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PT2 B1 > Lecture 37/38 -- Alcohol/Tb/Illicit Substances > Flashcards

Lecture 37/38 -- Alcohol/Tb/Illicit Substances Flashcards

1
Q

name some drug intoxications you can die from

A

Cocaine, amphetamines, benzodiazepines, alcohol, barbituates,
Opioids, PCP, steroids, inhalants,

NOT MARIJUANA

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2
Q

name some drug Withdrawals you can die from

A

Sedative – alcohol, benzos, barbituates

very rarely: opioids, but only in infants

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3
Q

describe the metabolism of ETOH

enzmyes?
what is the rate limiting step?
elimination kinetics?

A

Alcohol DHG: ETOH –> Aldehyde

Aldehyde DHG: Aldehyde –> Acetic acid

(some metab through P450s)

RLH: Aldehyde DHG

Zero Order elimination

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4
Q

how do gender and ethnicity factor into metabolism of alcohol

A

Women – less alcohol DHG; smaller volume of distribution

Asians – less ADH and ALDH

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5
Q

Neuropharmacology of ETOH intoxication – what NTs are involved and to what effect

A

Euphoria – DA, Opioids

Sedation/anxiolytic – GABA, decreased NMDA

Nausea – 5HT

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6
Q

Treatment for ETOH intoxication

A

Supportive – airway; correct fluid and electrolyte imbalances

Examine for other signs of trauma

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7
Q

two types of fatal ETOH withdrawal

A

DTs and Sz

usually mutually exclusive

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8
Q

Stages of ETOH DTs

A

95% are self limiting

Stage 1 withdrawal – 24h after last drink.

Tremulous, HTN, tachy, sweating, nausea, anxiety, mild derealization

Stage 2 – 48 hours after last drink. More severe symptoms than in stage I.
+ hallucinations (auditory) and patients are aware of reality

stage 3 = DTs
<1% of all cases
Marked disorientation
Hallucinations – visual, tactile, auditory

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9
Q

ETOH withdrawal sz

A

12-48 hours after stopping drinking; usually earlier

Tonic Clonic

<5% of withdrawal cases

Usually self limited and no status epilepticus

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10
Q

treatment options for etoh withdrawal

A

Supportive –

BZDs – longer acting ones give a smoother taper;

Barbituates –

Beta Blockers – as an add on agent for tachy

Anti convulsant – carvemezepine; gabapentin

Ethanol – can be used, but rare; IV

Propofol – generlized sedation; may specifically help with ETOH withdrawal, but respiratory depression does occur

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11
Q

effects on body systems with chronic etoh abuse?

A

B1 Deficinecy - -Wernickes and Korsakoffs

Brain, liver, pancreas, GI, Oro-esophageal cancers, Varicies, PNA,

Cardiomyopathies –> pulm congestion

Endocrine – decreased testosterone and loss of secondary sex characterisitcs

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12
Q

Biomarkers for chronic heavy drinking

A

GGT (an liver enzyme) > 30

CDT (carbohydrate deficient transferrin) > 20

MCV > 90

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13
Q

three FDA approved drugs to help treat alcoholism ?

Mechanism
rationale for treatment
side effects/toxicity

A

Dilsulfram – (antabuse) – Aldehyde DHG inhibition; leading to aversive condition with consumption of ETOH.
SE: Liver toxicity; drowsiness, HTN

Naltrexone – opiate blocker
Mu Antagonist
Decrease positive reinforcement of drinking
side effects: Minor liver tox; N/HA/Sedation

Acomprosate (Calcium acetyl homotuarinate) –
NMDA Glutamate R modulator

Helps control cravings, triggers

Side effects: Diarrhea
no liver toxicity

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14
Q

nicotine Pharmacology —

assay to monitor nicotine consumpiton?

A

cotinine

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15
Q

nicotine intoxication –
can this be fatal?

symptoms

A

Can be fatal due to peripheral nicotinic receptor stimulation, but only in infants

Sx – tachy, htn, n/v, diaphoresis, palpitations, sz, anxiety

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16
Q

Tx of nicotine intoxication

A

Primarily supportive
Gastric lavage
Activated charcoal

treat Bradycardia with atropine

17
Q

Nicotine withdrawal –

A

decreased HR, Insomnia, dysphoria, irritability, poor concentration

18
Q

FDA approved medications for smoking cessation

mechanism?

