Psychoactive Drug Intoxication And Withdrawal Flashcards
Name the Depressants (4)
Alcohol, Opioids, Barbiturates, Benzodiazapines
General depressant intoxication
Mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression
General depressant withdrawal
Anxiety, tremor, seizures, insomnia
Alcohol intoxication
Emotional lability, slurred speech, ataxia, coma, blackouts
Serum indicator of alcohol use
Gamma-glutamyltransferase (GGT)
AST= x2 ALT
Alcohol withdrawal
Mild: anxiety, tremors, seizures, insomnia
Severe: autonomic hyperactivity (tachycardia, hypertension), malaise, nausea, delirium tremens
Complications of alcoholism
Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy
Treatments for alcoholism
Disulfiram- condition to abstain
Acamprosate, Naltrexone
AA groups
What is the triad of Wernicke-Korsakoff syndrome
Confusion, opthalmoplegia, ataxia
Cause and treatment of Wernicke-Korsakoff syndrome
Vitamin B1 (thiamine) deficiency
Tx: IV vitamin B1
Symptoms of Korsakoff syndrome
Irreversible memory loss, confabulation, personality change
Associated with periventricular hemorrhage and necrosis of mammillary bodies
What is the timing of Delirium Tremens?
2-4 days after the last drink
Typically occurs in the hospital setting
Symptoms and treatment of Delirium Tremens
Tachycardia, tremors, anxiety, seizures, agitation
Tx: Benzodiazapines
What is alcoholic hallucinosis?
Visual hallucinations 12-48 hours after last drink
Tx: Benzodiazapines
Name 3 clinical CNS stimulants
Methylphenidate, dextroamphetamine, methamphetamine
Mechanism and clinical use of CNS stimulants
Increase NE and dopamine in synaptic cleft
ADHD, appetite control, narcolepsy
Opioid intoxication
Euphoria, respiratory and CNS depression, miosis, seizures, decreased gag reflex
Most common drug in overdose death
Opioids
Treatment of opioid overdose
Naloxone, Naltrexone
Opioid withdrawal
Anxious, hot, moist, yawning, mydriasis
Fever, sweating, piloerection
Rhinorrhea, nausea, diarrhea
Flu like symptoms
Treatment of opioid withdrawal
Long term support
Methadone, Buprenorphine
Barbiturate intoxication
Respiratory depression, low safety margin
Treatment for barbiturate intoxication
Supportive management: Increase BP, assist respiration
Barbiturate withdrawal
Delirium, cardiovascular collapse
Benzodiazepine intoxication
Ataxia, minor respiratory depression, safer than barbiturates
Treatment for benzodiazepine intoxication
Flumazenil- benzodiazepine receptor antagonist
Can precipitate seizures
Benzodiazepine withdrawal
Sleep disturbance, depression, rebound anxiety, seizures
Stimulants (4)
Amphetamines, Cocaine, Caffeine, Nicotine
General stimulant intoxication
Mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
General stimulant withdrawal
Post use crash, depression, lethargy, increased appetite, sleep disturbances, vivid nightmares
Amphetamine intoxication
Euphoria, grandiosity, mydriasis, alertness, HTN, tachycardia, anorexia, paranoia, fever
Severe: cardiac arrest, seizures
Treatment for amphetamine intoxication
benzodiazepines for agitation and seizures
Cocaine intoxication
Mydriasis, impaired judgement, hallucinations (tactile), paranoia, angina, sudden cardiac death
Treatment for cocaine intoxication
Alpha blockers, benzodiazepines
NO beta blockers
Caffeine intoxication
Restlessness, increased diuresis, muscle twitching
Caffeine withdrawal
Headaches, difficulty concentrating, flu like symptoms
Nicotine intoxication and withdrawal
Intoxication- restlessness
Withdrawal- irritable, anxiety, restless, difficulty concentrating
Treatment for nicotine use
Nicotine patch, gum, lozenges
Bupropion, Varenicline
Heroin addiction complications
Hepatitis, HIV, abscesses, bacteremia, right heart endocarditis
Treatment of Heroin addiction
Methadone- long acting opioid agonist- detox or long term maintenance
Naloxone and Buprenorphine- antagonist and partial agonist
Naltrexone- long acting antagonist- relapse prevention after detox is completed
Mallory- Weiss Syndrome
Partial thickness tear at gastroesophageal junction
Due to excessive/forceful vomiting
Hematemesis
Misdiagnosed as ruptured esophageal varices
Hallucinogens (4)
Phencyclidine, Lysergic acid diethylamide (LSD), Marijuana, MDMA (ecstasy)
Phencyclidine intoxication
Violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, psychosis, delirium, seizures
Usually complicated by trauma
Phencyclidine intoxication treatment
Benzodiazepines, rapid acting anti-psychotic
Lysergic acid diethylamide (LSD) intoxication
Visual/auditory perceptual distortion, depersonalization, anxiety, paranoia, psychosis, possible flashbacks
Marijuana (cannabinoid) intoxication
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations
Pharmaceutical form of marijuana
Dronabinol- tetrahydrocannabinol isomer
Antiemetic, appetite stimulant
For Chemotherapy side effects and AIDS patients
Marijuana withdrawal
Irritable, anxiety, depression, insomnia, restless, decreased appetite
Detectable in urine for up to a month
MDMA (ecstasy) intoxication
Hallucinogenic stimulant
Euphoria, disinhibition, hyperactivity
HTN, tachycardia, hyperthermia, hyponatremia, serotonin syndrome
MDMA withdrawal
Depression, fatigue, change in appetite, difficulty concentrating, anxiety
