lect 2 Flashcards
tobacco stats:
deaths:
480,000 deaths
41k due to 2nd hand smoke
it isnt banned bc the taxes help fund the economy
tobacco use disorder physiologic effects are?
stimulates the nicotinic cholinergic receptors in the brain
-HTN, tachy, vasoconstriction, inc. plt coag, decPaO2
tobacco use disorder prevention
-inc. price
-stop teen smoking
-penalties for sales to minor
tobacco use disorder tx:
the 5As to find who is willing to quit
-treat sx
-smoking cessation
-ask about tobacco at every visit
-advise pt to quit in strong, straightforward lang.
-assess pt willingness to quit in the next 30 days
-help pt if willing to quit
-arrange f/u
tobacco medication tx:
-nicotine replacement therapy (gum, patch, inhale), taper within time
-bupropion: blocks nicotine effect
-Varenicline: blocks effect of nocotine BUT cravings for alcohol occur
tobacco use higher in what populations:
-NA, white ppl, homos
cannabis use disorder:
what r its effects?
-tetrahydrocannibinol THC in weed
-euphoria, sedation, anxiolytic
cannibis use disorder effects when using?
chronic: lung dx, frequenct infxns
-no oral malignancies
-adolescents whp heavily use have hippocampal changes which is where it affects mood disorders
-linked to schizophrenia
what is cannabinoid hyperemesis syndrome?
-frequent users have cyclic nausea and vomiting
-relieved by hot showers and bath
cannabis use disorder withdrawal:
TX:
cessation can cause mild sx 3-7 days:
-insomnia
-irritability
-depression
-nausea
-anorexia
TX:
rehab counseling, no meds to help
Stimulant Use Disorder:
cocaine
-alkaloid derived from coca plant that enhances NE/dopamine/ serotonin in CNS/PNS
ppl who use cocaine stats:
-pure cocaine is usually 45-60% pure and mixed w other subs.
-crack cocaine is a highly biologically active form that has worsened the incidence of coc.use disorder
-most coc users are recreational users
-25% will have a stimulant disorder
Stimulant Use Disorders : cocaine
-dopaminergic effects:
-hyperstimulation
-alertness
-euphoria
-sense of increase energy, feelings of power
Stimulant Use Disorders : cocaine
-sympathomimetic effects due to NE:
-tachy
-htn
-mydriasis (pupillary dilation)
-diaphoresis
-hyperthermia
Stimulant Use Disorders : cocaine
-significant vasoconstrictive
-AFFECT ANY ORGAN
-mi
-cerebral
-ischemia/hemorrhage
-renal ischemia
in pregnant women:
-inc. risk of placental abruption
-inc risk of spontaneous abortion
cocaine inhaled: crack causes what … to your body ?
-inc. risk of pneumothorax and pneumomediastinum
-chest pain and dyspnea
Physical signs of Cocaine use:
Toxicity:
-tachy
-htn
-mydriasis (pupillary dilation)
-diaphoresis
-hyperthermia
T: anxiety, panic, agitation, aggression, hallucinations
tremors, delirium, delusions, impaired judgement
Cocaine w alcohol:
- concurrent use w/ alcohol produces a condensation product cocaethylene= additive effect
cocaine effect on severe overdose:
chronic effects:
-acute pyschosis
-rhabdomyolysis
-coagulopathy
-renal failure
-seizures
-severe hyperthermia
-death
chronic effects of coc:
-Lheart issues lol (LVH, cardiomyopathy, myocardial fibrosis)
-chronic renal failure
-nasal septum perforation
Cocaine acute overdose TX:
Rehab:
-IV benzodiazepines
-AVOID BB due to alpha adrenergic effects
- cooling therapy
-tx sx
-mechanical ventilation w propofol
R: outpt therapy such as support groups
INPT when its serious physical or mental comorbidity and fails tx
approved tx for ADHD:
FYI: prescription stimulant same physio effects as coc
-dextroamphetamine
-amphetamine
-methylphenidate
illicit:
meth, MDMA, ectasy
Hallucinogen definition:
false perception w/out sensory stimulation in the waking state
-auditory, visual, olfactory, tactile, somatic
what are hallucinogens:
intoxication causes :
TX: supportive :/
group pf drugs that can cause highly unpredictable rxns
-hallucinations
-impaired judgement
-ideas of reference: random events in world relates to oneself
-depersonalization
traditional hallucinogens:
LSD- lysergic acid diethylamide [derived from fungus that contaminate wheat and rye flour]
-Psilocybin “shrooms”
-mescalin [peyote cactus]
signs and sx of tripping:
long term and short term effects:
LSD FLASHBACKS
-visual disturbances
-persistent psychosis (paranoia, disorganized thinking, distored perception)
-mood changes:
pamic/fear/ anxiety
-dizzy/arrthymia
synthetic “designer drugs”
-tryptamines
-phenylethamines
-ketamine
-phencyclidine (angel dust)
-dextromethorphan
-MJ in large doses
Hallucinogen diagnoses:
pt presents to law enforcement/ED in acute psychosis
hallucinogen TX:
acute intox:
-supportive care
-anxiolytics for relief and anxiety –> BENZ
persistant sx/flashbacks:
-psychiatric care
-antipsychotic
use benz –> anxiety during flashbacks
inhalant use disorder:
the solvents that your inhaling:
-acetates
-alcohol
-ether
-ketones
-aliphatic and aromatic
-hydrocarbons
inhalent examples:
-adhesives
-paints
-paint strippers
-cleaning prods
acute affects of inhalants:
-dizzy, drowsy, slurred speech, unsteady gait, hallucinate, delulu, death
hypoxia, laryngospasm [airway obstruction], arrythmias
chronic effects of inhalants:
TX:
-perioral eczema
-hepatic/renal failure
-dysrhthmias
supportive care, relapse if frequent
most common misused benz:
-alprazolam
-diazepam
-clonazepam
Benz acute toxicity:
chronic effect:
-sedation
- respiratory depression
-flumazenil –>benz agonist that reverse resp.depress
CE: slow cognition, slurred speech, poor memory/faulty judgement
-emotional lability
cessation sx of benz:
TX:
mild withdrawal such as:
tachypnea/cardia
tremulousness
confusion
seizures
TX: flumazenil to induce withdrawal
tapering is better and LT cessation
