Sedative, Hyponotic, or Anxiolytic Related Disorders

Question 1

what is GHB

Answer 1

analog of GABA capable of crossing BBB

sexual, stimulant, relaxant effects

Question 2

how does GHB work

Answer 2

direct AGONIST of GABA-B receptors

affects multiple neurotransmitter systems including opioid, dopamine, serotonin, glutamate, Ach

also interacts with GHB specific receptors

Question 3

does GHB have a taste

Answer 3

salty or soapy

but is odorless and clear

Question 4

what ethnicity are the majority of the people with GHB use disorder

Answer 4

caucasian

Question 5

how quickly does GHB act

Answer 5

within 15-20 min of ingestion

peaks between 30-60 min

onset of sedation and loss of consciousness is usually abrupt as is recovery

duration is 2-4 hours

Question 6

how does GHB intoxication generally manifest

Answer 6

dose dependent CNS depression

(can also see stimulant effects though–> this peaks around 45-60 min and sedative effect peaks at 60-120min)

Question 7

what is a characteristic pattern of behaviour in GHB intoxication

Answer 7

agitation prior to, following, or in abrupt alternation with coma–> i.e agitation in alternation with somnolence, agitation followed by somnolence or self injurious or bizarre behaviours particularly in the absence of stimulant co-intoxicants

Question 8

how do people often take GHB

Answer 8

look for bottles and eye droppers

Question 9

how might GHB affect vital signs

Answer 9

low GCS–> 3-6

hypotension

bradycardia

low resp rate, apneas, resp arrest

hypothermia

Question 10

how might GHB affect the CNS

Answer 10

coma = common

can have emergence delirium, self injurious behaviour, alternating with somnolence

amnesia

seizures or seizure like effect

Question 11

what usually kills people in GHB intox?

Answer 11

apnea and resp arrest

Question 12

is GHB detectable on most routine hospital UDS?

Answer 12

no–need gas chromatography/mass spectroscopy which takes 7-14 days

Question 13

what is the principle of acute GHB intoxication management

Answer 13

supportive–> primary goals are airway protection, control of agitation and treatment of any complications

Question 14

what often happens if someone using GHB has to be intubated

Answer 14

often will self extubate in 4-6 hours

Question 15

is there any role for reversal agents like flumazenil, or decontamination like with charcoal, in management of GHB intoxication

Answer 15

no

Question 16

why is there greater risk of death as tolerance develops to benzo like meds

Answer 16

tolerance to the sedation effects begins first, but tolerance to brain stem depressant effects develops more slowly, meaning as people use more, more likely to die

Question 17

list the signs of sedative, hypnotic or anxiolytic intoxication per the DSM

Answer 17

slurred speech

incoordination

unsteady gait

nystagmus

impairment in cognition (attention, memory)

stupor or coma

Question 18

list the symptoms of sedative, hypnotic or anxiolytic intoxication withdrawal

Answer 18

autonomic hyperactivity (i.e sweating, pulse above 100)

hand tremor

insomnia

N/V

transient tactile, visual, or auditory hallucinations or illusions

psychomotor agitation

anxiety

grand mal seizures

can develop a DELIRIUM that can be LIFE THREATENING can also get SEIZURES in withdrawal

Question 19

how long does it take for sedative, hypnotic or anxiolytic withdrawal to develop

Answer 19

anywhere from about 10 hours to a week, dpeneding on the half life of the drug