Psychoactive drug intoxication & withdrawal Flashcards
What is Depressant intoxication like?
- Nonspecific
- Mood elevation
- Dec anxiety
- Sedation
- Behavioral disinhibition
- Resp depression
What does Depressant withdrawal look like?
- Nonspecific
- Anxiety
- Tremor
- Seizures
- Insomnia
What does Alcohol intoxication look like?
- Emotional lability
- Slurred speech
- Ataxia
- Coma
- Blackouts
What is Serum gamma-glutamyltransferase (GGT)?
Sensitive indicator of alchohol use
What labs indicate alcohol intoxication?
AST value is twice ALT value
What is Mild alcohol withdrawal like?
Sx similar to other depressants
What is severe alcohol withdrawal like?
Can cause autonomic hyperactivity & DTs
What is the tx for DTs?
Benzodiazepines
What is Opioid intoxication like?
- Euphoria
- Resp & CNS depression
- Dec gag reflex
- Pupillary constriction
- Seizures (overdose)
What is the tx for opiod intoxication?
Naloxone & naltrexone
What are the sx of Opiod withdrawal?
- Sweating
- Dilated pupils
- Piloerection
- Fever
- Rhinorrhea
- Yawning
- N/V
- Stomach cramps
What is the tx for Opiod withdrawal?
- LT support
- Methadone
- Buprenorphine
What is Barbiturates intoxication?
- Low safety margin
- Marked resp depression
What is the tx for Barbituate intoxication?
Sx management (assist rsp, inc BP)
What are the sx of Barbiturate withdrawal?
Delirium & life-threatening CV collapse
What are the characteristics of Benzodiazepine intoxication?
- Greater safety margin
- Ataxia
- Minor resp depression
What is the tx for Benzodiazepine intoxication?
Flumazenil (competitive benzodiazepine antagonsit)
What are the sx of Benzodiazepine withdrawal?
- Sleep disturbance
- Depression
- Rebound anxiety
- Seizure (severe)
What are the sx of Stimulant intoxication?
- Nonspecific
- Mood elevation
- Psychomotor agitation
- Insomnia
- Cardiac arrhythmias
- Tachycardia
- Anxiety
What are the sx of Stimulant withdrawal?
- Nonspecific
- “Post-use” crash
- Depression
- Lethargy
- Wt gain
- HA
What are the sx of Amphetamine intoxication?
- Euphoria
- Grandiosity
- Pupillary dilation
- Prolonged wakefulness & attention
- HTN
- Tachycardia
- Anorexia
- Paranoia
- Fever
- Severe: cardiac arrest, seizure
What are the sx of Ampheramine withdrawal?
- Anhedonia
- Inc appetite
- Hypersomnolence
- Existential crisis
What are the sx of Cocaine intoxication?
- Impaired judgement
- Pupillary dilation
- Hallucinations
- Paranoid ideations
- Angina
- Sudden cardiac death
What is the tx of cocaine intoxication?
Benzodiazepines
What are the sx of Cocaine withdrawal?
- Hypersomnolence
- Malaise
- Severe Psychological craving
- Depression/suicidality
What are the sx of Caffeine intoxication?
- Restlessness
- Inc diuresis
- Muscle twitching
What are the sx of Caffeine withdrawal?
Lack of concentration & HA
What are the sx of Nicotine intoxication?
Restlessness
What are the sx of Nicotine withdrawal?
- Irritability
- Anxiety
- Craving
What is the tx for Nicotine withdrawal?
- Nicotine patch, gum or lozenges
- Bupropion/varenicline
What are the sx of PCP intoxication?
- Belligerence
- Impulsiveness
- Fever
- Psychomotor agitation
- Analgesia
- Vertical & horizontal nystagmus
- Tachycardia
- Homicidality
- Psychosis
- Delirium
- Seizures
What is the tx for PCP intoxication?
- Benzodiazepine
- Rapid-acting antipsychotic
What are the sx of PCP withdrawal?
- Depression
- Anxiety
- Irritability
- Restlessness
- Anergia
- Disturbances of though & sleep
What are the sx of LSD intoxication?
- Perceptual distortion (visual, auditory)
- Depersonalization
- Anxiety
- Paranoia
- Psychosis
- Possible flashbacks
What are the sx of Marijuana intoxication?
- Euphoria
- Anxiety
- Paranoid delusions
- Perception of slowed time
- Impaired judgement
- Social withdrawal
- Inc appetite
- Dry mouth
- Conjuctival injection
- Hallucinations
What is Dronabinol (tetrahydrocannabinol isomer) used for?
Rx used as antiemetic (chemotherapy) & appetite stimulant (AIDs)
What are the sx of Marijuana withdrawal?
- Irritability
- Depression
- Insomnia
- Nausea
- Anorexia
When do marijuana withdrawal sx peak?
48 hours & lasts for 5-7 days
How long is marijuana detectable in the urine?
4-10 days
What are Heroin uses at inc risk for?
- Hepatitis
- Abscess
- Overdose
- Hemorrhoids
- AIDs
- Right-sided endocarditis
What should you look for in Heroin users?
Track marks (needle sticks in veins)
What is Methadone?
Long-acting opiate
What is Methadone used for?
Used for heroin detoxification or LT maintenance
What is Naoloxone + Buprenorphine?
Partial agonist; long acting w/ fewer sx than methadone
When is Naloxone not active?
Not active when taken orally, so w/drawal sx occur only if injected (lower abuse potential)
What is Alcoholism?
Physiologic tolerance & dependence w/ sx of w/drawal when intake is interrupted
What are the complications of alcoholism?
- Alcoholic cirrhosis
- Hepatitis
- Pancreatitis
- Peripheral neuropathy
- Testicular atrophy
What is the tx for alcoholism?
- Disulfiram
- Supportive care
- AA & peer support
What is Disulfiram used for?
To condition pts to abstain from alcohol use
What is Wernicke-Korsakoff synd caused by?
Thiamine (B1) deficiency
What is the Triad of Wernicke encephalopathy?
- Confusion
- Ophthalmoplegia
- Ataxia
What are the sx of Korsakoff’s psychosis?
- May progress to irreversible memorry loss
- Confuabulation
- Personality change
What is Wernicke-Korsakoff synd assoc w/?
Periventricular hemorrhage/necrosis of mammillary bodies
What is the tx for Wernicke-Korsakoff synd?
IV vitamin B1 (thiamine) 1st & then glucose
What is Mallory-Weiss synd?
Longitudinal lacerations at the gastroesphageal junction caused by excessive vomiting
What does Mallory-Weiss synd present w/?
Hematemesis
Assoc w/ pain
What are Delirium tremens (DTs)?
Life-threatening alcohol w/drawal synd taht peaks 2-5 days after last drink
What are the sx in order of appearance in Delirium tremens?
- Autonomic system hyperactivity
- Psychotic sx
- Confusion
What are the sx of autonomic system hyperactivity?
- Tachycardia
- Tremors
- Anxiety
- Seizures
What are psychotic sx?
Hallucinations & delusions
What is the tx for Delirium tremens?
Benzodiazepines
