recreational drugs in A&E Flashcards
what signs of alcohol withdrawal are there?
increased pulse increased bp shaking agitation confusion hallucinations seizures nausea tremor sweating headache
which neurotransmitters are involved in withdrawal?
GABA and glutamate
how is GABA involved?
alcohol potentiates GABA and also directly opens channels at high dose
chronic drinking leads to fewer and less responsive GABA receptors
Which neurotransmitter receptors does alcohol inhibit acutely, reducing neuronal excitation?
NMDA glutamate receptors
How does chronic alcoholism affect NMDA glutamate receptors?
upregulates receptors
associated with impaired memory
what is the effect of alcohol removal on these transmitters?
increased excitation at nmda glutamate receptor
decreased inhibition of GABA
Why should anaerobe cover antibiotics be given to alcoholics?
alcohol supresses gag reflex - aspiration pneumonia risk
alcohol dependence leads to hypo_____
hyponatremia
correcting hyponatremia too quickly leads to ____
central pontine mylenolysis
wernicke korsakoff syndrome is secondary to what deficiency?
thiamine
what are some signs of w. k. syndrome?
opthalmoplegia (paralysis of gaze)
ataxia
confusion
in w.k syndrome which parts of the brain are affected?
CN nuclei 6
vestibular nuclei
______ tremens can occur three days after withdrawal
delirium tremens
what signs put you at high risk of delirium tremens?
history
acute medical illness
low chloride, sodium, potassium
high alt and ggt
what regime of drugs can help with withdrawl
decreasing regimen of benzodiazepines, they potentiate gaba action
what can be given to replace thiamine and other b vits?
pabrinex IV
what are some acute effects of GHB?
eurphoria, sexual stamina and arousal, high self esteem, altered time perception, imparied memory, salivation, slouching, unsteadiness, loss of consciousness, bradycardia, hypotension, respiratory depression, death
GHB binds to presynaptic ______receptors and decreases ____release
GABA A
GHB is a depressant drug because it ______ neurotransmission
reduces
how is GHB intoxication treated?
supportively
what are some signs of GHB withdrawal?
anxiety, agitation, sweating, shaking, increased HP and BP, visual and auditory hallucinations, confusion
how is GHB withdrawal different to alcohol withdrawal
more likely to have hallucinations
quicker onset
fewer seizures
more delirium tremens
what can be used to treat GHB withdrawal?
benzopdiazepines - eg diazepam
how do opioids suppress respiration?
stimulate mu receptors in medulla and pons and chemoreceptors
