Nutritional and Toxic Disorders Flashcards
Opiate withdrawal
Occurs within hours to several days of cessation.
Dysphoria, myalgias, nausea, vomiting, rhinorrhea, lacrimation, piloerection, diaphoresis, diarrhea, mydriasis, fever and insomnia.
To differentiate from ETOH/Benzo withdrawal: Increased DTR are typical in ETOH/benzo withdrawal but not opiate.
Opioid receptor subtypes and their effects
Delta: analgesia, antidepressant effects, physical dependence
Kappa: spinal analgesia, sedation, miosis, inhibition of ADH release
Mu1: supraspinal analgesia and physical dependence
Mu2: respiratory depression, miosis, euphoria, reduced GI motility and physical dependence
ORL1/orphanin: anxiety, depression, appetite, tolerance
Amphetamine mechanism of action
direct release of dopamine and NE and inhibits their reuptake
Cocaine mechanism of action
primary: inhibits presynaptic reuptake of dopamine (as well as serotonin and NE)
Amphetamine and Cocaine Withdrawal
dysphoria, vivid/unpleasant dreams, increased appetite, insomnia or hypersomnia, agitation, psychomotor retardation
Stages of ETOH withdrawal
6-36 h: minor withdrawal symptoms–HA, tremors, diaphoresis, palpitations, insomnia, GI upset, diarrhea, anorexia, agitation, anxiety.
6-48 h: Seizures
12-48 h: ETOH hallucinosis
48-96h: Delirium tremens=delirium, hallucinations, disorientation, agitation, encephalopathy, hypertension, tachycardia, arrhythmias, low grade fever and diaphoresis
PCP mechanism of action
noncompetitive antagonist at glutamate NMDA receptor
also affects dopamine, NE, serotonin release and reuptake
Hallucinogen (LSD, psilocybin, mescaline) symptoms and mechanism of action
Symp: sensory distortions synesthesias, hallucinations, euphoria, anxiety, tachycardia, palpitations, mydriasis, diaphoresis
Primarily work at serotonin receptors (esp. 5HT2
Mercury toxicity
Exposure: fish and shellfish (organic form), inorganic forms in mining, dentistry, chloralkali industries, thermometer factories
If inhaled, a severe interstitial pneumonitis
Intention tremor, cerebellar ataxia, paresthesias, tender and inflamed gums, excessive salivation, swollen salivary glands, personality changes, psychiatric symptoms (anxiety, irritability, fearfulness, memory loss, depression, fatigue)
chemotherapy causing peripheral neuropathy
vincristine (sensory and motor), cisplatin, etoposide, taxol (painful dysesthesias)
chemotherapy causing leukoencephalopathy
methotrexate
chemotherapy causing aseptic meningitis
IT methotrexate
chemotherapy causing subacute pancerebellar syndrome
IV cytarabine, 5-fluorouracil
chemotherapy causing ICH or ischemic stroke
bevacizumab
chemotherapy causing SIADH
cyclophosphamide
Lead ingestion
Children: GI symptoms and altered mental status; associated with seizures and increased ICP. Chronic exposure causes neurodevelopmental problems
Adults: motor neuropathy (wrist and finger drop) or sensory neuropathy
Ethylene glycol
Patients first look drunk, then develop seizures, nonreactive pupils, lose their corneal reflexes and become comatose and cyanotic
Mercury poisoining
Inorganic: tremor and personality changes–>Mad Hatter
Acrodynia (pink extremities, tachycardia, sweating on the trunk, hypertension and encephalopathy)–seen more in kids
Organic: distal paresthesias, ataxia, constriction of visual fields, cortical vision loss
Nitrous Oxide abuse
Looks like B12 deficiency BUT
in N2O abuse, you have homocysteine only elevated
In B12 deficiency, homocysteine AND methylmalonic acid are elevated.
This is because N2O inhibits methionine synthase
Organophosphate poisoning
Organophosphates bind to acetylcholinesterase–>cholinergic crisis
Diarrhea Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Lethargy Salivation Seizures
Also cramps, fasciculations
Tx: atropine (anti-muscarinic) and pralidoxime (2-PAM) (speeds up reactivation of acetylcholinesterase)
strychnine
Glycine antagonist
Used as adulterant of cocaine
Apprehension, nausea, muscle twitching, extensor spasms, opisthotonus, seizures.
Severe muscle spasms that can lead to rhabdomyolysis and renal failure.
Thallium
Affects the Na/K ATPase
Found in rat poison
Acutely vomiting and diarrhea, then severe dysesthesias, cardiac and respiratory failure
Alopecia and axonal neuropathy
Mees lines (also seen in Arsenic poisoning)
Toluene
Causes emotional lability, tremor, neuropathy, optic, cerebral and cerebellar atrophy and white matter changes, opsoclonus, ocular dysmetria
latrotoxin
produced by black widow spiders
Causes release and blocks reuptake at aminergic, noradrenergic and cholinergic nerve endings
First, pain and target lesion at bite
Then pain and involuntary muscle contractions in abdomen that spreads to limbs
diffuse dysautonomia
