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Drugs of Abuse Flashcards

1
Q

Consider these interventions in ALL unknown causes of coma or decreased LOC

A
  • Oxygen
  • D50
  • Thaimine
  • Naloxone
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2
Q

Opioid drugs

A
  • Fentanyl
  • Heroin
  • Oxycodone
  • Morphine
  • Methadone
  • Hydrocodone
  • Carfentanil
  • Opium
  • Codeine
  • Hydromorphone
  • Oxycontin
  • Buprenorphine
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3
Q

S/sx of opioid OD

A
  • Triad: mental status depression, pinpoint pupils, respiratory depression
  • Bradycardia
  • Hypotension
  • Hypothermia
  • Pulmonary edema (ARDs-like on CXR)
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4
Q

Treatment of opioid OD

A
  • Naloxone
  • IVF
  • BVM (if hypoventilating/apneic)
  • ET intubation (if poor response to naloxone, acute lung injury)
  • Activated charcoal (for GI decontamination)
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5
Q

Naloxone pearls

A
  • Diagnostic tool (confirms opioid OD w/ improvement post-administration)
  • Can be given IM, IV, SQ, IN
  • Apnea -> 2 mg
  • Respiratory depression -> 0.4mg
  • Repeat every 2-3 minutes up to 10mg (consider other diagnoses w/o improvement)
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6
Q

Disposition for opioid OD: pt. is awake, asymptomatic w/ nml vitals

A

D/C in 4-6 hours after last naloxone dose

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7
Q

Disposition for opioid OD: pt. overdosed on long-acting opioids, recurrent respiratory depression, or required naloxone infusion or intubation

A

Admit to ICU

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8
Q

Disposition for opioid OD: survivors in the ED

A

BEFORE D/C…..

  • Burprenorphine
  • Counseling
  • Referral to treatment
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9
Q

Stimulants/sympathomimetic drug

A
  • Cocaine
  • Methamphetamine
  • Dextroamphetamine
  • Methylphenidate
  • Caffeine
  • Pseudoephedrine
  • Phenylpropanolamine
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10
Q

S/Sx of stimulants/sympathomimetic OD:

A
  • Dilated pupils (mydriasis)
  • Tachycardia
  • HTN
  • Chest pain
  • Hyperthermia
  • Diaphoresis
  • Agitation
  • Seizure
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11
Q

Treatment of stimulants/sympathomimetic OD:

A
  • ABCs
  • IVF
  • Activated charcoal (limited role) or whole bowel irrigation
  • Continuous cardiac and pulse ox monitoring (12 lead EKG if CP or shock)
  • Continuous temp monitoring
  • Haloperidol or BZDs (if agitated or sedated)
  • AVOID RESTRAINTS -> rhabdo
  • Minimally stimulating environment
  • Aggressive cooling
  • Seizure prevention w/ BZDs
  • CV concerns: BP (sedate, then BB), Dysrhythmias (NaHCO3), ACS (as before)
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12
Q

Other s/sx unique to methamphetamine (aka crank/ICE/crystal meth) OD

A
  • Paranoid delusions
  • Meth mouth and wasting
  • Co-ingestion with BZDs
  • Production injuries (burns & explosions)
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13
Q

S/Sx of MDMA (aka “Ecstasy/XTC/Adam/Molly/the love drug”) OD:

A
  • Euphoric, hallucinogen
  • Hyperthermia
  • Seizures
  • Hyponatremia
  • Bruxism
  • Prolonged use can cause memory loss
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14
Q

Treatment of MDMA OD:

A
  • Cooling
  • IVF
  • BZDs for seizure prevention
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15
Q

S/sx of acid/LSD (lysergic acid diethylamide) OD:

A
  • Mydriasis
  • Tachycardia
  • Muscle tension
  • Perception disorder/psychosis
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16
Q

Treatment of LSD/acid OD:

A
  • BZDs or haloperidol

- Supportive care

17
Q

S/sx of psilocybin (aka “magic mushrooms”) OD:

A
  • Euphoria/altered perception
  • Mydriasis
  • Tachycardia
  • Muscle tension
  • N/V
18
Q

Treatment of psilocybin OD:

A
  • BZDs

- Supportive care

19
Q

S/sx of phencyclidine (aka PCP, angel dust) OD:

A
  • Psychosis/agitation
  • Miosis
  • Nystagmus
  • Muscle rigidity
  • Coma/seizures/hyperthermia
20
Q

Treatment of phencyclidine OD:

A
  • BZDs
  • Hydration
  • Active cooling
21
Q

S/sx of ketamine (aka K, vitamin K, special K) OD:

A
  • Confusion and disorientation
  • Tachycardia/hypertension
  • N/V
  • Visual disturbances/out of body experiences
22
Q

Treatment of ketamine OD:

A
  • Supportive

* *AVOID BZDs** d/t frequent co-ingestion

23
Q

Treatment of cannibis OD:

A
  • Tachycardia
  • Nausea or “munchies”
  • Anxiety/panic
  • Conjunctival injection
  • Psychosis/panic/hallucinations
24
Q

What is cannabinoid hyperemesis syndrome (CHS)

A

Syndrome r/t overuse which presents w/ cyclical vomiting, diffuse abd pain, relief w/ hot showers

25
Q

Treatment of CHS:

A
  • Capsaicin cream to affected areas
  • Haloperidol (2nd line)
  • IVF
    AVOID OPIODS, REPEATED W/U (after diagnosis established)
26
Q

Commonly abused inhalants:

A
  • Halogenated hydrocarbons
  • Metallic based paints
  • Freon
  • Butane lighter fluid
  • Glue
27
Q

S/Sx of inhalants OD:

A
  • HA
  • Dizziness
  • Slurred speech
  • Stupor/coma
  • Respiratory distress
  • Tachycardia & palpitations
  • Myocardium sensitivity to catecholamines
28
Q

Treatment of inhalation OD:

A
  • High flow O2
  • Fluids/pressure support
  • Esmolol (tachy arrhythmia)
  • BZDs (agitation)
  • Assess for oral frostbite, high blood CO or MetHb

Emergency Med (3 decks)

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