Low Back Pain

Question 1

Non-specific depressant intoxication

Answer 1

• Mood elevation
• Decreased anxiety
• Sedation
• Behavioral disinhibition
• Respriatory depression

Question 2

Non-specific depressant withdrawal

Answer 2

• Anxiety
• Tremor
• Seizures
• Insomnia

Question 3

Alcohol Intoxication

Answer 3

• Emotional lability
• Slurred speech
• Ataxia
• Coma
• Blackouts
• Serum gamma-glutamyltransferase (GGT)
  
  • Sensitive indicator of alcohol use
• Lab AST value 2X ALT value

Question 4

Alcohol Withdrawal

Answer 4

• Mild
  
  • Symptoms similar to other depressants
• Severe
  
  • Autonomic hyperactivity & DTs
  • 5-15% mortality rate
• Delirium Tremens
  
  • Peaks 2-5 days after last drink
  • Autonomic system hyperactivity
  • Psychotic symptoms
  • Confusion
  • Treatment: Benzos

Question 5

Opioid Intoxication

Answer 5

• Euphoria
• Respiratory & CNS depression
• Decreased gag reflex
• Pupillary constriction (pinpoint pupils)
• Seizures (overdose)
• Treatment: Naloxone, Naltrexone

Question 6

Opioid Withdrawal

Answer 6

• Sweating
• Dilated pupils
• Piloerection (“cold turkey”)
• Fever
• Rhinorrhea
• Yawning
• Nausea
• Stomach cramps
• Diarrhea (“flu-like symptoms”)
• Treatment: long-term support, methadone, buprenorphine

Question 7

Barbiturate Intoxication

Answer 7

• Low safety margin
• Marked respiratory depression
• Treatment: symptom management (assist respiration, increase BP)

Question 8

Barbiturate Withdrawal

Answer 8

• Delirium
• Life-threatening CV collapse

Question 9

Benzo Intoxication

Answer 9

• Greater safety margin
• Ataxia
• Minor respiratory depression
• Treatment: supportive care, consider flumazenil (competitive benzo antagonist)

Question 10

Benzo Withdrawal

Answer 10

• Sleep disturbance
• Depression
• Rebound anxiety
• Seizure (can be triggered by reversal w/ flumazenil)