Intoxication and Withdrawal

Question 1

ALCOHOL TESTING

Answer 1

blood testing
breathalyzer
urine tests
liver enzymes-GGT ALT AST
biological assays- %carbohydrate deficient transferrin
-sensitive and specific
phosphatidylethanol for three weeks

Question 2

ALCOHOL LEVELS OF INTOXICATION

Answer 2

20-99% loss of musc coordination, change in mood personality and behavior
80% legal intoxication
100-199 neurological impairment
200-299 obvious intoxication, possible nausea and vomiting and ataxia
300-399 hypothermia, severe dysarthria and amnesia, stage I anesthesia
400-799 coma
600-800 fatal

Question 3

ALCOHOL WITHDRAWAL ONSET

Answer 3

withdrawal 6-24h after last drink.
seizures begin 8-24h after last drink, peak 24-48h
DTs 72-96h after, lasting 2-3d

Question 4

CIWA-Ar

Answer 4

= 10 mild, 11-15 moderate, > 15 severe

Question 5

ALCOHOL WITHDRAWAL MECHANISM

Answer 5

GABA - rebound hyperactivity of brain, and peripheral noradrenergic systems, -> increased sympathetic autonomic activity
norepinephrine
glutametergic
N methyl-D-asparte dysregulation

Question 6

ALCOHOL W/D MEDICATIONS LATENCY

Answer 6

diazepam latency 20-30min
chlordiazepoxide latency 1-2h
oxazepam latency 1.5-2 h

Question 7

ALCOHOL W/D MEDICATIONS doses

Answer 7

diazepam 10-20mg
chlorazepate 3.75-7.5mg
chlordiazepoxide 50-100mg

Question 8

WERNICKE

Answer 8

mental disturbance
paralysis of eye movements
ataxia

Question 9

KORSAKOFF

Answer 9

relative disproportionate disorder of retentive memory

Question 10

BERI BERI

Answer 10

high output heart failure thiamine deficiency

Question 11

BENZO WITHDRAWAL MECHANISM

Answer 11

as tolerance develops, GABA receptors downregulated, and glutamate gated NMDA upregulated, with abrupt stop GABA unable to overtake NMDA -> CNS excitation

Question 12

BENZO W/D timeline

Answer 12

short start 24h peak 1-5d, last 7-21 d

longer start 5d peak 1-9d last 10-28 d

Question 13

OPIOID WITHDRAWAL TIMELINE

Answer 13

meperidine peak 8-12 —> 4-5d
heroin peak 36-72h —> 7-14d (half life 3-4h)
methadone half life 13-47 h

Question 14

METHADONE

Answer 14

5-10mg increments to max of 30mg

Question 15

FLUNITRAZEPAM

Answer 15

date rape

Question 16

SEROTONIN SYNDROME

Answer 16

mental status changes
autonomic hyperactivity
neuromuscular signs
neuroleptic malignant syndrome - extrapyramidal signs

Question 17

“Z” drugs

Answer 17

imidazopyridine derives zolpidem
zaleplon, eszopiclone
bind to GABA receptor at ω subunit

Question 18

BENZO PHARMA

Answer 18

bind to GAB A receptor, opens chloride channel, decreases neuronal excitability

Question 19

BARBITURATE VS BENZO PHARMA

Answer 19

barb increase duration of opening of Cl channel,

bento increase frequency of opening