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Y3R2 - Toxicology ☠️ > L10: Substance Abuse Toxicity > Flashcards

L10: Substance Abuse Toxicity Flashcards

1
Q

Difficulties arise in diagnosing the withdrawal syndrome due to …..

A
  • Patients will deny significant ethanol and opioid abuse.
  • Patients present with a spectrum of signs and symptoms that confused with other illnesses.
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2
Q

Withdrawal syndromes are most commonly seen in patients who use ……

A
  • Ethanol
  • Sedative-hypnotic agents
  • Opioids on a chronic basis.
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3
Q

The most severe withdrawal symptoms are usually associated with …..

A

ethanol and other sedative-hypnotic agents.

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4
Q
  • Withdrawal from these sedative agents can produce ……
  • The withdrawal syndrome associated with opioid abstinence is ……
A
  • life-threatening problems.
  • generally not life threatening.
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5
Q

Factots affecting severity of withdrawl syndrome

A
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6
Q

Intro to AUD

A
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7
Q

Dx of AUD

A
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8
Q

DSM5 Creiteria of AUD

A
  • Large Amount
  • Persistent Desire
  • Huge Time
  • Strong Craving
  • Multiple Troubles
  • Decreased Activities
  • Pesistent Use
  • Tolerance
  • Withdrawal
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9
Q

Large Amount

A

Take Alcohol in large amounts or for long duration.

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10
Q

Persistent Desire

A

To control alcohol with unsuccessful results

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11
Q

Huge Time

A
  • Spent a huge time to obtain alcohol, use it or recover from its effects
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12
Q

Strong Craving

A

Continuous Craving “a strong desire” to use it.

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13
Q

Multiple Troubles

A

Reported major troubles at home, school, work & social relationship due to alcohol abuse.

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14
Q

Decreased Activities

A

Decrease social, occupational or recreational activities due to alcohol dependence.

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15
Q

Persistent Use

A
  • Continuous use of Alcohol despite its exacerbation for recurrent medical problems.
  • Continuous use of Alcohol despite its exacerbation for recurrent psychological problems.
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16
Q

Tolerance

A

Tolerance to alcohol occurs, which defining by one of the following:

  • Incraesed Dose of alcohol to achieve same mental desired effect.
  • Decreased Mental desired effect that obtain by alcohol in same persistent alcohol dose.
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17
Q

Withdrawl

A
  • Presence of characteristic withdrawal manifestations to alcohol
  • Subside of those alcoholic withdrawal manifestations by benzodiazepines given
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18
Q

Severity degrees of alcohol abuse

A
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19
Q

CP of AUD

A
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20
Q

CVS CP of AUD

A
  • Atrial fibrillation
  • Cardiomyopafhy
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21
Q

GIT CP of AUD

A
  • Hepatitis
  • Pancreatitis.
  • Gastritis
  • Cirrhosis
  • Esophageal varices
  • GIT hemorrhage
  • Malabsorption
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22
Q

Malignancy in CP of AUD

A
  • Breast
  • Esophagus
  • Larynx
  • Oropharynx
  • Hepatic
  • Colorectal
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23
Q

Hematolgical CP of AUD

A
  • Anemia
  • Leucopenia
  • Thrombocytopenia
  • Coagulopathy
  • Macrocytosis
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24
Q

Psychiatric CP of AUD

A
  • Hallucination
  • Delusions
  • Depression and suicide
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25
Q

Endocrine CP of AUD

A
  • Hypoglycemia
  • Hypogonadism
  • Osteoporosis
  • Steatosis
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26
Q

Neurological CP of AUD

A
  • Dementia
  • Cerebellar degeneration
  • Peripheral neuropathy
  • Korsakoff’s syndrome
  • Wernicke’s encephalopathy
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27
Q

Electrolytes CP of AUD

A

Decreased

  • Ca
  • Mg
  • K
  • PO4
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28
Q

Malnutrition in CP of AUD

A
  • Stomatitis

Decreased Folate, Niacin (pellagra), Vitamin C (scurvy)

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29
Q

When does Alcohol withdrawal criteria start?

A
  • The alcoho/ withdrawal syndrome usually develops within 6-24 hours of stop or reduction in alcohol consumption in dependent cases.
  • It commonly develops in patients admitted to hospital.
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30
Q

Toxic action of Alcohol

A
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31
Q

CP of Alcohol Withdrawal

A
  • Autonomic Excitation
  • Neuro-Excitation
  • Delirium Tremens
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32
Q

Onset & Peak of Autonomic Excitation of Alcohol Withdrawal

A

Starts within hours of cessation and peaks at 24-48 hours

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33
Q

Manifestations of Autonomic Excitation of Alcohol Withdrawal

A

Tremor & Asterixis
Anxiety & Agitation
Hyperthermia & Sweating
Hypertension & Tachycardia
Nausea & Vomiting

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34
Q

Onset & Peak of Neuro Excitation of Alcohol Withdrawal

A

Starts within 12-48 hours of alcohol cessation.

