Overdose/Withdrawal

Question 1

Depressants: intox

Answer 1

Nonspecific: mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression

Question 2

Depressants: withdrawal

Answer 2

Nonspecific: anxiety, tremor, seizures, insomnia

Question 3

Alcohol: intox

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 alcohol withdrawal: symptoms similar to other depressants.
Severe alcohol withdrawal: autonomic hyperactivity and DTs (5-15% mortality rate). Tx for DTs: benzos

Question 5

Opioids: intox

Answer 5

Euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose).
Tx: naloxone, naltrexone

Question 6

Opioids: withdrawal

Answer 6

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms).
Tx: long-term support, methadone, buprenorphine

Question 7

Barbiturates: intox

Answer 7

Low safety margin, marked respiratory depression.

Tx: symptom management (assist respiration, increase BP)

Question 8

Barbiturates: withdrawal

Answer 8

Delirium, life-threatening cardiovascular collapse

Question 9

Benzodiazepines: intox

Answer 9

Greater safety margin. Ataxia, minor respiratory depression.
Tx: supportive care; consider flumazenil (competitive benzodiazepine antagonist)

Question 10

Benzodiazepines: withdrawal

Answer 10

Sleep disturbance, depression, rebound anxiety, seizure (can be triggered by reversal with flumazenil)

Question 11

Stimulants: intox

Answer 11

Nonspecific: mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety.

Question 12

Stimulants: withdrawal

Answer 12

Nonspecific: post-use “crash,” including depression, lethargy, weight gain, HA.

Question 13

Amphetamines: intox

Answer 13

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever.
Severe: cardiac arrest, seizure

Question 14

Amphetamines: withdrawal

Answer 14

Anhedonia, increased appetite, hypersomnolence, existential crisis

Question 15

Cocaine: intox

Answer 15

Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.
Tx: benzos

Question 16

Cocaine: withdrawal

Answer 16

Hypersomnolence, malaise, severe psychological craving, depression/suicidality

Question 17

Caffeine: intox

Answer 17

Restlessness, increased diuresis, muscle twitching

Question 18

Caffeine: withdrawal

Answer 18

Lack of concentration, HA

Question 19

Nicotine: intox

Answer 19

Restlessness

Question 20

Nicotine: withdrawal

Answer 20

Irritability, anxiety, craving.

Tx: nicotine patch, gum, or lozenges; bupropion/varenicline

Question 21

PCP: intox

Answer 21

Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicadlity, psychosis, delirium, seizures.
Tx: benzos, rapid-acting antipsychotic

Question 22

PCP: withdrawal

Answer 22

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

Question 23

LSD: intox

Answer 23

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

Question 24

Marijuana: intox

Answer 24

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations.
Prescription form: dronabinol: used as antiemetic and appetite stimulant (AIDS pts)

Question 25

Marijuana: withdrawal

Answer 25

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5-7 days. Generally detectable in urine for 1 month.