Psychoactive drug intoxication and withdrawal

Question 1

Depressants

Answer 1

Alcohol, opioids (morphine, heroin, methadone), barbiturates, benzodiazepines. Increase GABA activity.

Question 2

Alcohol intoxication

Answer 2

Emotional lability, slurred speech, ataxia, coma, blackouts,. GGT is a sensitive indicator of alcohol use. AST > ALT.

Question 3

Alcohol withdrawal

Answer 3

Severe: autonomic hyperactivity, and DTs. Treatment for DTs is benzodiazepines

Question 4

Opioids intoxication

Answer 4

Euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures. Treatment is naloxone for acute and naltrexone for chronic management.

Question 5

Opioids withdrawal

Answer 5

Sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu-like symptoms). Treatment: methadone, buprenorphine.

Question 6

Barbiturates intoxication

Answer 6

Low safety margin, marked respiratory depression. Treatment: assist respiration

Question 7

Barbiturates withdrawal

Answer 7

Delirium, CV collapse

Question 8

Benzodiazepines intoxication

Answer 8

Greater safety margin. Ataxia, minor respiratory depression. Treatment: flumazenil.

Question 9

Benzodiazepines withdrawal

Answer 9

Sleep disturbance, depression, rebound anxiety, seizure.

Question 10

Stimulants

Answer 10

Amphetamines, cocaine, Ceffeine, nicotine

Question 11

Amphetamines intoxication

Answer 11

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

Question 12

Amphetamines withdrawal

Answer 12

Anhedonia, increased appetite, hypersomnolence, existential crisis.

Question 13

Cocaine intoxication

Answer 13

Impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angian, sudden cardiac arrest. Treatment: alpha blockers, benzodiazepines, beta blockers not recommended.

Question 14

Cocaine withdrawal

Answer 14

Hypersomnolence, malaise, severe psychological craving, depression.

Question 15

Caffeine intoxication

Answer 15

Restlessness, increased diuresis, muscle twitching

Question 16

Caffeine withdrawal

Answer 16

Lack of concentration, headache.

Question 17

Nicotine intoxication

Answer 17

Restlessness

Question 18

Nicotine withdrawal

Answer 18

Irritability, anxiety, craving. Treatment: nicotine patch, gum, or lozenges; bupropion, varenicline.

Question 19

Hallucinogens

Answer 19

PCP, LSD, marijuana

Question 20

PCP intoxication

Answer 20

Belligerence, impulsivity, fever, psychomotor agitation, analgesia, nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. Treatment: benzodiazepines, rapid-acting antipsychotics.

Question 21

PCP withdrawal

Answer 21

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

Question 22

LSD intoxication

Answer 22

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

Question 23

Marijuana intoxication

Answer 23

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjuntival injection, hallucinations.

Question 24

Marijuana withdrawal

Answer 24

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hrs and last for about 5-7 days. Detectable in urine for up to a month.