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35
Q

Manifestations of Neuro Excitation of Alcohol Withdrawal

A
  • Hyperreflexia & Seizures “Generalized Tonic-Clonic”
  • Nightmares & Hallucinations “Visual, Tactile & Occasionally Auditory”
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36
Q

Def of Delirium Tremens

A

It is a severe form of alcoholic withdrawal manifestations

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37
Q

Incidence of Delirium Tremens

A

Up to 20% of patients admitted to hospitals with alcohol withdrawal

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38
Q

Severity of Delirium Tremens

A

Up to 8% mortality rate

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39
Q

Criteria of Delirium Tremens

A

Associated with other medical co-morbidities and delayed presentation

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40
Q

Manifestations of Delirium Tremens

A
  • Hallucinations & Confusion
  • Disorientation & Clouding of consciousness
  • Respiratory & Cardiovascular collapse
  • Severe Autonomic hyperactivity & Death
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41
Q

Co-Morbidities of High alcohol intake

A
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42
Q

Manifestations of Wernike’s encephalopathy

A
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43
Q

TTT of Alcohol withdrawal

A
  • Mild Forms of Alcohol Withdrawal
  • Severe Forms of Alcohol Withdrawal
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44
Q

Managment of Mild Forms of Alcohol Withdrawal

A
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45
Q

Managment of Severe Forms of Alcohol Withdrawal

A

(Supportive & Emergency Care in an Inpatient Setting) “Minority of Cases”

  • Site
  • Indications
  • Type
  • Emergency TTT
  • Maintenace TTT
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46
Q

Site of Managment of Severe Forms of Alcohol Withdrawal

A

They are managed in inpatient clinic setting

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47
Q

Indications of Managment of Severe Forms of Alcohol Withdrawal

A

As in cases with high risk of:

  • Presence of significant medical co-morbidities,
  • Presence of significant psychiatric co-morbidities.
  • Presence of persistent abnormal vital signs
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48
Q

Type of managment of Severe Forms of Alcohol Withdrawal

A

Delirium tremens treatment

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49
Q

Emergency TTT in Managment of Severe Forms of Alcohol Withdrawal

A
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50
Q

Maintainence TTT in Managment of Severe Forms of Alcohol Withdrawal

A
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51
Q

Investigations in Alcohol Withdrawal

A
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52
Q

Disposition & Follow Up in Alcohol Withdrawal

A
  • Referral to home detoxification and psychosocial support
  • Once Acute Withdrawal is controlled or resolving.
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53
Q

Intro to Opioid use disorder

54
Q

Dx of Opioid use disorder

A

as mentioned before (DSM5)

55
Q

Opioid withdrawal criteria

A

Opioid withdrawal syndrome is the physiological response that develops:

  • When there is abrupt cessation or rapid reduction in opioid dose in a dependent case
  • when that case is administered an opioid antagonist or partial agonist.
56
Q

Toxic action of Opiates

57
Q

CP of Opioid withdrawal

58
Q

is Opioid withdrawal Life threatening?

A
  • Opioid Withdrawal Manifestation is not life threatening.
  • As contrast to withdrawal from alcohol or sedative-hypnotics.
59
Q

Sensation in Opioid withdrawal

A

The symptoms are usually sufficiently uncomfortable and unpleasant to enforce dependent to obtain opioids by any means

60
Q

Onset of Opioid withdrawal

A

Withdrawal symptoms begins within 6 hours of last heroin dose

61
Q

Peak of Opioid withdrawal

A

At 36-48 hours

62
Q

when does Opioid withdrawal Resolve?

A

Within 1 week

63
Q

Characters of Methadone Abuser

A
  • In contrast, onset of symptoms may be delayed 2-3 days after cessation of methadone,
  • Peak at several days
  • Last for up to 2 weeks
64
Q

Characters of Cocktail Abuser

A
  • Patients may present with withdrawal symptoms associated with cessation of more than one agent (cocktail abuser).
  • It is a very common presentation.
65
Q

Manifestations of Opiod Withdrawal

66
Q

what manifestations are absent in Opiod Withdrawal?

