Drugs of Abuse

Question 1

What mixture of cocaine and another common substance increases your risk of death? What does it make? What are three effects?

Answer 1

Ethanol
Makes Cocaethlyne
Potentiates effect and duration of cocaine
25x increased risk of cardiac death

Question 2

What are two pathophysiologic mechanisms of meth mouth?

Answer 2

Xerostomia

Maxillary artery vasospasm

Question 3

The average body packer has this many packets in their system?
Bonus: what is max seen

Answer 3

50-100
Max seen is 500
Packers will often know the exact number for delivery to be complete
Packs can contain 1-10 grams, and one package leak can be lethal

Question 4

What is divine mint?

Answer 4

Hallucinogen - Salvia divinorum
Opioid receptor – euphoria
30 min to 2 hours
Supportive care

Question 5

Which clinical exam finding correlates with psilocybin? What is a common complication? What should you be wary about with a known ingestion?

Answer 5

The degree of mydriasis 
Heat resistant 
Common complication is panic reaction 
Beware of other mushroom types 
Could also be a normal mushroom with PCP or LSD

Question 6

What plant has both opioid and stimulant properties

Answer 6

Kratom
Native to SE asia – teas or eat leaves
Ataxia, euphoria
Can have co ingestions

Question 7

What opioid contaminate can lead to naloxone-resistant overdoses?

Bonus: what % of opioid ingestions contained other drugs?

Answer 7

Etizolam (Benzo)

75% of the sample contained other drugs

Question 8

What morphine derivative is 10x more potent and contains corrosive by products?

Answer 8

Krokodil
Desomorphine/codeine
Causes rash looks like the scale of a crocodile
Common in eastern Europe, Russia, Florida (classic)

Question 9

What are three possible toxic exposures from being in a meth lab?

Answer 9

White phosphorus
Phosphine gas
Anhydrous ammonia

Question 10

What are three mechanisms of cocaine related MI?

Answer 10

Increased O2 demand
Coronary artery vasospasm
Coronary artery thombus

Question 11

What class of hallucinogens cause hypoNa and SS?

Answer 11

Entactogens
(amphetamines, mescaline/peyote, nutmeg)

Vomiting, hallucinations
SIADH

Question 12

What drug mixed with K2 and Spice leads to bleeding?

Answer 12

Superwarfarin (rat posion)

Question 13

What percentage of asymptomatic packers have a positive drug screen?

Answer 13

50-70%
External contamination/ micro perforation
Often taken opioid to slow bowel mobility during transport
Less likely to use substance than packer

Question 14

What is a complication of edibles in peds? How long can it last?

Answer 14

CNS or respiratory depression

24-48 hours

Question 15

What is spice/K2/ Mr Nice Guy?

Answer 15

Synthetic cannabinoid receptor antagonists

Sometimes put on leaves (think co-ingestion)

Question 16

Two most common complications of levthimisole?

Answer 16

Agranulocytosis and ANCA positive vasculitis

10% of cocaine

Question 17

7 features are reasons for admission with cocaine induced chest pain

Answer 17

Pre existing CAD/RFs
Persistent pain/SOB 
CHF/cardiogenic shock 
Vasodilator required 
Elevated trop 
EKG changes
Dysrhythmias

Question 18

What synthetic cathinone can cause psychosis lasting days to weeks?

Answer 18

Bath salts

Synthetic amphetamine

Question 19

What are the primary ocular effects of cannabis? Does it give you pupillary changes?

Answer 19

Conjunctival injection
Decreased IOP

Pupillary changes? No – think co-ingestions

Question 20

What is a patient called who places drug in a body cavity to avoid police?

Answer 20

“Body stuffer”

Question 21

What do you place on the belly for CHS?

Answer 21

Capsaicin cream

Question 22

Name a smoked pant that leads to tachycardia, flushed skin and hallucinogens?

Answer 22

Jimson weed (pink flower)
Anticholinergic
Supportive care, observe 8 hours

Question 23

What is the treatment and dose for an asymptomatic pediatric body packer? What if symptomatic?

Answer 23

WBI at 25ml/kg/hour
To clear effluent

Sympathomimetic – OR for removal
Opioid trial medical management

Question 24

What is crank? What is the duration?

Answer 24

Crystal meth (methamphetamine)
15 hours

Question 25

First choice drug for HTN with cocaine? Second choice drug for HTN in cocaine toxicity? What is the mechanism and dose?

Answer 25

Benzos
Phentolamine – alpha antagonist 1mg IV increase q3 minutes x2 to max 5
Duration 45 minutes

Question 26

Common adverse effects methadone? (two others that do same thing?)

Answer 26

QT prolongation

Cipro + ondansetron

Question 27

Methcathinone is an ingredient in this amphetamine like plant

Answer 27

Khat

Cant smoke it, used fresh

Question 28

What mechanism of hyponatremia with MDMA?

Answer 28

SIADH

Psychogenic polydipsia or SS two other options

Question 29

What common OTC med is used for opioid properties? Why might it be bad in overdose?

Answer 29

Massive overdose can cause dysrhythmias due to Na/K blockade

Question 30

What is best test for a suspected body packer?

Answer 30

CT abdo/pelvis – count the packets

abdo xray if unstable

Question 31

What are three main physiologic effects of using hydrocarbons?

Answer 31

Pulmonary - pneumonitis
Cardiac – dysrhythmias, VT storm due to sensitivity to catecholamines
Neurologic – narcotic, neuropathy