recreational drugs in emergency medicine Flashcards
what symptoms signs help you recognise alcohol withdrawal
increased pulse and vbp, sweating, shaking, agitated, hallucinations, seizures, use ciwa ar. bac does not have to be zero
what two neurotransmitter pathways involved in alcohol withdrawal
gaba and glutamate
what does alcohol do to gaba a receptors in the brain
alcohol potentiates gaba receptors so they open more and more. chronic drinking causes adaptations fewer and less responsive gaba a receptors
why can gaba be described as the break in the brain
gaba is the main inhibitory neurotransmitter on the brain giving it a break a pause. alcohol reduces gaba pausing ability and fills in for it. so when a chronic drinker stops drinking they have no brain break.
what does alcohol do to NDMA
it is an antagonist to ndma. reduces neuronal excitation
how is ndma receptor affected
chronic alcohol leads to glutamate receptor up regulation. impaired memory
what are other potential differential diagnosis for a patient with suspected alcohol withdrawal, what could explain delirium
alcoholics at risk of aspiration pneumonia due to weakened gag reflex. less functional lung macrophages, watch for lungs. dyemyelination in pons due to alcoholic being hyponatremic, nutritional deficiency and malabsorption causing thaimine deficiency korsakoff syndrome
why is thiamine important
essential in glucose metabolism. nadph and ribose 5 phosphate
what is ribose 5 phosphate used for
nucliec acids, complex sugars, coenzymes
how do you distinguish between dt and seizures
dt normally 3-4 days after seizures will normally happen more immediately
how do you treat alcohol dependent patient
well lit room, orientate patient to where they are and time. reassure them, give benzodiazepine on decreasing schedule. correct electrolytes. assess motivation to abstain and speak to alcohol services. consider relapse meds
what drugs given to treat korsakoff. alcohol withdrawal patient
pabrinex and thiamine
what is the biggest modifiable risk factor for suicide
alcohol intake
what are the clinical effects of Ghb/gbl
euphoria, sexual arousal,increased stamina, pleasure, less negative self eesteem, impaired memory and sense of time, hypotension bradycardia, respiratory depression, death,
what type of analogue is ghb
GHB is a GABA analogue
why do gbl gbh users dispense the drug out of soy sauce dispensers
ghb and gbl have a narrow therapeutic index. just a little too much can cause death so has to be measured carefully
when wont an individual taking g have bradycardia or hypotension
if they taking cocaine mixed intoxication
what advice do you give patient taking g (harm minimization)
use pre measured doses, avoid alcohol and stimulants, watch out for g slouch or g dribble (indicates worsening state), set alarams on phone to track time, rwrite g on your wrist so paramedics know you take g. check sexual health. dont use it to go to sleep
how do you distinguish between g withdrawal and alchohol withdrawal
g withdrawal is quicker in onset, fewer seizures and more delirium tremors
what do opioids do to ventilation namely heroin
supress respiration via action onb medulla and pons which control ventilation. stimulations of opiod receptors in these respiratory centres and chemorecptors for po2 and pco2 slow respiration
how do you reverse opioid toxicity
use nalaxone. give basic life support, give 400mcg of nalaxone inejection do three cyles of this until help comes
how does nalaxone work
blocks opioid transmission by being a high potency antagonist
what is spice
synthetic agonist for cannaboid receptor
why are scra worse than cannabis
higher affinity for cb1 receptor than thc. scra are full agonists thc partial
