallucinations
- exaggeration of current mood
- reduced awareness leading to injuries
How is LSD toxicity managed?
Benzodiazepines for a “bad trip” causing agitation
Antipsychotics for drug induced psychosis
How would someone who has taken “spice” present?
Catatonic state
Respiratory depression
How would someone who has taken GHB/ liquid ecstasy present?
Respiratory depression
Bradycardic, hypotensive
Can have a GCS of 3
How would someone who has taken an opioid OD present?
Bradycardic, bradypnoeic, pinpoint pupils
Drowsy
What are the long term effects of opioid misuse?
Infective endocarditis
Septic arthritis
HIV
Crime and prostitution
How is opioid misuse managed in the short and long term?
IV or IM Naloxone
Methadone and buprenorphine
How would organophosphate poisoning present?
Salivation, lacrimation, urinate, diarrhoea
Bradycardic and hypotensive
Small pupils
How is organophosphate poisoning managed?
Atropine
How would a benzodiazepine OD managed?
Drowsy
Respiratory depression
Slurred speech
Ataxia
When and how is a benzodiazepine OD managed?
Only in iatrogenic
Flumazenil
What are some supportive management strategies used for symptomatic control of drug ODs?
BB for tachycardia Nifedipine for HTN Cool fluids for pyrexia Benzodiazepines for agitation Sodium bicarbonate for agitation Insulin/glucose for K
How do you calculate the units of alcohol in a drink?
What is considered safe?
(ml x %ABV) / 1000
14 units for men and women
Describe the timing and progression of symptoms occurring in alcohol withdrawal
6-12 hours: sweating, tachycardia, nausea, anxiety, tremor
36 hours: peak time for tonic-clonic seizures
48-72 hours: delirium tremens
What signs and symptoms define delirium tremens?
- coarse tremor
- confusion
- autonomic dysfunction (tachy, pyrexia)
- hallucinations and delusions
How is alcohol withdrawal managed?
How is this different if there is significant liver impairment?
Chlordiazepoxide and Pabrinex
Often Lorazepam is used instead of chlordiazepoxide in severe liver impairment
What VBG results are seen in alcohol ketoacidosis?
metabolic acidosis with elevated anion gap
normal to low glucose
raised ketones
How is alcoholic ketoacidosis managed?
Saline and Thiamine
What is Wernicke’s encephalopathy?
Neuropsychiatric disorder due to thiamine deficiency
How does Wernicke’s encephalopathy present?
Nystagmus Ophthalmoplegia Ataxia Confusion Peripheral sensory neuropathy
When does Wernicke-Korsakoff’s syndrome occur? How would it present?
When Wernicke’s is not treated with thiamine
+ antero/retrograde amnesia
+ confabulation
How is Wernicke’s managed?
Thiamine replacement
What are some complications of alcohol abuse and therefore what investigations should be done?
Liver damage - LFTs Vitamin deficiencies - B12, thiamine Anaemia - FBC Pancreatitis - amylase HTN - BP Psychological - social history
How do you screen for alcohol dependence?
CAGE questionnaire
- Thought about CUTTING down?
- Get ANGRY when asked about drinking habits?
- Feel GUILTY about drinking?
- Drink EARLY in the morning?
