Lecture 20 - Addiction in the ER

Question 1

true or false: emergancy department (ED) presentations related to substance use require more resources than those without

Answer 1

true

Question 2

any substance of misuse can have:

Answer 2

negative effects requiring emergent care

Question 3

what are the four key treatments to treat addiction emergencies?

Answer 3

• reversal agents/antidotes
• downstream effects on the body
• alternative pathways
• chronic changes

Question 4

what are the most common symptoms of ethanol/alcohol intoxication?

Answer 4

• decreased level of consciousness
• agitation

Question 5

intoxication due to alcohol consumption is caused by:

Answer 5

excessive GABAergic signalling

Question 6

go read case study 1

Answer 6

:P

Question 7

what are the three major treatments for ethanol intoxication?

Answer 7

• thamine (vitamin B1)
• folic acid (vitamin B12)
• magnesium

Question 8

how does alcohol affect thiamine in the body?

Answer 8

reduces the rate of thiamine absorption, inhibits the active transport of thiamine, and reduces production of thiamine related enzymes

Question 9

how does chronic alcohol use affect essential vitamins for normal body function?

Answer 9

depletes vitamin reserves

Question 10

depleted folic acid (vitamin B12) leads to:

Answer 10

increased urinary excretion

Question 11

depleted magnesium in the body leads to:

Answer 11

increased urinary and bowel excretion (can also lead to serious heart problems)

Question 12

what causes alcohol withdrawl?

Answer 12

• 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)

Question 13

the degree of severity of alcohol withdrawl depends on:

Answer 13

daily amount of EtOH consumed and underlying genetic effects

Question 14

a history of previous seizures can predict:

Answer 14

future withdrawl seizures

Question 15

when do symptoms of alcohol withdrawl start?

Answer 15

normally, 24-48 hours after the last drink was consumed

Question 16

go read case study 2

Answer 16

ba la la la

Question 17

what are the three main steps to resuscitate patients with alcohol withdrawl?

Answer 17

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)

Question 18

the most common IV benzodiazepine used to treat alcohol withdrawl?

Answer 18

diazepam

Question 19

which IV benzodiazepine is used to treat alcohol withdrawl if the patient has a history of liver disease?

Answer 19

lorazepam

Question 20

second line therapy which opens GABA receptors and down-regulates glutamatergic signalling

Answer 20

phenobarbital

Question 21

a surgical medicine with rapid onset (15-30 seconds) that hyperpolarizes cells with GABA neurons and inhibits NMDA receptors

Answer 21

propofol

Question 22

what is the risk of using propofol?

Answer 22

it stops the respiratory drive

Question 23

when is propofol used in emergency departments?

Answer 23

seizures induced by alcohol withdrawl

Question 24

how is a patient going into an alcohol withdrawl related seizure treated?

Answer 24

propofol and/or intubation

Question 25

a postitive allosteric modulator for GABAa receptors and an NMDA antagonist

Answer 25

acamprosate

Question 26

what are the three major cannabis related emergencies seen in hospitals?

Answer 26

- cannabis overdose - cannabinoid hyperemesis syndrome - cannabis-induced psychotic disorder

Question 27

go read case study 3

Answer 27

you can do it!

Question 28

what are three symptoms of an opioid overdose?

Answer 28

- hypoxia - pneumonia - arrythmias

Question 29

what are three symptoms for opioid withdrawl?

Answer 29

- dehydration - pain - electrolyte disturbances

Question 30

go read case study 4

Answer 30

good luck babe

Question 31

go read case study 5

Answer 31

arghp

Question 32

what are the three options for opioid agonist therapy in Alberta?

Answer 32

- methadone - suboxone - sublocade

Question 33

- 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:

Answer 33

methadone opioid agonist therapy

Question 34

- buprenorphine - mixed opioid agonist/antagonist - naloxone - reduces euphoric effect - can dispense 1+ week of pills - can cause precipitated withdrawl these are all characteristics of:

Answer 34

suboxone opioid agonist therapy

Question 35

- 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:

Answer 35

sublocade opioid agonist therapy

Question 36

what are major symptoms of methamphetamine related emergencies?

Answer 36

- skin infections - trauma - myocardial ischemia - psychosis

Question 37

go read case study 6

Answer 37

last one I swear

Question 38

methamphetamines have a potent effect on the:

Answer 38

dopaminergic system (causes large dopamine surges in reward systems of the brain)

Question 39

at presynaptic neurons, methamphetamines:

Answer 39

- inhibit dopamine reuptake - triggers dopamine vesicle release