A
  • Altered Mental Status, Delirium, Hyperthermia & Seizures Do not occur in opioid withdrawal.
  • Their presence should alert the clinician to an Alternative Diagnosis or Complication “Not opioid withdrawal”.
67
Q

Co-morbidities of Opiod Withdrawal

A
  • Cocktail Abuser: Alcohol or sedative-hypnotic withdrawal syndrome.
  • Psychiatric Problems.
  • Dehydration
  • Infective complications of IV drug abuse
  • Electrolyte abnormalities
68
Q

Principle of TTT of Opiod Withdrawal

A

1st: Opioid adminstration

2nd: Opioid Removal (Detoxification Process)

69
Q

Opioid adminstration

TTT of Opioid Adminstration

A
  • Administration of opioids in sufficient dose will eliminate all withdrawal manifestations.
  • Administration of opioids to control withdrawal may be the best appropriate treatment protocol, especially where management of co-morbiditios takes first priority (1st priority to treat dehydration & olestrolytes abnormalities).
70
Q

opioid Removal (Detoxification Process)

TTT of Opioid Adminstration

71
Q

Site of TTT of Opioid Withdrawal

A
  • Outpatient or hospital admission
72
Q

when is Opioid Withdrawal Treated in outpatient Clinic?

A
  • Most patients with opioid withdrawal can be managed in an Outpatient setting.
  • Information and reassurance provided in a non-judgmental way are vital to engage the patient in a realistic withdrawal treatment program.
73
Q

what is hospital admission nedded in Opioid Withdrawal?

A
  • Severe withdrawal syndrome (e.g. following administration of antagonist)
  • Significant complications (e.g. severe dehydration or Infection)
  • Psychiatric problems
74
Q

Drugs used in TTT of Opioid Withdrawal

75
Q

what are drugs used for opioid replacment therapy?

A
  • Methadone
  • Bupernorphine
76
Q

Indications of methadone

A
  • Used in opioid withdrawal and for maintenance in abstinence programs
  • By its usage in. maintenance treatment, it produces significant reduction in heroin use and Decreases mortality from heroin overdose.
77
Q

Dose of methadone

A

Tapered over Many Weeks (By 5% each week).

78
Q

Indications of Buprenorphine

A
  • It is a high-affinity partial p-opioid agonist used as an alternative to methadone.
  • Buprenorphine treatment is as effective as methadone in maintenance treatment of heroin dependence..
79
Q

Dose of Buprenorphine

A

Tapered over Many Weeks (By 5% each week).

80
Q

Methods of Detoxification in Opiod withdrawal

A
  • Rapid
  • Ultra-Rapid
81
Q

Technique of Rapid detoxification

A
  • Using Naltrexone, Buprenorphine & Clonidine in various combinations & rapid tapering.
  • Using Methadone & rapid tapering.
82
Q

Efficiency of Rapid detoxification

A

has been successful if the following conditions present:

  • In selected patients.
  • By close clinical supervision from a experienced staff member.
  • In specialized hospital for substance of abuse treatment program.
83
Q

Technique of Ultra-rapid detoxification

A
  • It is an invasive procedure involving the precipitation of severe opioid withdrawal using naltrexone, often under general anesthesia & hemodialysis.
84
Q

Efficiency of Ultra-rapid detoxification

A

It is not recommended technique due to the following condition:

  • Not improve success drug free rates.
  • Carries a high risk of serious side effects up to death.
85
Q

Symptomatic TTT of Opiod withdrawal

86
Q

Dx of Amphetamine Use Disorder

87
Q

Prevelance & Age of Amphetamine Use Disorder

A
  • Prevalence of stimulant abuse “Involve Amphetamine” is estimated < 95% of total abused disorder.
  • Their peaks in 15-30-year-olds.
88
Q

ER burden of Amphetamine Use Disorder

A

Amphetamine & other stimulant-related presentations represent 1% ER burden.

89
Q

what are Highly addictive substances?

A

Amphetamines, particularly Methamphetamine, are highly addictive

90
Q

CP of Amphetamine Use Disorder

91
Q

CP of Amphetamine Withdrawal

92
Q

Course of Amphetamine Withdrawal

93
Q

TTT of Amphetamine Withdrawal

94
Q

Dx of Sedative-hypnotic abuse

95
Q

Forms of Sedative-hypnotics

A
  • Benzodiazepines
  • Barbiturates
  • non-benzodiazepine agents: (Zolpidem, zopiclone), baclofen, gamma-hydroxybutyrate, chloral hydrate and paraldehyde.
96
Q

Incidence of Sedative-hypnotic abuse

A

Intentional poisoning with sedative & hypnotics is extremely common.

97
Q

Criteria of Sedative-hypnotic withdrawal

A

Abrupt cessation or reduction in dose of a sedative-hypnotic agent can produce a characteristic withdrawal syndrome in a dependent individual nearly like alcohol withdrawal.

