Psych - Pathology (Psychoactive drug intoxication & withdrawal) Flashcards
Pg. 514-515 in First Aid 2014 Sections include: -Psychoactive drug intoxication and withdrawal
What are 4 drugs that act as depressants?
(1) Alcohol (2) Opioids (e.g., morphine, heroin, methadone) (3) Barbiturates (4) Benzodiazepines
What are 4 drugs that act as stimulants?
(1) Amphetamines (2) Cocaine (3) Caffeine (4) Nicotine
What are 3 drugs that act as hallucinogens?
(1) PCP (2) LSD (3) Marijuana (cannabinoid)
What are 5 nonspecific signs/symptoms of intoxication with depressants in general?
Nonspecific: (1) Mood elevation (2) Decreased anxiety (3) Sedation (4) Behavioral disinhibition (5) Respiratory depression
What are 4 nonspecific signs/symptoms of withdrawal from depressants in general?
Nonspecific: (1) Anxiety (2) Tremors (3) Seizures (4) Insomnia
What are 5 specific signs/symptoms of alcohol intoxication?
(1) Emotional lability (2) Slurred speech (3) Ataxia (4) Coma (5) Blackouts
What are significant lab measures/findings associated with alcohol intoxication?
(1) Serum gamma-glutamyltransferase (GGT) - sensitive indicator of alcohol use. (2) Lab AST value is twice ALT value
In general, what kind of symptoms accompany mild alcohol withdrawal?
Mild alcohol withdrawal: Symptoms similar to other depressants
What can result from severe alcohol withdrawal? What mortality rate is associated with this?
Severe alcohol withdrawal can cause autonomic hypersensitivity and DTs (5-15% mortality rate)
What is the treatment for DTs?
Treatment for DTs: Benzodiazepines.
What are 3 examples of Opioids?
(1) Morphine (2) Heroin (3) Methadone
What are 5-6 specific signs/symptoms of opioid intoxication? Which in particular is seen in opioid overdose?
(1) Euphoria (2-3) Respiratory and CNS depression (4) Decreased gag reflex (5) Pupillary constriction (pinpoint pupils) (6) Seizures (overdose)
What is the treatment for opioid overdose?
Treatment: Naloxone, Naltrexone
What are 9 specific signs/symptoms of opioid withdrawal?
(1) Sweating (2) Dilated pupils (3) Piloerection (“cold turkey”) (4) Fever (5) Rhinorrhea (6) Yawning (7) Nausea (8) Stomach cramps (9) Diarrhea (“flu-like” symptoms)
What is the treatment for opioid withdrawal?
Treatment: Long-term support, Methadone, Buprenorphine
What major sign/symptom is associated with barbiturate intoxication?
Marked respiratory depression
What kind of safety margin do Barbiturates have?
Low safety margin
What is the treatment for Barbiturate intoxication/overdose?
Treatment: Symptom management (assist respiration, increase BP)
What 2 symptoms/consequences are associated with Barbiturate withdrawal?
Delirium, life-threatening cardiovascular collapse
How do Benzodiazepines compare to Barbiturates in terms of their safety margin?
Greater safety margin (than Barbiturates)
What are 2 signs/symptoms associated with Benzodiazepine intoxication?
(1) Ataxia (2) Minor respiratory depression
What is the main treatment for Benzodiazepine intoxication/overdose? What else should be considered as a treatment option?
Treatment: Supportive care; Consider Flumazenil (competitive benzodiazepine antagonist)
What are 4 signs/symptoms of Benzodiazepine withdrawal? What is an important consideration in the case of Benzodiazepine reversal?
(1) Sleep disturbance (2) Depression (3) Rebound anxiety (4) Seizure (can be triggered by reversal with flumazenil)
What are 6 nonspecific signs/symptoms of intoxication with Stimulants?
Nonspecific: (1) Mood elevation (2) Psychomotor agitation (3) Insomnia (4) Cardiac arrhythmias (5) Tachycardia (6) Anxiety
What is the major consequence of Stimulant withdrawal? What 4 symptoms characterize this consequence?
Nonspecific: post-use “crash,” including depression, lethargy, weight gain, headache.
What are 9 specific signs/symptoms of (mild-moderate) amphetamine intoxication?
(1) Euphoria (2) Grandiosity (3) Pupillary dilation (4) Prolonged wakefulness and attention (5) Hypertension (6) Tachycardia (7) Anorexia (8) Paranoia (9) Fever
What are 2 specific signs/symptoms of severe amphetamine intoxication?
Severe: (1) Cardiac arrest (2) Seizure
What are 4 specific signs/symptoms of Amphetamine withdrawal?
(1) Anedonia (2) Increased appetite (3) Hypersomnolence (4) Existential crisis
What are 6 specific signs/symptoms of Cocaine intoxication?
(1) Impaired judgement (2) Pupillary dilation (3) Hallucinations (including tactile) (4) Paranoid ideations (5) Angina (6) Sudden cardiac death
What is the treatment for Cocaine intoxication?
Treatment: Benozdiazepines
What are 4 specific signs/symptoms of Cocaine withdrawal?
