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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
Endocrine CP of **AUD**
- Hypoglycemia - Hypogonadism - Osteoporosis - Steatosis
26
Neurological CP of **AUD**
- Dementia - Cerebellar degeneration - Peripheral neuropathy - Korsakoff's syndrome - Wernicke's encephalopathy
27
Electrolytes CP of **AUD**
**Decreased** - Ca - Mg - K - PO4
28
Malnutrition in CP of **AUD**
- Stomatitis **Decreased** Folate, Niacin (pellagra), Vitamin C (scurvy)
29
When does Alcohol withdrawal criteria start?
- 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.
30
Toxic action of Alcohol
31
CP of **Alcohol Withdrawal**
- Autonomic Excitation - Neuro-Excitation - Delirium Tremens
32
Onset & Peak of Autonomic Excitation of **Alcohol Withdrawal**
Starts within hours of cessation and peaks at 24-48 hours
33
Manifestations of Autonomic Excitation of **Alcohol Withdrawal**
Tremor & Asterixis Anxiety & Agitation Hyperthermia & Sweating Hypertension & Tachycardia Nausea & Vomiting
34
Onset & Peak of Neuro Excitation of **Alcohol Withdrawal**
Starts within 12-48 hours of alcohol cessation.
35
Manifestations of Neuro Excitation of **Alcohol Withdrawal**
- Hyperreflexia & Seizures "Generalized Tonic-Clonic" - Nightmares & Hallucinations "Visual, Tactile & Occasionally Auditory"
36
Def of **Delirium Tremens**
It is a severe form of alcoholic withdrawal manifestations
37
Incidence of **Delirium Tremens**
Up to 20% of patients admitted to hospitals with alcohol withdrawal
38
Severity of **Delirium Tremens**
Up to 8% mortality rate
39
Criteria of Delirium Tremens
Associated with other medical co-morbidities and delayed presentation
40
Manifestations of **Delirium Tremens**
- Hallucinations & Confusion - Disorientation & Clouding of consciousness - Respiratory & Cardiovascular collapse - Severe Autonomic hyperactivity & Death
41
Co-Morbidities of High alcohol intake
42
Manifestations of **Wernike's encephalopathy**
43
TTT of **Alcohol withdrawal**
- Mild Forms of Alcohol Withdrawal - Severe Forms of Alcohol Withdrawal
44
Managment of **Mild Forms of Alcohol Withdrawal**
45
Managment of **Severe Forms of Alcohol Withdrawal**
(Supportive & Emergency Care in an Inpatient Setting) "Minority of Cases" - Site - Indications - Type - Emergency TTT - Maintenace TTT
46
Site of Managment of **Severe Forms of Alcohol Withdrawal**
They are managed in inpatient clinic setting
47
Indications of Managment of **Severe Forms of Alcohol Withdrawal**
**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
48
Type of managment of **Severe Forms of Alcohol Withdrawal**
Delirium tremens treatment
49
Emergency TTT in Managment of **Severe Forms of Alcohol Withdrawal**
50
Maintainence TTT in Managment of **Severe Forms of Alcohol Withdrawal**
51
Investigations in **Alcohol Withdrawal**
52
Disposition & Follow Up in **Alcohol Withdrawal**
- Referral to home detoxification and psychosocial support - Once Acute Withdrawal is controlled or resolving.
53
Intro to **Opioid use disorder**
54
Dx of **Opioid use disorder**
as mentioned before (DSM5)
55
**Opioid withdrawal criteria**
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
Toxic action of **Opiates**
57
CP of **Opioid withdrawal**
58
is **Opioid withdrawal** Life threatening?
- Opioid Withdrawal Manifestation is not life threatening. - As contrast to withdrawal from alcohol or sedative-hypnotics.