A

Nicotine replacement
Patch/gum/nasal spray/inhaler/oral spray/lozenge

Bupropion (Zyban/wellbutrin)

Varenicline(Chantix) – nicotine partial agonist

19
Q

rationale for nicotine replacement therapy

contraindications

A

Nicotine absorption is worse than cigarettes
Lower does is delivered
First pass metabolism can inactivate
Less rewarding –

Contraindications – Recent MI, smoke less than 10 cigs per day; use with caution in breast feeding/pregnant patients

20
Q

Contraindications for Buproprion

Mechanism Verenicline (chantix)
side effects
A

Bup: Contraidncated – SZ or Eating D/o

Varenicline (Chantix)
Mechansims – Nicotinic partial agonist; some effect on 5HT
Taken BID
Side effects – N/V/HA/ Insomnia/abnormal dreams
Increased risk of suicide

21
Q

cocaine intoxication –

Phsyical effects?
behavioral/psychiatric effects?

what are a lot of the severe effects due to?

A

vasconstriction in the setting of cocaine use

tachy, midriasis, HTN, N/V, CP, SZ, HA, bruxisms

manic: Grandiosity, hyperactivity, delusions, paranoia, hallucinations (formication)

Cardiac arrythmia, MI, Stroke, Rhabdo, Death

22
Q

cocaine withdrawal

sx?

tx?

A

opposite of intoxication: fatigue, hypersomnia, lethargy, irritability, dysphoria, SI

Tx – supportive; unless there is underlying depression

23
Q

hallucinogen intoxication

fatal?
sx?

A

not life threatening expcept for impaired judgement which can lead to fatal decisions

Tachy, diaphoresis, palpitations, tremulous, disoriented, intesnified perceptions, illusions, visual distortions, hallucinations, delusions, distorted sense of time

24
Q

tx of hallucinogen intoxication

A 
Largely supportive
Provide a quiet,stimulus-free environment
Agitation
benzodiazepine
high-potency neuroleptic
25
Q

hallucinogen withdrawal?

what is a manifestation than occur long after using hallucinogens?

A

No real withdrawal syndrome

HALLUCINOGEN PERSISTING PERCEPTION DISORDER (flashbacks)
Often triggered by stress, fatigue, anxiety, entry into a dark environment, drug use

26
Q

classic finding for PCP

A

vertical nystagmus

27
Q

Benzo intoxication:

symptoms
worse with?
treatment of benzo over-dose
what drug

A

Sx: same as alcohol; sedatiave;
Worse with Alcohol, opioids, barbituates

Flumezanil

28
Q

benzo withdrawal

A

similar to alcohol

including seizures

29
Q

main concern for fatality with opioids

Intoxication sx

A

Respiratory depression

Pinpoint pupils; resp depresion, drowsiness,
Pruritiis (histamines), euphoria, sedative

30
Q

Opioid intoxication treatment:

difference if its a methadone overdose

A

Airway, oxygenation

Naloxone – short acting mu opioid antagonist; response within 1-2 minutes;

Methadone overdose – long half life; have to adminster multiple doses;

31
Q

Opioid withdrawal

sx
peak if untreated
duration

A

Sx – Pupilary dilation, piloerection, diaphoresis, lacrimation, rhinorrhea, N/V/D
Involuntary muscle jerks

Dysphoria, irritable, hyperalgesia, craving

Peak – 1-3 days
Sub acute symptoms –can last for months;

Not life threatening

32
Q

Treating opioid withdrawal

A

Clonidine
Opioids – methadone
Buprenorphine

symptomatic

33
Q

(rationale for treating opioid withdrawal with clonidine)

A

opioid use can destroy LC, therefore decreasing NE

Rebound effect of NE when in withdrawal

Teat with A2 agonist to decrease NE release

34
Q

Inhalants – 3 kinds

general mechanism

A

Volatile Compounds

Nitrites

Nitrous Oxide

mechanism – CNS depression and hypoxemia

35
Q

Steroids

intoxication symptom

A

HA, diaphoresis, tachy,
anxiety, irritability
aggressive, combative, some psychosis, paranoid, depression
“roid rage”

36
Q

Treatment of steroid intoxication

taking patients off steroids?

A

supportive

Psychosis – neuroleptics;

Agitated –Benzos

need to taper pts off steroids

PT2 B1 (38 decks)

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