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csp 2 > Drugs of Misuse - NO L.O.s > Flashcards

Drugs of Misuse - NO L.O.s Flashcards

1
Q

Flumazenil should be used in suspected benzodiazepine overdose - true or false?

A

False - should only be given if documented bzd overdose as it causes fits

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2
Q

Cannabis use is associated with cyclical vomiting syndrome - true or false?

A

True

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3
Q

Consuming 1 unit alcohol daily increases risk of breast cancer - true or false?

A

True

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4
Q

Cocaine-induced chest pain does not require treatment as an acute coronary syndrome - true or false?

A

False - treat as ACS with anti-platelets, GTN
Avoid beta blockers
Give BZDs

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5
Q

Methadone has a short half-life and is given several times daily in opiate addiction management - true or false?

A

False - half-life is long

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6
Q

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?

  1. atenolol 25mg orally
  2. chilled 0.9% saline, 1 litre iv STAT
  3. diazepam 10mg orally
  4. observe in ED for 4h
  5. safe for discharge now
A

diazepam 10mg orally

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7
Q

Serotoninergic toxidrome - neuromuscular symptoms. (3)

A

hyperreflexia, clonus, tremor

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8
Q

Serotoninergic toxidrome - CNS symptoms. (4)

A

agitation, confusion, delirium, seizures

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9
Q

Serotoninergic toxidrome - autonomic symptoms. (4)

A

hyperthermia, labile BP, bladder instability, flushing

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10
Q

Causes of serotoninergic toxidrome?

A

Anti-depressants: SSRIs, MAO-I, SNRI, (TCAs)
Recreational: MDMA, cocaine, amphetamine
Other: triptans, tramadol, linezolid

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11
Q

How to treat serotoninergic toxidrome?

A

Benzodiazepine for agitation, seizures and hypertension
(or GTN, phentolamine, labetalol for hypertension)
Conventional cooling, benzodiazepines, active cooling, dantrolene, cyproheptadine for hyperthermia

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12
Q

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?

  1. atenolol 25mg orally
  2. GTN iv, titrate from 1mg/hr
  3. diazepam 10mg orally
  4. aspirin 300mg orally
  5. cardiac monitor
A

2, 3, 4, 5

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13
Q

How does cocaine induced myocardial ischaemia occur?

A

Myocardial ischaemia is due to increased myocardial oxygen demand from increased cardiac output

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14
Q

How can cocaine induced myocardial ischaemia be treated?

A

Benzodiazepine sedation will lower HR and BP

and reduce cardiac output and oxygen consumption

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15
Q

Why should beta blockers be avoided in cocaine induced myocardial ischaemia?

A

would lead to unopposed alpha-stimulation and

potential catastrophic hypertension/vasoconstriction

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16
Q

Why are vasodilators such as GTN or calcium channel

blockers of use in cocaine induced myocardial ischaemia?

A

Myocardial ischaemia is due to coronary vasospasm

17
Q

Why should anti-platelet agents be used in cocaine induced myocardial ischaemia?

A

Myocardial ischaemia is due to catecholamine induced platelet thrombosis

18
Q

Opioid syndrome - symptoms?

A

depressed consciousness, decreased RR, decreased tidal volume, miosis, hypotension, response to naloxone

19
Q

How is opioid overdose treated?

A

Naloxone

20
Q

BZ sedative syndrome - symptoms?

A

depressed consciousness, decreased RR, ataxia, dysarthria, nystagmus

21
Q

How is BZ overdose treated?

A

Flumazenil

22
Q

What are GHB and GBL?

A

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.

23
Q

GHB/GBL syndrome - symptoms?

A

depressed consciousness, decreased RR, decreased tidal volume, miosis, hypotension

24
Q

GHB/GBL syndrome - how is overdose treated? What about withdrawal?

A

No specific drug therapy for overdose - patients wake up and walk out, or withdraw
For withdrawal, large BZ doses +/- baclofen

25
Q

Alcohol toxidrome - symptoms?

A

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)

26
Q

Mild alcohol poisoning treatment.

A

Mild alcohol poisoning can be slept off

27
Q

Moderate/severe alcohol poisoning treatment.

A

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

28
Q

What is ethylene glycol?

A

anti-freeze

29
Q

If severe high anion gap acidosis with high osmolal gap, what should be suspected?

A

Methanol co-ingested with ethanol

30
Q

How is toxic alcohol toxidrome treated?

A

fomepizole

31
Q

Chronic ethanol use is associated with…?

A
  • Increased HTN, CCF, AF
  • Hepatic failure, cancer and GI tract cancers
  • Breast cancer
  • Osteoporosis
  • Psychiatric and legal issues
32
Q

What is the u/day optimum median consumption of ethanol to balance risks and possible benefits?

A

0.5u/day

33
Q

What are novel psychoactive substances (NPS)?

Are they legal in the UK?

A

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.

34
Q

What four categories can NPS be grouped in?

Which are the most commonly encountered?

A

stimulants, cannabinoids, hallucinogens, and depressants

stimulants (such as mephedrone) and cannabinoids (such as “spice”)

35
Q

Risks associated with chronic illicit opiate use?

A

paraphernalia and infections
legality
acute overdose

36
Q

What is methadone?

A

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

37
Q

Risks of chronic cannabis use?

A

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)

csp 2 (12 decks)

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