59
Sensation in **Opioid withdrawal**
The symptoms are usually sufficiently uncomfortable and unpleasant to enforce dependent to obtain opioids by any means
60
Onset of **Opioid withdrawal**
Withdrawal symptoms begins within 6 hours of last heroin dose
61
Peak of **Opioid withdrawal**
At 36-48 hours
62
when does **Opioid withdrawal** Resolve?
Within 1 week
63
Characters of **Methadone Abuser**
- 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
Characters of **Cocktail Abuser**
- Patients may present with withdrawal symptoms associated with cessation of more than one agent (cocktail abuser). - It is a very common presentation.
65
Manifestations of **Opiod Withdrawal**
66
what manifestations are absent in **Opiod Withdrawal**?
- 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
Co-morbidities of **Opiod Withdrawal**
- Cocktail Abuser: Alcohol or sedative-hypnotic withdrawal syndrome. - Psychiatric Problems. - Dehydration - Infective complications of IV drug abuse - Electrolyte abnormalities
68
Principle of TTT of **Opiod Withdrawal**
1st: Opioid adminstration 2nd: Opioid Removal (Detoxification Process)
69
Opioid adminstration **TTT of Opioid Adminstration**
- 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
opioid Removal (Detoxification Process) **TTT of Opioid Adminstration**
71
Site of TTT of Opioid Withdrawal
- Outpatient or hospital admission
72
when is **Opioid Withdrawal** Treated in outpatient Clinic?
- 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
what is hospital admission nedded in **Opioid Withdrawal**?
- Severe withdrawal syndrome (e.g. following administration of antagonist) - Significant complications (e.g. severe dehydration or Infection) - Psychiatric problems
74
Drugs used in TTT of **Opioid Withdrawal**
75
what are drugs used for opioid replacment therapy?
- Methadone - Bupernorphine
76
Indications of methadone
- 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
Dose of methadone
Tapered over Many Weeks (By 5% each week).
78
Indications of **Buprenorphine**
- 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
Dose of **Buprenorphine**
Tapered over Many Weeks (By 5% each week).
80
Methods of **Detoxification** in Opiod withdrawal
- Rapid - Ultra-Rapid
81
Technique of **Rapid detoxification**
- Using Naltrexone, Buprenorphine & Clonidine in various combinations & rapid tapering. - Using Methadone & rapid tapering.
82
Efficiency of Rapid detoxification
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
Technique of **Ultra-rapid detoxification**
- It is an invasive procedure involving the precipitation of severe opioid withdrawal using naltrexone, often under general anesthesia & hemodialysis.
84
Efficiency of Ultra-rapid detoxification
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
Symptomatic TTT of Opiod withdrawal
86
Dx of **Amphetamine Use Disorder**
DSM 5
87
Prevelance & Age of **Amphetamine Use Disorder**
- Prevalence of stimulant abuse "Involve Amphetamine" is estimated < 95% of total abused disorder. - Their peaks in 15-30-year-olds.
88
ER burden of **Amphetamine Use Disorder**
Amphetamine & other stimulant-related presentations represent 1% ER burden.
89
what are Highly addictive substances?
Amphetamines, particularly Methamphetamine, are highly addictive
90
CP of **Amphetamine Use Disorder**
91
CP of **Amphetamine Withdrawal**
92
Course of **Amphetamine Withdrawal**
93
TTT of **Amphetamine Withdrawal**
94
Dx of **Sedative-hypnotic abuse**
DSM 5
95
Forms of Sedative-hypnotics
- Benzodiazepines - Barbiturates - non-benzodiazepine agents: (Zolpidem, zopiclone), baclofen, gamma-hydroxybutyrate, chloral hydrate and paraldehyde.
96
Incidence of **Sedative-hypnotic abuse**
Intentional poisoning with sedative & hypnotics is extremely common.
97
Criteria of **Sedative-hypnotic withdrawal**
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
Toxic action of **Sedative-hypnotic withdrawal**
99
Characters of CP of Sedative-hypnotic withdrawal
- Great Variability - Onset of Symptoms - Severity of symptoms
100
Great variability in **Sedative-hypnotic withdrawal**
- In rate of onset, type and severity of withdrawal symptoms "Inter-Individual Difference".
