Lecture 20 - Addiction in the ER Flashcards
true or false: emergancy department (ED) presentations related to substance use require more resources than those without
true
any substance of misuse can have:
negative effects requiring emergent care
what are the four key treatments to treat addiction emergencies?
- reversal agents/antidotes
- downstream effects on the body
- alternative pathways
- chronic changes
what are the most common symptoms of ethanol/alcohol intoxication?
- decreased level of consciousness
- agitation
intoxication due to alcohol consumption is caused by:
excessive GABAergic signalling
go read case study 1
:P
what are the three major treatments for ethanol intoxication?
- thamine (vitamin B1)
- folic acid (vitamin B12)
- magnesium
how does alcohol affect thiamine in the body?
reduces the rate of thiamine absorption, inhibits the active transport of thiamine, and reduces production of thiamine related enzymes
how does chronic alcohol use affect essential vitamins for normal body function?
depletes vitamin reserves
depleted folic acid (vitamin B12) leads to:
increased urinary excretion
depleted magnesium in the body leads to:
increased urinary and bowel excretion (can also lead to serious heart problems)
what causes alcohol withdrawl?
- chronic EtOH use leads to a downregulation of GABA receptors and increases glutamatergic signalling
- sudden removal of EtOH causes an imbalance
- glutamate signalling greater than GABA signalling (causes severe issues)
the degree of severity of alcohol withdrawl depends on:
daily amount of EtOH consumed and underlying genetic effects
a history of previous seizures can predict:
future withdrawl seizures
when do symptoms of alcohol withdrawl start?
normally, 24-48 hours after the last drink was consumed
go read case study 2
ba la la la
what are the three main steps to resuscitate patients with alcohol withdrawl?
1) immediate treatment with GABA enhancing drugs (IV valium) to help restore the GABA:glutamate balance
2) IV benzodiazepines
3) second line therapies (phenobarbital, ketamine, clonidine, dexmedetomidine)
the most common IV benzodiazepine used to treat alcohol withdrawl?
diazepam
which IV benzodiazepine is used to treat alcohol withdrawl if the patient has a history of liver disease?
lorazepam
second line therapy which opens GABA receptors and down-regulates glutamatergic signalling
phenobarbital
a surgical medicine with rapid onset (15-30 seconds) that hyperpolarizes cells with GABA neurons and inhibits NMDA receptors
propofol
what is the risk of using propofol?
it stops the respiratory drive
when is propofol used in emergency departments?
seizures induced by alcohol withdrawl
how is a patient going into an alcohol withdrawl related seizure treated?
propofol and/or intubation
a postitive allosteric modulator for GABAa receptors and an NMDA antagonist
acamprosate
what are the three major cannabis related emergencies seen in hospitals?
- cannabis overdose
- cannabinoid hyperemesis syndrome
- cannabis-induced psychotic disorder
go read case study 3
you can do it!
what are three symptoms of an opioid overdose?
- hypoxia
- pneumonia
- arrythmias
what are three symptoms for opioid withdrawl?
- dehydration
- pain
- electrolyte disturbances
go read case study 4
good luck babe
go read case study 5
arghp
what are the three options for opioid agonist therapy in Alberta?
- methadone
- suboxone
- sublocade
- full agonist at the mu opioid receptor
- antagonist for kappa and delta opioid receptors
- simple management (easy syrup, long acting)
- requires daily dispensing
- still possible to overdose
these are all characteristics of:
methadone opioid agonist therapy
- buprenorphine - mixed opioid agonist/antagonist
- naloxone - reduces euphoric effect
- can dispense 1+ week of pills
- can cause precipitated withdrawl
these are all characteristics of:
suboxone opioid agonist therapy
- depo-injection of buprenorphine
- slow release to help manage cravings
- only need one injection every 28 days
- some patients don’t find much relief with it
these are all characteristics of:
sublocade opioid agonist therapy
what are major symptoms of methamphetamine related emergencies?
- skin infections
- trauma
- myocardial ischemia
- psychosis
go read case study 6
last one I swear
methamphetamines have a potent effect on the:
dopaminergic system (causes large dopamine surges in reward systems of the brain)
at presynaptic neurons, methamphetamines:
- inhibit dopamine reuptake
- triggers dopamine vesicle release
