Lippincott Chapter 15: Drug Of Abuse

Question 1

15.1 A 22-year-old HIV patient has been told that marijuana
may benefit him should he start using the substance.
Which of the following adverse effects has been
associated with marijuana usage and may be a reason
for this patient to avoid use of marijuana?
A. Hyperphagia.
B. Hyperthermia.
C. Hepatitis.
D. Progression of HIV.
E. Hyponatremia.

Answer 1

Correct answer = D. Although hyperphagia is a side effect
observed with marijuana usage, this may be of benefit for
some HIV patients. Hyperthermia, hepatitis, and hypo-
natremia have not been associated with marijuana use.
Progression of HIV has been linked to marijuana use and is
a serious consideration for anyone with this disease.

Question 2

15.2 A 21-year-old college student is curious about the
effects of LSD. She asks what type of risks may be
involved with using the drug for the first time. Which of
the following is a correct response to her question?
A. Exaggerated hallucinations.
B. Cardiomyopathy.
C. Hyperphagia.
D. Bronchitis.

Answer 2

Correct answer = A. Exaggerated hallucinations, sometimes
known as “bad trips,” may occur, even in first-time users.
These hallucinations can lead to extreme panic, which has
caused individuals to react in a manner very uncharacteris-
tic of their typical behavior.

Question 3

15.3 A 58-year-old male is brought into the emergency
department following an automobile accident. His blood
alcohol level on admission is 280 mg/dL. He has been
treated in the past for seizures related to alcohol abuse,
and he confirms that he has been drinking heavily over
the past month since losing his job. What treatment
should be given to this patient if he begins to go into
withdrawal while hospitalized?
A. None.
B. Lorazepam.
C. Acamprosate.
D. Naltrexone.
E. Disulfiram.

Answer 3

Correct answer = B. Should this patient go into alcohol
withdrawal, he will likely also have seizures associated with
it, given his past history. Benzodiazepines are used to treat
seizures associated with alcohol withdrawal. Acamprosate,
naltrexone, and disulfiram may be considered at a later
time to treat the dependence, but would not be useful in the
acute withdrawal setting.

Question 4

15.4 A 35-year-old man has been abusing cocaine and is
agitated, tachycardic, hypertensive, and hyperthermic.
Which of the following is correct regarding treatment in
this situation?
A. This patient should undergo gastric lavage; that is,
he should have his stomach pumped immediately.
B. Cocaine toxicity commonly involves CNS
depression that can be reversed with IV atropine.
C. Benzodiazepines would be a good choice, as they
should help calm the patient down, decrease heart
rate, decrease blood pressure, and decrease body
temperature.
D. Phenobarbital should be the first choice as an
anticonvulsant.

Answer 4

Correct answer = C. Benzodiazepines such as lorazepam
have anxiolytic properties and can calm a cocaine toxic
patient down, thereby decreasing heart rate and blood
pressure. As the patient becomes less agitated, he/she
decreases movement and his or her body temperature
drops. In addition, the use of benzodiazepines decreases
the chance of the patient experiencing a convulsion
and would be the first choice to treat cocaine-induced
convulsions.

Question 5

15.5 A 22-year-old man with a history of substance abuse
arrives in the emergency department hypertensive,
hyperthermic, and tachycardic, with altered mental
status and hyperreflexia. His friends say he has been
snorting “bath salts.” Which of the following is correct
regarding this patient?
A. This patient’s clinical presentation is consistent
with opioid toxicity and he should receive an opioid
antagonist such as naloxone immediately.
B. “Bath salts” are often labeled as “not for human
consumption” and sold with an unstated
understanding that they contain synthetic
cathinones, which are amphetamine-like
compounds.
C. Treatment with a serotonin agonist might be
beneficial.
D. Along with cooling measures, antihypertensives,
β-blockers, and monoamine oxidase inhibitors
would be reasonable options for the treatment.

Answer 5

Correct answer = B: “Bath salts” often contain synthetic
cathinones and are labeled, marketed, and sold as some-
thing “not for human consumption” to avoid law enforcement
and prosecution. In addition, they are usually not detected
on urine toxicology screening. These products can cause
an amphetamine-like sympathomimetic toxidrome, as well
as serotonin syndrome, which would be treated with symp-
tomatic/supportive care and possibly a serotonin antago-
nist (not a serotonin agonist) such as cyproheptadine. The
combination of an amphetamine or amphetamine-like sub-
stance and a monoamine oxidase inhibitor (MAO inhibitor)
can precipitate serotonin syndrome and should be avoided
in a hyperdynamic patient such as this.