101
Onset of **Sedative-hypnotic withdrawal**
- 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
Severity of symptoms of Sedative-hypnotic withdrawal
- 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
what is absent in **Opioid & Cannabis withdrawal**?
In opioid or cannabis withdrawal. No Reported Delirium or Seizures.
104
Manifestations of **Sedative-hypnotic withdrawal**
- Autonomic excitation - Neuro-excitation - DTs - Co-Morbidities
105
Autonomic Excitation in Sedative-hypnotic withdrawal
**Starts within hours of cessation and peaks at 24-48 hours** - Anorexia - Palpitaions - Spasticity (baclofen)
106
Neuro-Excitation in **Sedative-hypnotic withdrawal**
**Starts within 12-48 hours of cessation** - Agitation & Hallucinations - Insomnia & Inattention -Memory Disturbances & Perceptual Disturbances, "as Photophobia & Hyperacusis")
107
Delerium Tremens in **Sedative-hypnotic withdrawal**
In Rare Cases similar as Alcohol Withdrawals - Hallucinations & Confusion - Clouding of Consciousness & Autonomic hyperactivity - CVS & Respiratory collapse and Death
108
Co-Morbiditis with **Sedative-hypnotic withdrawal**
**Co-morbidities that should be considered in patients with sedative-hypnotic withdrawal include:** - Dehydration & Electrolyte abnormalities - Psychiatric Troubles - Alcohol withdrawal syndrome
109
TTT of **Sedative-hypnotic withdrawal** in mild to moderate cases
Replace of the offending agent "Sedative/Hypnotic Abused Substance" By Long-Acting Benzodiazepine. (LABz)
110
Principle of Therapy of **mild to moderate Sedative-hypnotic withdrawal**
- 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
Aim of therapy of **mild to moderate Sedative-hypnotic withdrawal**
It is to achieve permanent safe withdrawal or dose reduction.
112
Strategy of therapy of **mild to moderate Sedative-hypnotic withdrawal**
113
TTT of **severe cases of Sedative-hypnotic withdrawal**
Similar to treatment of Alcohol Delirium Tremens (Previously Discussed).
114
Site (Disposition) of **Sedative-Hypnotic Withdrawal** Treatment
- Outpatient setting - Inpatient setting
115
TTT of **Sedative-Hypnotic Withdrawal** in outpatient setting
**In Majority patients** - Outpatient setting is appropriate because most of sedative-hypnotic withdrawal is mild.
116
TTT of **Sedative-Hypnotic Withdrawal** In inpatient Setting
117
Definition of **Solvent Abuse**
Liquid that has the ability to dissolve, suspend or extract another material without chemical change to either the material or solvent.
118
The abuse of solvents involves inhalation of these volatile substances for achieving an alteration in mental status, principally euphoria.
..
119
Incidence of **Solvent Abuse**
It is a public health problem particularly in adolescents and low social state communities.
120
Uses & Forms of **Solvent Abuse**
121
**Common Chemicals Used for Inhalational Abuse**
122
Toxic Action in **Solvent Abuse**
123
Modes of abuse in **Solvent Abuse**
124
manifestations of **Solvent Withdrawal**
Generally mild with lethargy, headaches, anxiety or depressed mood.
125
Criteria of **Solvent Withdrawal**
It may last from several days to a few weeks
126
TTT of **Solvent Withdrawal**
It does not require any specific treatment (NO treatment).
127
Etiology of **Neonatal abstinence**
- It results from maternal drug abuse, primarily of opioids. - Mainly due to Noradrenergic hyperactivity in born baby
128
CP of **Neonatal abstinence**
129
TTT of **Neonatal abstinence**
Various treatment modalities including Diazepam & Phenobarbital.
130
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Y3R2 - Toxicology ☠️ (15 decks)

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