Illegal drugs

Question 1

What are some of the adverse effects of cocaine use?

Answer 1

CVS: coronary artery spasm –>MI, tachycardia. hypertension, QRS widening and QT prolongation
Neuro: seizures, hypertonia, hyperreflexia
Pscyh: Agitation, psychosis, hallucinations
Others: Ischaemic colitis, hyperthermia

Question 2

How is cocaine toxicity managed?

Answer 2

Benzodiazepines are first line
Chest pain = Benzo + GTN
Hypertension = Benzo + sodium nitroprusside

Question 3

Clinical features of opioid misuse?

Answer 3

• Rhinorrhoea
• Needle track marks
• Pinpoint pupils
• Drowsiness
• Watering eyes

Question 4

Complications of opioid misuse?

Answer 4

• Viral infections secondary to sharing needles - HIV, Hep B,C
• Bacterial infections from injecting - infective endocarditis, septicaemia, necrotising fasciitis
• VTE
• Respiratory depression –> death
• Social problems - homelessness, crime, prostitution

Question 5

What is the emergency treatment for opioid misuse?

Answer 5

IM/ IV naloxone

Question 6

Management of opioid dependence…

Answer 6

First line = Methadone or Buprenorphine
Methadone = ful agnoist of mu-opioid receptor - relieves withdrawal symptoms and cravings
Buprenorphine = partial agonist of mu-opioid receptor - partial activation is enough to alleviate withdrawal symptoms
Detox can last up to 4 weeks in inpatient setting, and up to 12 weeks in community

Question 7

What are the clinical features of ecstasy poisoning?

Answer 7

Neuro= agitation, anxiety, confusion
CVS = tachycardia, hypertension
Hyponatraemia = SIADH or excessive water consumption
Hyperthermia

Question 8

What is the management for ecstasy poisoning?

Answer 8

Supportive management
Dantrolene given if hyperthermia does not respond to simple measures