Psych: Psychoactive & Illegal drugs, Intox/Wdl

Question 1

Depressants

General sx of Intoxication?

Sx of Withdrawal?

Answer 1

Alcohol, Opioids, Barbituates, Benzos

Intox: Mood elevation, decr anxiety, sedation, behavioral disinhibition, respiratory depression

Wdl: anxiety, tremors, seizures, insomnia

Question 2

Alcohol: sx of intox?

Labs?

Answer 2

• ataxia, slurred speech, coma, blackouts
• serum gamma-glutamyltransferase is sensitive indicator of alcohol use.

Lab AST value is twice ALT value

Question 3

Alcohol: sx of wdl?

Treatment if severe?

Answer 3

Mild: similar sx as other depressants

Severe: autonomic hyperactivity, DTs (5-15% mortality)

Tx = benzodiazepines (ex chlordiazepoxide)

Question 4

Delirium Tremens?

Tx?

Answer 4

“Glutamate storm”

Life-threatening alcohol wdl. Peaks 2-5 days after last drink.

Symptoms (in chrono order):

1. Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
2. Psychotic sx (hallucinations, delusions)
3. Confusion

Tx = Benzos

Question 5

Alcohol: what receptors are involved?

Answer 5

GABA-A agonist

Glutamate/NMDA blocker

incr ß endorphins

Question 6

Opioids

sx of toxication?

Tx?

Answer 6

(morphine, heroin, methadone)

Euphoria, pinpoint pupils

Resp/CNS depression - coma

seizures if OD

Tx: Naloxone (acute), Naltrexone (rehab)

Question 7

Opioids

Sx of withdrawal?

Tx?

Answer 7

cold turkey: sweating, dilated pupils, piloerection

flu-like: fever, rhinorrhea, yawning, nausea, cramps, diarrhea

Tx: methadone, buprenorphine

Question 8

Barbituates: sx of tox?

Tx?

Answer 8

Resp depression

low safety margin

Tx: manage symptoms, assist with respiration, BP support)

Question 9

Barbituates: sx of wdl?

Answer 9

Delirium

CV collapse (life-threatening)

Question 10

Benzodiazepines: sx of tox?

Answer 10

(ex diazepam, lorazepam)

ataxia, slight resp depression

Tx: support, flumazenil (competitive benzo antagonist)

Question 11

Benzodiazepines: sx of wdl?

Answer 11

sleep issues, depression, rebound anxiety, seizure

(can be triggered by flumazenil in attempt to reverse intoxication)

Question 12

alcohol: what is it the causes the hangover sx?

Answer 12

buildup of acetaldehyde

ADH = enzyme that converts this to acetate –> acetyl CoA –> TCA

Question 13

what blocks ADH/what is the effect?

Answer 13

Disulfuram blocks ADH leading to a buildup of acetaldehyde if someone drinks alcohol.

Leads to really bad hangover sx. “antabuse”

Question 14

Besides disulfuride, what drug can block acetaldehyde dehydrogenase (ADH) and cause hangover-like sx?

Answer 14

metronidazole

used to treat Trichomonas, giardia, and bacterial vaginosis

Question 15

Stimulants: general signs of intoxication?

Answer 15

mood elevation, psychomotor agitation, insomnia, arrhythmias, tachycardia, anxiety

Question 16

Stimulants: general signs of withdrawal?

Answer 16

post-use crash:

depression, lethargy, weight gain, headache

Question 17

s/s of what?

euphoria, grandiosity, pupillary dilation, prolonged wakefulness, HTN, tachycardia, anorexia, paranoia, fever

(severe: cardia arrest, seizure)

Answer 17

amphetamine use

Question 18

s/s of what?

anhedonia, incr apetite, hypersomnolence, existential crisis

Answer 18

amphetamine withdrawal

Question 19

s/s of what?

impaired judgement, pupillary dilatation, hallucinations, paranoia, angina, sudden cardiac death

Answer 19

cocaine use

Question 20

hypersomnolence, malaise, severe craving, depression/suicidality

Answer 20

cocaine wdl

Question 21

restlessness, incr diuresis, muscle twitching

Answer 21

caffeine use

Question 22

no concentration, headache

Answer 22

caffeine wdl

Question 23

restlessness

Answer 23

nicotine use

Question 24

irritability, anxiety, craving

Answer 24

nicotine wdl

Question 25

tx for cocaine use/od

Answer 25

benzodiazepines

Question 26

tx for nicotine wdl

Answer 26

nicotine patch, gum, lozenges

bupropion/varenicline

Question 27

violent behavior, impulsiveness, fever, nystagmus, delirium (+ more)

Answer 27

PCP (phencyclidine) use

Question 28

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

Answer 28

PCP wdl

Question 29

perceptual distortion, depersonalization, anxiety, paranoia, psychosis, flashbacks

Answer 29

LSD use

(lysergic acid diethylamide)

Question 30

euphoria, anziety, paranoid delusions, perception of slowed time, incr appetite, social withdrawal, conjunctival injection

Answer 30

marijuana (cannabinoid) use

Question 31

irritability, depression, insomnia, nausea, anorexia

Answer 31

marijuana (cannabinoid) wdl