Drugs of Misuse - NO L.O.s Flashcards
Flumazenil should be used in suspected benzodiazepine overdose - true or false?
False - should only be given if documented bzd overdose as it causes fits
Cannabis use is associated with cyclical vomiting syndrome - true or false?
True
Consuming 1 unit alcohol daily increases risk of breast cancer - true or false?
True
Cocaine-induced chest pain does not require treatment as an acute coronary syndrome - true or false?
False - treat as ACS with anti-platelets, GTN
Avoid beta blockers
Give BZDs
Methadone has a short half-life and is given several times daily in opiate addiction management - true or false?
False - half-life is long
24 yr old woman presents to the ED with agitation after taking MDMA (ecstasy).
PMH: Asthma; DH: OCP daily, Salbutamol PRN
Obs: T 38.5C; HR 112 bpm regular; BP 178/112 mmHg; RR 35 b/min; oxygen sats 99% room air
O/E: GCS 15/15; bruxism; agitated
What is the appropriate management at this stage?
- atenolol 25mg orally
- chilled 0.9% saline, 1 litre iv STAT
- diazepam 10mg orally
- observe in ED for 4h
- safe for discharge now
diazepam 10mg orally
Serotoninergic toxidrome - neuromuscular symptoms. (3)
hyperreflexia, clonus, tremor
Serotoninergic toxidrome - CNS symptoms. (4)
agitation, confusion, delirium, seizures
Serotoninergic toxidrome - autonomic symptoms. (4)
hyperthermia, labile BP, bladder instability, flushing
Causes of serotoninergic toxidrome?
Anti-depressants: SSRIs, MAO-I, SNRI, (TCAs)
Recreational: MDMA, cocaine, amphetamine
Other: triptans, tramadol, linezolid
How to treat serotoninergic toxidrome?
Benzodiazepine for agitation, seizures and hypertension
(or GTN, phentolamine, labetalol for hypertension)
Conventional cooling, benzodiazepines, active cooling, dantrolene, cyproheptadine for hyperthermia
24 yr old woman presents to the ED with ongoing central crushing chest pain after taking cocaine.
PMH: Nil DH: OCP daily
Obs: T 36.5C; HR 112 bpm regular; BP 178/112 mmHg; RR 35 b/min; oxygen sats 99% room air
O/E: GCS 15/15; in distress
Ix: ECG – sinus tachycardia, mild ST depression in lateral leads; POC TN I <30ng/L
How many of the following treatments is it appropriate to initiate?
- atenolol 25mg orally
- GTN iv, titrate from 1mg/hr
- diazepam 10mg orally
- aspirin 300mg orally
- cardiac monitor
2, 3, 4, 5
How does cocaine induced myocardial ischaemia occur?
Myocardial ischaemia is due to increased myocardial oxygen demand from increased cardiac output
How can cocaine induced myocardial ischaemia be treated?
Benzodiazepine sedation will lower HR and BP
and reduce cardiac output and oxygen consumption
Why should beta blockers be avoided in cocaine induced myocardial ischaemia?
would lead to unopposed alpha-stimulation and
potential catastrophic hypertension/vasoconstriction
Why are vasodilators such as GTN or calcium channel
blockers of use in cocaine induced myocardial ischaemia?
Myocardial ischaemia is due to coronary vasospasm
Why should anti-platelet agents be used in cocaine induced myocardial ischaemia?
Myocardial ischaemia is due to catecholamine induced platelet thrombosis
Opioid syndrome - symptoms?
depressed consciousness, decreased RR, decreased tidal volume, miosis, hypotension, response to naloxone
How is opioid overdose treated?
Naloxone
BZ sedative syndrome - symptoms?
depressed consciousness, decreased RR, ataxia, dysarthria, nystagmus
How is BZ overdose treated?
Flumazenil
What are GHB and GBL?
GHB (gammahydroxybutrate) and GBL (gammabutyrolactone), are closely related, dangerous drugs with similar sedative and anaesthetic effects.
GBL is converted to GHB shortly after entering the body. Both produce a feeling of euphoria and can reduce inhibitions and cause sleepiness.
GHB/GBL syndrome - symptoms?
depressed consciousness, decreased RR, decreased tidal volume, miosis, hypotension
GHB/GBL syndrome - how is overdose treated? What about withdrawal?
No specific drug therapy for overdose - patients wake up and walk out, or withdraw
For withdrawal, large BZ doses +/- baclofen
Alcohol toxidrome - symptoms?
Slurred speech, nystagmus, disinhibited behaviour,
incoordination, ataxia, memory impairment, stupor, coma
Hypotension and tachycardia can be related to
peripheral vasodilation
Hypoglycaemia
(Mild) lactic acidosis (with high osmolal gap)
Mild alcohol poisoning treatment.
Mild alcohol poisoning can be slept off
Moderate/severe alcohol poisoning treatment.
Moderate/severe should be treated supportively with
iv crystalloid and vitamins
Hypoglycaemia (<4mmol/L) should be treated
B vitamins are given opportunistically to those at risk
of malnutrition to prevent Wernicke’s
What is ethylene glycol?
anti-freeze
If severe high anion gap acidosis with high osmolal gap, what should be suspected?
Methanol co-ingested with ethanol
How is toxic alcohol toxidrome treated?
fomepizole
Chronic ethanol use is associated with…?
- Increased HTN, CCF, AF
- Hepatic failure, cancer and GI tract cancers
- Breast cancer
- Osteoporosis
- Psychiatric and legal issues
What is the u/day optimum median consumption of ethanol to balance risks and possible benefits?
0.5u/day
What are novel psychoactive substances (NPS)?
Are they legal in the UK?
Compounds designed to mimic existing established recreational drugs
In the UK it is now illegal to distribute or sell NPS, but possession is not a criminal offence.
What four categories can NPS be grouped in?
Which are the most commonly encountered?
stimulants, cannabinoids, hallucinogens, and depressants
stimulants (such as mephedrone) and cannabinoids (such as “spice”)
Risks associated with chronic illicit opiate use?
paraphernalia and infections
legality
acute overdose
What is methadone?
a long-acting opioid agonist (prevent withdrawal if doses missed for >24h) which reduces euphoria of illicit consumption e.g. used in opiate substitution programmes
Risks of chronic cannabis use?
Pulmonary - possible increased risk of cancer
Psychiatric – increased risk of psychosis
Immunity – laboratory evidence of disordered innate/adaptive immunity
Reproduction – reduced male libido, impotence and sperm count
GI – cannabinoid hyperemesis (hot shower to relieve)
