Recreational drugs lecture

Question 1

What is the difference between freebase and crack cocaine?

Answer 1

Freebase cocaine is essentially “pure” cocaine which is formed by powdered cocaine being mixed with ammonia. It virtually contains no addictive hydrochloride. It is smoked.
Crack cocaine is a hydrochloride salt and is formed by mixing powdered cocaine with baking soda and water. It is heated and makes a cracking sound. This then forms a rock like solid which can be smoked when heated. Crack cocaine is highly addictive.

Question 2

What is the mechanism of action of cocaine?

Answer 2

Inhibits uptake of monoamines. Noradrenaline>Dopamine>serotonin

Question 3

What are the complications of cocaine?

Answer 3

Hypertensive emergencies, cardiac dysrhythmia and ischaemia, coagulation abnormalities, neuropsychological “crack dancing”, IV drug use complications

Question 4

Describe the toxidrome associated with cocaine

Answer 4

Sympathomimetic-CNS excitation - tachycardia, tachypnoea, hypertension, sweating, anxiety, mydriasis, agitation, seizures

Question 5

What is the MOA of heroin?

Answer 5

Opioid antagonist- binds to Kappa, Mu and Delta receptors centrally. Reduces respiratory drive because acts on Mu receptors in medulla.

Question 6

Describe the toxidrome associated with opiates

Answer 6

Miosis, bradypnea->apnoea, bradycardia, seizures (secondary to hypoxia), hypothermia (due to prolonged coma), stupor/coma

Question 7

What is chasing the dragon?

Answer 7

Heroin is burned over foil and then the user inhales the produced white smoke using a tube.

Question 8

State the name and dose of the substance that can reverse opioid toxicity.

Answer 8

Naloxone- initial dose 400mcg IV increased in same incremental doses of 200-400mcg. Naloxone has a shorter half life than heroin so dose needs to be repeated

Question 9

What are the acute effects of ecstasy ?

Answer 9

Relaxation, empathy, euphoria, energy, excitement

Question 10

What are some of the complications of ecstasy?

Answer 10

Paranoia, hallucinations, anxiety, cardiac arrhythmia
ABD
Serotonin syndrome
Dependence

Question 11

What are the symptoms of serotonin syndrome?

Answer 11

Altered mental status, Neuromuscular abnormality, Autonomic hyperactivity.

Question 12

Apart from ecstasy, what other drugs can cause serotonin syndrome?

Answer 12

Antidepressants e.g. SSRIs. Especially MAOIs

Question 13

What other syndromes are similar to serotonin syndrome?

Answer 13

Neuroleptic malignant syndrome- Slower onset, reaction to dopamine agonists, lead pipe rigidity and bradykinesiaa.

Malignant hyperthermia- mottled, cyanosed skin changes, severe rigidity and hyporeflexia (hyperreflexia occurs in SS) following certain anaesthetics in genetically predisposed individuals. E.g. suxamethonium

Question 14

What can be given for a patient with serotonin syndrome who has a temperature over 40.5?

Answer 14

Cyproheptadine - serotonin antagonist.

Question 15

What are the complications of serotonin syndrome?

Answer 15

Neuromuscular abnormalities such as akathisia (inner restlessness) can lead to metabolic acidosis->rhabdomyolysis->AKI & DIC.

Question 16

What are three features you get with malignant hyperthermia?

Answer 16

Hypermetabolism, rhabdomyolysis and muscle rigidity.

Question 17

What are poppers?

Answer 17

Yellow volatile liquids that are ‘alkyl nitrates’ e.g. amyl nitrate

Question 18

What are the acute effects of poppers?

Answer 18

Euphoria and altered perception of time

Question 19

Name some complications of nitrates?

Answer 19

Hypoxia, metabolic acidosis, respiratory depression (deep sighing breaths), methaemoglobinaemia.

Question 20

How are poppers patients managed?

Answer 20

Symptomatic and methylene blue for methaemoglobinaemia

Question 21

Describe the signs and symptoms associated with an anticholinergic toxidrome

Answer 21

Dilated pupils and blurred vision
Hyperthermia
Tachycardia and arrhythmias
Urinary retention
Dry mouth and skin
Altered mental status , delirium, psychosis

Question 22

What is the definition of a novel recreational substance?

Answer 22

Hasn’t been tested
Available to public
Stimulant/relaxant effect

Question 23

Give some examples of some novel recreational drugs

Answer 23

Nitrous oxide

Question 24

Where is nitrous oxide commonly sourced from?

Answer 24

Whipped cream canisters

Question 25

What are the complications of nitrous oxide?

Answer 25

Neurological-> psychosis, sensory, paralysis.

Long term neurological, psychiatric and bone marrow suppression (decreased vitamin b12)

Question 26

What is the MOA of mephedrone (fertiliser)?

Answer 26

Stimulates MAO release and prevents reuptake

Question 27

What does GHB stand for? What are its effects?

Answer 27

Gamma-hydroxybutanate - agonist at GABA and GHB receptor

Question 28

How do we detect new drugs?

Answer 28

Forensic early warning system

Question 29

What are the symptoms and signs of acute behavioural disorder?

Answer 29

“Excited delirium”

Pain tolerance, tachypnea, sweating, agitation, Hyperthermia (sweating/naked), bizarre behaviour, altered perceptions, superhuman strength, psychomotor agitation (constant moving), hallucinations, speech disturbance, disorientation, violence,

Question 30

What restraint has been banned ?

Answer 30

Hogtie

Question 31

What can be a life-threatening complication of ABD?

Answer 31

Cardiovascular collapse

Metabolic acidosis due to restlessness->rhabdomyolysis->AKI & DIC

Question 32

What are the principles of restraint?

Answer 32

Proportionate
Minimal and relative
Done in the patients best interest
Done to reduce risk of harm

Question 33

Management of someone with ABD?

Answer 33

sedation e.g. with IV ketamine or BDZ (IM if difficult)

Manage hyperthermia and metabolic acidosis

Question 34

How do you manage malignant hyperthermia?

Answer 34

Dantrolene. Reduces calcium influx in skeletal muscle

Question 35

What can be given to treated Neuroleptic malignant syndrome?

Answer 35

Procyclidine

Question 36

Differential diagnoses of intoxication

Answer 36

Hypoglycaemia, DKA, SAH,