98
Q

Toxic action of Sedative-hypnotic withdrawal

99
Q

Characters of CP of Sedative-hypnotic withdrawal

A
  • Great Variability
  • Onset of Symptoms
  • Severity of symptoms
100
Q

Great variability in Sedative-hypnotic withdrawal

A
  • In rate of onset, type and severity of withdrawal symptoms “Inter-Individual Difference”.
101
Q

Onset of Sedative-hypnotic withdrawal

A
  • Most of them, onset of symptoms occurs within days (2-10 days) of abrupt cessation.
  • Few of them, onset of symploms occurs within hours as (e.g., GHB) of abrupt cessation
102
Q

Severity of symptoms of Sedative-hypnotic withdrawal

A
  • Most of them, are mild severity.
  • Few of them, are severe and potentially lethal syndrome similar to delirium tremens of alcohol and including seizures.
103
Q

what is absent in Opioid & Cannabis withdrawal?

A

In opioid or cannabis withdrawal.
No Reported Delirium or Seizures.

104
Q

Manifestations of Sedative-hypnotic withdrawal

A
  • Autonomic excitation
  • Neuro-excitation
  • DTs
  • Co-Morbidities
105
Q

Autonomic Excitation in Sedative-hypnotic withdrawal

A

Starts within hours of cessation and peaks at 24-48 hours

  • Anorexia
  • Palpitaions
  • Spasticity (baclofen)
106
Q

Neuro-Excitation in Sedative-hypnotic withdrawal

A

Starts within 12-48 hours of cessation

  • Agitation & Hallucinations
  • Insomnia & Inattention
    -Memory Disturbances & Perceptual Disturbances, “as Photophobia & Hyperacusis”)
107
Q

Delerium Tremens in Sedative-hypnotic withdrawal

A

In Rare Cases similar as Alcohol Withdrawals

  • Hallucinations & Confusion
  • Clouding of Consciousness & Autonomic hyperactivity
  • CVS & Respiratory collapse and Death
108
Q

Co-Morbiditis with Sedative-hypnotic withdrawal

A

Co-morbidities that should be considered in patients with sedative-hypnotic withdrawal include:

  • Dehydration & Electrolyte abnormalities
  • Psychiatric Troubles
  • Alcohol withdrawal syndrome
109
Q

TTT of Sedative-hypnotic withdrawal in mild to moderate cases

A

Replace of the offending agent “Sedative/Hypnotic Abused Substance” By Long-Acting Benzodiazepine. (LABz)

110
Q

Principle of Therapy of mild to moderate Sedative-hypnotic withdrawal

A
  • Where withdrawal develops as a result of an interruption in regular benzodiazepine (or other sedative-hypnotic agent) use due to an intercurrent medical illness,
  • It is best to reverse withdrawal syndrome by Reinstitution of offending agent until the precipitating illness is treated
111
Q

Aim of therapy of mild to moderate Sedative-hypnotic withdrawal

A

It is to achieve permanent safe withdrawal or dose reduction.

112
Q

Strategy of therapy of mild to moderate Sedative-hypnotic withdrawal

113
Q

TTT of severe cases of Sedative-hypnotic withdrawal

A

Similar to treatment of Alcohol Delirium Tremens (Previously Discussed).

114
Q

Site (Disposition) of Sedative-Hypnotic Withdrawal Treatment

A
  • Outpatient setting
  • Inpatient setting
115
Q

TTT of Sedative-Hypnotic Withdrawal in outpatient setting

A

In Majority patients

  • Outpatient setting is appropriate because most of sedative-hypnotic withdrawal is mild.
116
Q

TTT of Sedative-Hypnotic Withdrawal In inpatient Setting

117
Q

Definition of Solvent Abuse

A

Liquid that has the ability to dissolve, suspend or extract another material without chemical change to either the material or solvent.

118
Q

The abuse of solvents involves inhalation of these volatile substances for achieving an alteration in mental status, principally euphoria.

119
Q

Incidence of Solvent Abuse

A

It is a public health problem particularly in adolescents and low social state communities.

120
Q

Uses & Forms of Solvent Abuse

121
Q

Common Chemicals Used for Inhalational Abuse

122
Q

Toxic Action in Solvent Abuse

123
Q

Modes of abuse in Solvent Abuse

124
Q

manifestations of Solvent Withdrawal

A

Generally mild with lethargy, headaches, anxiety or depressed mood.

125
Q

Criteria of Solvent Withdrawal

A

It may last from several days to a few weeks

126
Q

TTT of Solvent Withdrawal

A

It does not require any specific treatment (NO treatment).

127
Q

Etiology of Neonatal abstinence

A
  • It results from maternal drug abuse, primarily of opioids.
  • Mainly due to Noradrenergic hyperactivity in born baby
128
Q

CP of Neonatal abstinence

129
Q

TTT of Neonatal abstinence

A

Various treatment modalities including Diazepam & Phenobarbital.

130
Q

done

131
Q

done

Y3R2 - Toxicology ☠️ (15 decks)

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