(1) Hypersomnolence (2) Malaise (3) Severe psychological craving (4) Depression/Suicidality
What are 3 specific signs/symptoms of Caffeine intoxication?
(1) Restlessness (2) Increased diuresis (3) Muscle twitching
What are 2 specific signs/symptoms of Caffeine withdrawal?
(1) Lack of concentration (2) Headache
What is the major specific sign/symptom of Nicotine intoxication?
Restlessness
What are 3 specific signs/symptoms of Nicotine withdrawal?
(1) Irritability (2) Anxiety (3) Craving
What are the treatment options for Nicotine withdrawal?
Treatment: Nicotine patch, gum, or lozenges; bupropion/varenicline
What are 11 specific signs/symptoms of PCP intoxication?
(1) Belligerence (2) Impulsiveness (3) Fever (4) Psychomotor agitation (5) Analgesia (6) Vertical and Horizontal Nystagmus (7) Tachycardia (8) Homicidality (9) Psychosis (10) Delirium (11) Seizures
What is the treatment for PCP intoxication?
Treatment: Benzodiazepines, Rapid-acting antipsychotic
What are 6 specific signs/symptoms of PCP withdrawal?
(1) Depression (2) Anxiety (3) Irritability (4) Restlessness (5) Anergia (6) Disturbances of thought and sleep
What are 6 specific signs/symptoms of LSD intoxication?
(1) Perceptual distortion (visual, auditory) (2) Depersonalization (3) Anxiety (4) Paranoia (5) Psychosis (6) Possible flashbacks
What are 10 specific signs/symptoms of Marijuana (cannabinoid) intoxication?
(1) Euphoria (2) Anxiety (3) Paranoid delusions (4) Perception of slowed time (5) Impaired judgement (6) Social withdrawal (7) Increased appetite (8) Dry mouth (9) Conjunctival injection (10) Hallucinations
What is the prescription form of Marijuana (cannabinoid)? What are 2 clinical uses for it?
Prescription form is dronabinol (tetrahydrocannabinol isomer): used as antiemetic (chemotherapy) and appetite stimulant (in AIDS)
What are 5 specific signs/symptoms of Marijuana (cannabinoid) withdrawal?
(1) Irritability (2) Depression (3) Insomnia (4) Nausea (5) Anorexia
When do most marijuana withdrawal symptoms peak, and how long do they last?
Most symptoms peak in 48 hours and last for 5-7 days
How long is marijuana generally detectable in urine?
Generally detectable in urine for 4-10 days.
For what 6 conditions are heroin users at increased risk?
Users at increased risk for (1) hepatitis, (2) abscesses, (3) overdose, (4) hemorrhoids, (5) AIDS, and (6) right-sided endocarditis.
What physical sign should you look for if suspicious of heroine use?
Look for track marks (needle stick in veins)
What are 3 treatments for Heroin addiction?
(1) Methadone (2) Naloxone & Buprenorphrine (3) Naltrexone
What kind of drug is Methadone, and how is it used in terms of treatment for Heroine addiction?
Long-acting oral opiate; Used for heroin detoxification or long-term maintenance
What kind of drug is Naloxone + buprenorphine, and how does it compare to Methadone?
Partial agonist; Long acting with fewer withdrawal symptoms than methadone.
What is naloxone’s abuse potential, and why?
Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential).
What kind of drug is naltrexone, and how is it used in terms of treatment for Heroin addiction?
Long-acting opioid antagonist used for relapse prevention once detoxified
What is alcoholism? What happens when alcohol intake is interrupted?
Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted
What are 5 complications associated with Alcoholism?
Complications: (1) Alcoholic cirrhosis (2) Hepatitis (3) Pancreatitis (4) Peripheral neuropathy (5) Testicular atrophy
What are the treatment options for alcoholism?
Treatment: Disulfiram (to condition the patient to abstain from alcohol use), naltrexone, supportive care. Alcoholics Anonymous and other peer support groups are helpful in sustaining abstinence.
What causes Wernicke-Korsakoff syndrome?
Caused by thiamine deficiency
What is the triad that characterizes Wernicke-Korsakoff syndrome? What is the collective triad called?
Triad of confusion, ophthalmoplegia, and ataxia (Wernicke encephalopathy).
To what symptoms may Wernicke-Korsakoff syndrome progress? What are these symptoms collectively called?
May progress to irreversible memory loss, confabulation, personality change (Korsakoff psychosis).
With what condition(s) is (are) Wernicke-Korsakoff syndrome association?
Associated with periventricular hemorrhage/necrosis of mammillary bodies.
What is the treatment for Wernicke-Korsakoff syndrome?
Treatment: IV vitamin B1 (thiamine)
What causes Mallory-Weiss syndrome, and how does it often present?
Longitudinal partial thickness tear at the gastroesophageal junction caused by excessive vomiting; Often presents with hematemesis
With what symptom/condition is Mallory-Weiss syndrome associated?
Associated with pain (vs. esophageal varices).
What is Delirium tremens (DTs)? When does it occur?
Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
What are the 3 major symptoms of DTs in order of appearance?
Symptoms in order of appearance: (1) Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) (2) Psychotic symptoms (hallucinations, delusions) (3) Confusion
What is the treatment for DTs?
Treatment: Benzodiazepines
