Medicine (Substance Abuse)

Question 1

What is Wernicke’s encephalopathy?

Answer 1

-Thiamine deficiency
-Risk of Wernicke’s Korsakoff syndrome

Question 2

Describe alcohol withdrawal syndrome?

Answer 2

-Begins 6-24h after last intake of alcohol
-Tremors, agitation, nausea, sweating, delirium, seizures
-Biggest concern for delirium tremens (hyperthermia, tremors, seizures; high mortality rate)

-Treat with: Benzos, electrolyte/fluid correction, thiamine/folic acid/magnesium/multivitamin)

Question 3

How can alcoholism be screened for?

Answer 3

-CAGE questionnaire (>2 concerning of alcohol having effect on health)

Question 4

What is the management for patients with alcoholism?

Answer 4

-CBC, BMP, LFTs
-EKG
-Manage coagulopathy, electrolyte imbalances
-Antibiotic prophylaxis
-Sensitization to anesthetic agents

Question 5

What is cocaine?

Answer 5

-An amphetamine that blocks the reuptake of norepinephrine, serotonin, and dopamine in the CNS

Question 6

What is the management for patients who use cocaine?

Answer 6

-Determine last use of cocaine (Need to be off 24h)
-Avoid ketamine, monitor local anesthetics
-Monitor for cardiomyopathy
-Be prepared for myocardial ischemia and seizures

Question 7

What is your management for patients who use marijuana?

Answer 7

-Cancel cases when intoxication suspected
-Consider 72h cessation prior to procedure
-Auscultate lungs
-May require higher doses of benzo/opioids/propofol

Question 8

What are opioids?

Answer 8

-Narcotic drugs derived from opium plant
-Bind to opioid receptors in CNS and PNS (mu, delta, kappa)

Question 9

What is naloxone?

Answer 9

-Opioid receptor antagonist
-Treat acute opioid intoxication

Question 10

What are symptoms of opioid withdrawal?

Answer 10

-Tachycardia, HTN
-Lacrimation, diarrhea
-Nausea/vomiting

Question 11

What is methadone?

Answer 11

-Mu opioid agonist
-Used for management of opioid dependence

Question 12

What is buprenorphine?

Answer 12

-Synthetic mixed mu opioid agonist-antagonist

Question 13

What is clonidine?

Answer 13

-Alpha 2 agonist
-Can help with sympathetic manifestations of withdrawal (tachycardia, HTN, mydriasis, diaphoresis

Question 14

What is the management for a patient with opioid abuse?

Answer 14

-Pre-op labs: LFTs, hepatitis titers, HIV titer, CBC
-Toxicology screening, cancel case if acute intoxication
-Difficult IV access
-Avoid buprenorphine (could precipitate withdrawal syndromes)
-Difficult to achieve profound anesthesia
-EKG (possible prolonged QT)

Question 15

What are methamphetamines?

Answer 15

-Potent CNS stimulators
-Increase neurotransmitters (5-HT), slow reuptake of neurotransmitters (dopamine, norepinephrine, serotonin)

Question 16

What is seratonin syndrome?

Answer 16

-Central 5HT receptor hyperstimulation results in hyperthermia, mental status changes, autonomic instability, rigidity

Question 17

What are bath salts?

Answer 17

-Synthetic cathinones and beta-ketone amphetamine analogs
-Stimulate alpha/beta
-Releases neurotransmitters and possibly inhibit reuptake