recreational drugs in emergency medicine

Question 1

what symptoms signs help you recognise alcohol withdrawal

Answer 1

increased pulse and vbp, sweating, shaking, agitated, hallucinations, seizures, use ciwa ar. bac does not have to be zero

Question 2

what two neurotransmitter pathways involved in alcohol withdrawal

Answer 2

gaba and glutamate

Question 3

what does alcohol do to gaba a receptors in the brain

Answer 3

alcohol potentiates gaba receptors so they open more and more. chronic drinking causes adaptations fewer and less responsive gaba a receptors

Question 4

why can gaba be described as the break in the brain

Answer 4

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.

Question 5

what does alcohol do to NDMA

Answer 5

it is an antagonist to ndma. reduces neuronal excitation

Question 6

how is ndma receptor affected

Answer 6

chronic alcohol leads to glutamate receptor up regulation. impaired memory

Question 7

what are other potential differential diagnosis for a patient with suspected alcohol withdrawal, what could explain delirium

Answer 7

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

Question 8

why is thiamine important

Answer 8

essential in glucose metabolism. nadph and ribose 5 phosphate

Question 9

what is ribose 5 phosphate used for

Answer 9

nucliec acids, complex sugars, coenzymes

Question 10

how do you distinguish between dt and seizures

Answer 10

dt normally 3-4 days after seizures will normally happen more immediately

Question 11

how do you treat alcohol dependent patient

Answer 11

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

Question 12

what drugs given to treat korsakoff. alcohol withdrawal patient

Answer 12

pabrinex and thiamine

Question 13

what is the biggest modifiable risk factor for suicide

Answer 13

alcohol intake

Question 14

what are the clinical effects of Ghb/gbl

Answer 14

euphoria, sexual arousal,increased stamina, pleasure, less negative self eesteem, impaired memory and sense of time, hypotension bradycardia, respiratory depression, death,

Question 15

what type of analogue is ghb

Answer 15

GHB is a GABA analogue

Question 16

why do gbl gbh users dispense the drug out of soy sauce dispensers

Answer 16

ghb and gbl have a narrow therapeutic index. just a little too much can cause death so has to be measured carefully

Question 17

when wont an individual taking g have bradycardia or hypotension

Answer 17

if they taking cocaine mixed intoxication

Question 18

what advice do you give patient taking g (harm minimization)

Answer 18

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

Question 19

how do you distinguish between g withdrawal and alchohol withdrawal

Answer 19

g withdrawal is quicker in onset, fewer seizures and more delirium tremors

Question 20

what do opioids do to ventilation namely heroin

Answer 20

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

Question 21

how do you reverse opioid toxicity

Answer 21

use nalaxone. give basic life support, give 400mcg of nalaxone inejection do three cyles of this until help comes

Question 22

how does nalaxone work

Answer 22

blocks opioid transmission by being a high potency antagonist

Question 23

what is spice

Answer 23

synthetic agonist for cannaboid receptor

Question 24

why are scra worse than cannabis

Answer 24

higher affinity for cb1 receptor than thc. scra are full agonists thc partial

Question 25

what are symptoms of spice

Answer 25

agiatation aggressive coma delirium, a lot of cardiovascular effects

Question 26

how does scra differ from thc

Answer 26

similar demographics men mid 30s, more likely cardiac arrythmias and agitation

Question 27

how do you treat scra

Answer 27

anti psychosis drugs