Drugs and Alcohol

Question 1

What are the physical health risks of misusing cocaine?

Answer 1

CARDIAC: MI, dissection, coronary vasospasm, HTN, QT prolongation
NEURO: seizures, stroke (haemorrhagic or ischaemic), increased tone (rhabdomyolysis)
GI: ischaemic colitis
OTHER: DVT

Question 2

How is cocaine toxicity managed?

Answer 2

Benzodiazepines (inc. for cocaine induced chest pain)

+/- GTN for chest pain
+/- sodium nitroprusside for HTN

Question 3

How could someone presenting with MDMA/ecstasy toxicity present? Signs, symptoms, bloods?

Answer 3

Agitated, confused, ataxic
Tachycardic, hypertensive, pyrexic, dilated pupils
Rhabdomyolysis
Hyponatraemia

Question 4

How could MDMA associated pyrexia be managed?

Answer 4

Dantrolene if supportive measures don’t work

Question 5

What are the effects of LSD?

Answer 5

Hallucinogenic

• visual hallucinations
• exaggeration of current mood
• reduced awareness leading to injuries

Question 6

How is LSD toxicity managed?

Answer 6

Benzodiazepines for a “bad trip” causing agitation

Antipsychotics for drug induced psychosis

Question 7

How would someone who has taken “spice” present?

Answer 7

Catatonic state

Respiratory depression

Question 8

How would someone who has taken GHB/ liquid ecstasy present?

Answer 8

Respiratory depression
Bradycardic, hypotensive
Can have a GCS of 3

Question 9

How would someone who has taken an opioid OD present?

Answer 9

Bradycardic, bradypnoeic, pinpoint pupils

Drowsy

Question 10

What are the long term effects of opioid misuse?

Answer 10

Infective endocarditis
Septic arthritis
HIV
Crime and prostitution

Question 11

How is opioid misuse managed in the short and long term?

Answer 11

IV or IM Naloxone

Methadone and buprenorphine

Question 12

How would organophosphate poisoning present?

Answer 12

Salivation, lacrimation, urinate, diarrhoea
Bradycardic and hypotensive
Small pupils

Question 13

How is organophosphate poisoning managed?

Answer 13

Atropine

Question 14

How would a benzodiazepine OD managed?

Answer 14

Drowsy
Respiratory depression
Slurred speech
Ataxia

Question 15

When and how is a benzodiazepine OD managed?

Answer 15

Only in iatrogenic

Flumazenil

Question 16

What are some supportive management strategies used for symptomatic control of drug ODs?

Answer 16

BB for tachycardia
Nifedipine for HTN
Cool fluids for pyrexia 
Benzodiazepines for agitation 
Sodium bicarbonate for agitation 
Insulin/glucose for K

Question 17

How do you calculate the units of alcohol in a drink?

What is considered safe?

Answer 17

(ml x %ABV) / 1000

14 units for men and women

Question 18

Describe the timing and progression of symptoms occurring in alcohol withdrawal

Answer 18

6-12 hours: sweating, tachycardia, nausea, anxiety, tremor
36 hours: peak time for tonic-clonic seizures
48-72 hours: delirium tremens

Question 19

What signs and symptoms define delirium tremens?

Answer 19

• coarse tremor
• confusion
• autonomic dysfunction (tachy, pyrexia)
• hallucinations and delusions

Question 20

How is alcohol withdrawal managed?

How is this different if there is significant liver impairment?

Answer 20

Chlordiazepoxide and Pabrinex

Often Lorazepam is used instead of chlordiazepoxide in severe liver impairment

Question 21

What VBG results are seen in alcohol ketoacidosis?

Answer 21

metabolic acidosis with elevated anion gap
normal to low glucose
raised ketones

Question 22

How is alcoholic ketoacidosis managed?

Answer 22

Saline and Thiamine

Question 23

What is Wernicke’s encephalopathy?

Answer 23

Neuropsychiatric disorder due to thiamine deficiency

Question 24

How does Wernicke’s encephalopathy present?

Answer 24

Nystagmus
Ophthalmoplegia 
Ataxia
Confusion 
Peripheral sensory neuropathy

Question 25

When does Wernicke-Korsakoff’s syndrome occur? How would it present?

Answer 25

When Wernicke’s is not treated with thiamine

+ antero/retrograde amnesia
+ confabulation

Question 26

How is Wernicke’s managed?

Answer 26

Thiamine replacement

Question 27

What are some complications of alcohol abuse and therefore what investigations should be done?

Answer 27

Liver damage - LFTs
Vitamin deficiencies - B12, thiamine 
Anaemia - FBC
Pancreatitis - amylase 
HTN - BP
Psychological - social history

Question 28

How do you screen for alcohol dependence?

Answer 28

CAGE questionnaire

• Thought about CUTTING down?
• Get ANGRY when asked about drinking habits?
• Feel GUILTY about drinking?
• Drink EARLY in the morning?