Recreational drugs lecture Flashcards
What is the difference between freebase and crack cocaine?
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.
What is the mechanism of action of cocaine?
Inhibits uptake of monoamines. Noradrenaline>Dopamine>serotonin
What are the complications of cocaine?
Hypertensive emergencies, cardiac dysrhythmia and ischaemia, coagulation abnormalities, neuropsychological “crack dancing”, IV drug use complications
Describe the toxidrome associated with cocaine
Sympathomimetic-CNS excitation - tachycardia, tachypnoea, hypertension, sweating, anxiety, mydriasis, agitation, seizures
What is the MOA of heroin?
Opioid antagonist- binds to Kappa, Mu and Delta receptors centrally. Reduces respiratory drive because acts on Mu receptors in medulla.
Describe the toxidrome associated with opiates
Miosis, bradypnea->apnoea, bradycardia, seizures (secondary to hypoxia), hypothermia (due to prolonged coma), stupor/coma
What is chasing the dragon?
Heroin is burned over foil and then the user inhales the produced white smoke using a tube.
State the name and dose of the substance that can reverse opioid toxicity.
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
What are the acute effects of ecstasy ?
Relaxation, empathy, euphoria, energy, excitement
What are some of the complications of ecstasy?
Paranoia, hallucinations, anxiety, cardiac arrhythmia
ABD
Serotonin syndrome
Dependence
What are the symptoms of serotonin syndrome?
Altered mental status, Neuromuscular abnormality, Autonomic hyperactivity.
Apart from ecstasy, what other drugs can cause serotonin syndrome?
Antidepressants e.g. SSRIs. Especially MAOIs
What other syndromes are similar to serotonin syndrome?
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
What can be given for a patient with serotonin syndrome who has a temperature over 40.5?
Cyproheptadine - serotonin antagonist.
What are the complications of serotonin syndrome?
Neuromuscular abnormalities such as akathisia (inner restlessness) can lead to metabolic acidosis->rhabdomyolysis->AKI & DIC.
What are three features you get with malignant hyperthermia?
Hypermetabolism, rhabdomyolysis and muscle rigidity.
What are poppers?
Yellow volatile liquids that are ‘alkyl nitrates’ e.g. amyl nitrate
What are the acute effects of poppers?
Euphoria and altered perception of time
Name some complications of nitrates?
Hypoxia, metabolic acidosis, respiratory depression (deep sighing breaths), methaemoglobinaemia.
How are poppers patients managed?
Symptomatic and methylene blue for methaemoglobinaemia
Describe the signs and symptoms associated with an anticholinergic toxidrome
Dilated pupils and blurred vision Hyperthermia Tachycardia and arrhythmias Urinary retention Dry mouth and skin Altered mental status , delirium, psychosis
What is the definition of a novel recreational substance?
Hasn’t been tested
Available to public
Stimulant/relaxant effect
Give some examples of some novel recreational drugs
Nitrous oxide
Where is nitrous oxide commonly sourced from?
Whipped cream canisters
What are the complications of nitrous oxide?
Neurological-> psychosis, sensory, paralysis.
Long term neurological, psychiatric and bone marrow suppression (decreased vitamin b12)
What is the MOA of mephedrone (fertiliser)?
Stimulates MAO release and prevents reuptake
What does GHB stand for? What are its effects?
Gamma-hydroxybutanate - agonist at GABA and GHB receptor
How do we detect new drugs?
Forensic early warning system
What are the symptoms and signs of acute behavioural disorder?
“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,
What restraint has been banned ?
Hogtie
What can be a life-threatening complication of ABD?
Cardiovascular collapse
Metabolic acidosis due to restlessness->rhabdomyolysis->AKI & DIC
What are the principles of restraint?
Proportionate
Minimal and relative
Done in the patients best interest
Done to reduce risk of harm
Management of someone with ABD?
sedation e.g. with IV ketamine or BDZ (IM if difficult)
Manage hyperthermia and metabolic acidosis
How do you manage malignant hyperthermia?
Dantrolene. Reduces calcium influx in skeletal muscle
What can be given to treated Neuroleptic malignant syndrome?
Procyclidine
Differential diagnoses of intoxication
Hypoglycaemia, DKA, SAH,
