Recreational Drugs Flashcards
How would serotonin syndrome present
Hypertonia, hypereflexia and clonus
Mental state changes
Autonomic instability inc hyperthermia, sweating, raised HR, mydriasis
What recreational drugs can cause serotonin syndrome
Ecstasy, LSD, amphetamines
How would you differentiate serotonin syndrome and NMS
Serotonin syndrome is quicker onset and reflexes are swift
How is serotonin syndrome managed
Cooling
Benzo’s for agitation
Propofol for rigidity
Cyproheptadine can be given in severe cases
What is ABD characterised by
Mentally - aggressive, violent, struggling, psychotic
Hyperadrenergic - raised temp, sweating, raised HR and RR
What is the typical ABD patient
Acute toxicity on top of long term cocaine use
What are the factors leading to death in ABD
Lactic acidosis, increased O2 demand (which may not be met if restrained etc), risk of arrythmias
How should ABD be managed
Don’t restrain them, ventilate them at the rate they were breathing at, sedation, IV fluids, temperature control
What are your options for sedation in ABD
Benzodiazepines
Good - familiarity, safe
Bad - resp depression, unpredictable dose-response relationship
Ketamine
Good - rapid, predictable, wide therapeutic range
Bad - inhibit catecholamine uptake so worse sympathomimetic effects
Haloperidol
Good - dopamine antagonist
Bad - need ECG, prolong QT, reduced seizure threshold
How would you reserve Benzodiazepines
Flumazenil - GABA antagonist (competitive inhibitor)
What are the risks of giving Flumazenil
Lowers seizure threshold
Cardiac arrhythmia
What is the mechanism of action of Benzodiazepines
Increase the affinity of GABAa receptors for GABA= Cl- influx = hyerpolarised cell
How do benzodiazepines differ from barbiturates
They have less action in the brainstem meaning there is less respiratory depression
What is spice
It’s a synthetic canabinoid
Full agonist at the canabinoid receptor so more potent
How would someone who has taken spice present
Catatonic state Hallucinogenic Increased temp and HR Respiratory depression Risk of MI and seizures